Sample records for causing tracheal rupture

  1. Tracheal rupture caused by blunt chest trauma: radiological and clinical features

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    Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S. [Dept. of Diagnostic Radiology, Justus Liebig Univ., Giessen (Germany); Hoppe, M. [Dept. of Diagnostic Radiology, University Hospital, Philipps University, Marburg (Germany); Popella, C. [Dept. of ENT, Justus Liebig University, Giessen (Germany)


    The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

  2. Surgical Treatment of Patients with Tracheal Rupture Following Endotracheal Intubation

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    Gönül Sağıroğlu


    Full Text Available Objective: We aimed to present clinical features and treatment outcomes of patients who had tracheal rupture following intubation due to surgical interventions.Material and Methods: Five patients (M/F, 1/4; Mean age, 53.8±10.9 years who were diagnosed as having tracheal rupture during or soon after surgery were included in the study and evaluated retrospectively. History, clinical features, patient characteristics, and localizations of rupture, diagnostic modalities, and treatment outcomes were reported.Results: Two of the patients were intubated with a single-lumen tube, whereas 3 patients were intubated by using a double-lumen tube. The most common symptom that led to diagnosis was subcutaneous emphysema. One patient was diagnosed during stump control before the occurrence of symptoms. It is considered that using a stylet during intubation might be a risk factor, as four of our patients were intubated with the help of a stylet. Only one patient had a difficult intubation. Conclusion: Close postoperative monitorization of patients intubated due to surgical interventions, may enable us to determine tracheal ruptute cases in the early period before symptoms occur. The most common symptom was subcutaneous emphysema in the present case series. Thus, it is considered as the most effective warning symptom. In the light of the above findings, it is suggested that difficult intubation may not add to the risk of tracheal rupture.

  3. Conservative versus Surgical Management of Iatrogenic Tracheal Rupture. (United States)

    Panagiotopoulos, Nikolaos; Patrini, Davide; Barnard, Matthew; Koletsis, Efstratios; Dougenis, Dimitrios; Lawrence, David


    Iatrogenic tracheal rupture (ITR) represents a life-threatening condition requiring prompt diagnosis, management, and treatment. The management of ITR is challenging, and treatment options depend on tear location, size, injury extent, and the patient's respiratory status. Although this complication has been extensively reported in published literature, the best evidence practice, for the management, requires clarification. In this review, the authors focused on the establishment of a differential diagnosis and the potential mechanism of the injury, the decision-making process, and the therapeutic approaches. It is suggested that for small lacerations or stable patients, conservative management could be considered sufficient, whereas invasive surgical therapy would be more appropriate in cases of large defects with significant air leak and patient instability. © 2017 S. Karger AG, Basel.

  4. Successfully repaired traumatic tracheal disruption and cardiac rupture with cardiopulmonary support. (United States)

    Daitoku, Kazuyuki; Sakai, Takehiro; Yamada, Yoshitsugu; Tsushima, Takao; Koyama, Masayuki; Takaya, Shunichi


    A 19-year-old man suffering from dyspnea associated with tracheal and cardiac rupture from a traffic accident was found by bronchoscopy to have a 7.5 cm longitudinal tear in the membranous portion of the trachea. Right posterolateral thoracotomy was conducted and open ventilation through the left main bronchus initiated with standby cardiopulmonary bypass cannulation of the right femoral artery and vein. When oxygenation was poor, extracorporeal circulation was initiated through the cannulated artery and vein. Under the cardiopulmonary bypass, we safely repaired the tracheal laceration and cardiac rupture.

  5. A rare cause of stridor: Isolated tracheal amyloidosis

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    Numbere K Numbere


    Full Text Available A 50-year-old man presented to clinic with a two-year history of progressive exertional dyspnea and voice hoarseness. This history suggested upper airways obstruction, which was confirmed on computed tomography imaging that revealed extensive thickening of the proximal tracheal wall causing severe luminal narrowing. Bronchoscopic debulking was then performed and the samples obtained confirmed tracheal amyloidoisis. Extensive investigation confirmed that disease was localized solely to the trachea. Ultimately, after multiple discussions, the chosen treatment modality was radiotherapy, which proceeded relatively uneventfully and achieved excellent radiological and clinical response. Although tracheal amyloidosis is rare, it is most commonly observed as part of a multisystem presentation. The present report describes the even more uncommon diagnosis of isolated tracheal amyloidosis and highlights the role of radiotherapy in its management.

  6. Tracheotomy-related posterior tracheal wall rupture, trans-tracheal repair (United States)

    Deganello, A; Sofra, MC; Facciolo, F; Spriano, G


    Summary Laceration of the membranous part of the tracheo-bronchial tree is a rare complication that can occur after single lumen intubation, double-lumen intubation, percutaneous and surgical tracheotomy. The case of a 76-year-old male is presented in whom a posterior tracheal wall laceration, related to tracheotomy, was diagnosed and immediately treated at the end of a head and neck operation. A 6 cm long laceration started 1.5 cm below the tracheotomy level and ended 2 cm above the carina. The tear was closed from distal to proximal area via the tracheotomy opening with PDS 4/0 interrupted sutures using a thoracoscopic needle-holder. This original surgical technique is described in detail. In tracheotomy related tears, the fact that an opening in the trachea already exists and that the lesion rarely extends beyond the carina, should guide the surgeon to make every effort to repair the laceration through this already existing access. PMID:18198757

  7. Ectopic Intralaryngo-Tracheal Thyroid Tissue Causing Neonatal Death. (United States)

    Furnas, Lauren; Safa, Huda; Hutchinson, Fiona; Joseph, Lindsay; Armes, Jane E


    Ectopic thyroid tissue can be found anywhere along the embryologic path of thyroid descent. Intralaryngo-tracheal thyroid tissue is the least common site of ectopia and can present with upper airways obstruction. Its presentation in the neonate is exceptional. We describe a term female neonate with subglottic thyroid tissue causing near-total occlusion of the larynx, which led to upper airways obstruction and neonatal death. This emphasizes the importance of considering intralaryngo-tracheal tumors as a cause of acute and otherwise unexplainable respiratory distress immediately after birth. The cause of this neonatal death would not have been elucidated without careful autopsy examination.

  8. Snake Envenomation Causing Distant Tracheal Myonecrosis

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    Amina Khimani


    Full Text Available Snakebites are often believed to be poisonous. However, this is not always the case. In fact, each bite differs from snake to snake, depending on if the snake is poisonous and if there is envenomation. Venom in pit viper snakebites is often associated with local necrosis. The abundant literature selections and research articles justify local myonecrosis due to envenomation, but there is not much in the literature regarding myonecrosis at a site distant from the snakebite. We hereby present a case of a 42-year-old man who was transferred to our emergency department after a rattlesnake bit him twice. The patient, besides developing local myonecrosis at the site of the snakebite, developed necrosis of the scrotum as well as tracheal pressure myonecrosis at the site of the endotracheal tube balloon. In this review, we will attempt to discuss the myonecrosis pathophysiology and management related to the rattle snakebite.

  9. Life-saving effects of fetal tracheal occlusion on pulmonary hypoplasia from preterm premature rupture of membranes. (United States)

    Kohl, Thomas; Geipel, Annegret; Tchatcheva, Kristina; Stressig, Rüdiger; Willinek, Winfried A; Gembruch, Ulrich; Müller, Andreas


    Preterm premature rupture of membranes before 22 weeks of gestation may result in severe fetal pulmonary hypoplasia. Fetoscopic tracheal balloon occlusion might result in catch-up pulmonary growth. After preterm premature rupture of membranes at 16 weeks of gestation, magnetic resonance imaging at 26 0/7 weeks showed a fetal lung volume of 13 mL and pulmonary blood flow hardly could be detected. Fetoscopic tracheal balloon occlusion was performed at 27 6/7 weeks; within 6 days, fetal lung volume increased to 70 mL and lung blood flow normalized. The fetus was delivered electively at 28 6/7 weeks. Six hours after delivery, the neonate required only 21% oxygen and was extubated after 55 hours. Short-term fetoscopic tracheal balloon occlusion may result in rapid normalization of fetal lung volume and blood flow in fetuses with life-threatening pulmonary hypoplasia from preterm premature rupture of membranes before 22 weeks of gestation.

  10. Tracheal rupture (United States)

    ... that may be done include: Neck CT scan Chest x-ray Bronchoscopy ... People who have had a trauma will need to have their injuries ... who have breathed a foreign body into the airways, bronchoscopy ...

  11. Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology. (United States)

    Zambudio, Antonio Ríos; Calvo, Maria Jose Roca; Lanzas, Juan Torres; Medina, J García; Paricio, Pascual Parrilla


    Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

  12. Thyroid gland rupture caused by blunt trauma to the neck. (United States)

    Hara, Hirotaka; Hirose, Yoshinobu; Yamashita, Hiroshi


    Thyroid rupture following blunt trauma is extremely rare, and neck pain without swelling may be the only presenting symptom. However, hemorrhage and hematoma subsequently causes severe tracheal compression and respiratory distress. A 71-year-old Japanese woman visited our emergency room with a complaint of increasing right-sided neck pain at the thyroid cartilage level after she tripped and accidentally hit her neck against a pole 3 h back. On admission, her vital signs were stable. There was no swelling or subcutaneous emphysema. Laryngeal endoscopy revealed mild laryngeal edema, although there was no impairment in vocal fold mobility on either side. Contrast-enhanced computed tomography (CT) revealed rupture of the right lobe of the thyroid gland accompanied by a large hematoma extending from the neck to the mediastinum. Under general anesthesia, the right lobe was resected and the hematoma was evacuated. Only a few isolated cases of thyroid rupture caused by blunt neck trauma have been reported in patients with normal thyroid glands and neck pain without swelling may be the only presenting symptom. When suspected, CT should be performed to confirm the diagnosis determine the optimal treatment.

  13. [Contact allergy-induced tracheal stenosis caused by vulcanization accelerators in the endotracheal tube?]. (United States)

    Niehaus, H H; Enzmann, H


    Tracheal stenoses occur mainly under iatrogenic conditions: they develop specially after long-term intubation, but also after tracheotomy. Etiological-pathogenic relevant factors include the mechanical irritation of mucosa, perichondrium and cartilage in addition to infected tracheal secretions. An allergic cell-mediated reaction in the respiratory tract has been already described. It is seldom recognized. The possibility of such a hyperergic, allergic, delayed reaction (Type IV Coombs-Gell response) with subsequent tracheal stenosis caused by rubber chemicals (accelerators) found in endotracheal tubes is presented in the following case report.

  14. Cigarette smoke causes rapid lipid peroxidation of rat tracheal epithelium.


    Churg, A.; Cherukupalli, K.


    Cigarette smoke-induced lipid peroxidation may be an important mechanism of smoke toxicity, but attempts to demonstrate peroxidation of pulmonary tissues after smoke exposure have yielded conflicting results. To examine this question, we exposed rat tracheal explants to whole smoke for 10 minutes followed by air recovery for periods up to 50 minutes (test), or to air alone (controls) and measured conjugated diene levels in the tissue. A dose-related increase in conjugated diene levels was see...

  15. Spontaneous calyceal rupture caused by a ureteral calculus ...

    African Journals Online (AJOL)

    Rupture of the urinary collecting system with perirenal and retroperitoneal extravasation of the urine is an unusual condition that is typically caused by ureteral-obstructing calculi. We report a case of calyceal rupture with urinoma formation, due to a stone in the distal ureter. The diagnosis was confirmed by computed ...

  16. Bladder rupture causing pseudo acute renal failure

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    Luciana Andrea Avena Smeili


    Full Text Available Bladder rupture is a rare condition associated with significant morbidityand mortality. It is classified into traumatic, nontraumatic or idiopathic andspontaneous. The nonspecific initial clinical presentation is followed bydiscomfort in the lower abdomen, oliguria, hematuria and ascitis. Laboratoryabnormalities simulate the picture of acute renal failure and occurs by amechanism called auto reverse dialysis, with absorption of excreta throughthe peritoneal membrane. The authors describe a case of bladder rupturein morphologically and functionally normal urinary bladder associated withalcohol intake in young healthy man, manifested by abdominal discomfort,pseudo renal failure and massive ascitis. The diagnosis was made by anabdominal multidetector computed tomography confirmed by the finding of7 cm laceration at laparotomy.

  17. Hemothorax caused by spontaneous rupture of hepatocellular carcinoma in the pleural cavity: A case report

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    Seo, Hin Hee; Ohm, Joon Young [Dept. of Radiology, Chungnam National University Hospital, Daejeon (Korea, Republic of); Kim, Song Soo; Kim, Jin Hwan [Dept. of Radiology, Chungnam National University School of Medicine, Daejeon(Korea, Republic of)


    Hemothorax resulting from ruptured hepatocellular carcinoma (HCC) is extremely rare and is generally caused by ruptured intrathoracic metastatic lesions. However, we report a rare case of hemothorax resulting from intrathoracic rupture of primary HCC.

  18. Case Report: Early Neonatal Death Due To Liver Rupture Caused ...

    African Journals Online (AJOL)

    An early neonatal death due to liver to liver rupture caused by maternal abdominal manipulation and massage is presented. An apparently health baby girl was born to 26 years old primigravida who came in the second state of labour and deliver of her baby within eight minutes of arrival to the labour ward. Her labour lasted ...

  19. Hemobilia caused by a ruptured hepatic cyst: a case report

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    Dutta Sudhir


    Full Text Available Abstract Introduction Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma. Case presentation A 91-year-old African-American woman was referred to our out-patient gastroenterology clinic for evaluation of mild epigastric pain and intermittent melena. An abdominal computed tomography scan was remarkable for multiple hepatic cysts. Esophagogastroduodenoscopy revealed multiple blood clots at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography showed a single 18 mm-sized filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The ruptured hepatic cyst communicated to the bile ducts and was the cause of hemobilia with an atypical clinical presentation. Conclusion Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.

  20. Point-of-care ultrasound detection of tracheal wall thickening caused by smoke inhalation. (United States)

    Kameda, Toru; Fujita, Masato


    Smoke inhalation is the leading cause of death due to fires. When a patient presents with smoke inhalation, prompt assessment of the airway and breathing is necessary. Point-of-care ultrasonography (US) is used for the rapid assessment of critically ill or injured patients. We herein present a case report of a 54-year-old male who was transferred to the emergency department with shortness of breath, coughing, carbonaceous sputa, and rhinorrhea after inhaling smoke caused by a fire in his locked bedroom. He had no surface burns on the face and no edema or erosion in the oral cavity. He had hoarseness without stridor. His breath sounds were positive for expiratory wheezes. Laryngoscopy showed light edema and erosive findings on the supraglottic region. Bedside point-of-care US revealed hypoechoic thickening of the tracheal wall. The thickening was confirmed by a computed tomographic scan. The patient was carefully monitored with preparation for emergency airway management and was treated with supplemental oxygen and an aerosolized beta-2 adrenergic agonist in the intensive care unit. The symptoms were subsequently relieved, and reexamination by US after 2 days showed remission of the wall thickening. Point-of-care US may therefore be a useful modality for the rapid diagnosis and effective follow-up of tracheal wall thickening caused by smoke inhalation.

  1. Traumatic rupture of the globe caused by cow horns. (United States)

    Helbig, H; Iseli, H P


    We investigated the epidemiology, clinical findings and functional outcome of open-globe injuries caused by cow horns over a 50-year period in eastern Switzerland. We retrospectively evaluated the files of cases with ruptures of the globe caused by cow horns between 1950 and 1999. We found 59 cases with ruptures of the globe by cow horns, accounting for 5% of all open-globe injuries. The incidence of these accidents did not change during the observation period. Twenty-two eyes (37%) were enucleated. Only 7 eyes (12%) retained a vision of > or = 0.1. Between 1950 and 1989 only 2/43 eyes (5%) reached a vision of > or = 0.1. In the 1990's, with the introduction of vitreous surgery 5/16 eyes (31%) had a vision of > or = 0.1. Four patients (7%) had blinding eye disease in the partner eye, and three (5%) had a second open-globe trauma. In rural regions, with cattle breeding, open-globe injuries by cow horns are relatively common and the frequency is still the same as 50 years ago. The visual prognosis of these eyes is still guarded, but functional results have improved with the introduction of vitreous surgery. Patients who have had a rupture of the globe appear to have an increased risk for partner eye trauma. Therefore, all efforts are justified to preserve even limited vision in severely injured eyes.

  2. Tracheal occlusion conditioning causes stress, anxiety and neural state changes in conscious rats. (United States)

    Pate, K M; Davenport, P W


    Evidence from human and animal studies indicates that mechanical loads to breathing are stressful stimuli and evoke compensatory behaviours. Conditioning of stressful stimuli is known to cause changes in basal stress levels and behaviour. Individuals with respiratory obstructive diseases repeatedly experience bouts of airway obstruction, which may act as a form of conditioning, and often have affective disorders, such as anxiety and depression. It is unknown whether the development of affective disorders in these individuals results from the unexpected recurring respiratory perturbations. To investigate this possibility, we developed a model to elicit tracheal occlusion (TO) in conscious rats and exposed them to 10 days of TO conditioning. We hypothesized that healthy, conscious animals exposed to TO conditioning would develop stress and anxiety and would have modulated neural activity in respiratory, stress, discriminative and affective neural regions. Following TO conditioning, rats had increased basal corticosterone levels, greater adrenal weights and elevated anxiety levels compared with animals not receiving TO. Significant increases in cytochrome oxidase staining were found in brainstem respiratory nuclei, periaqueductal grey, dorsal raphe, thalamus and insular cortex. These results suggest that healthy animals develop stress and anxiety responses to respiratory load conditioning via inescapable tracheal occlusions, which may be mediated through state changes in specific brain nuclei.

  3. Unusual cause of massive hemothorax: spontaneous rupture of nonfunctioning mediastinal paraganglioma


    Lin, Feng; Liu, Chengwu; Ma, Lin; Pu, Qiang; Zhu, Yunke; Xiao, Zhilan; Guo, Chenglin; Zhang, Xiaolong; Li, Chuan; Liu, Lunxu


    Mediastinal paraganglioma is a rare neurogenic tumor with a hypervascular feature. The spontaneous rupture of mediastinal paraganglioma is an unusual cause of massive hemothorax. Here we present a case of 39-year-old man with massive hemothorax due to the spontaneous rupture of a mediastinal paraganglioma. The man underwent successful resection of tumor and had an uneventful recovery. To our knowledge, this is the first reported case of spontaneous rupture of nonfunctioning mediastinal paraga...

  4. Uterine rupture: a retrospective analysis of causes, complications ...

    African Journals Online (AJOL)

    Case notes with diagnosis of ruptured uterus were retrieved from the records department and information on maternal demographic characteristics, surgical intervention, maternal and perinatal outcome were collected using a check list. Where information was inadequate it was sought from the obstetric database. Obtained ...

  5. Aspergillus Tracheobronchitis Causing Subtotal Tracheal Stenosis in a Liver Transplant Recipient

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    Sonia Radunz


    Full Text Available Invasive aspergillosis is recognized as one of the most significant opportunistic infections after liver transplantation. Diagnosis of invasive aspergillosis in transplant recipients has been proven to be challenging, and optimal approach to the treatment of invasive aspergillosis is still controversial. We here present an unusual case of Aspergillus tracheobronchitis in the setting of liver transplantation. A 47-year-old female patient with persistent dry cough after liver transplantation developed respiratory insufficiency and was readmitted to the intensive care unit 55 days after liver transplantation. A CT scan revealed subtotal tracheal stenosis; bronchoscopy was performed, and extended white mucus coverings causative of the tracheal stenosis were removed. Microbiological assessment isolated Aspergillus fumigatus. The diagnosis was obstructive Aspergillus tracheobronchitis. The patient was started on a treatment of voriconazole 200 mg orally twice daily, adjusted to a trough level of 1–4 mg/L. For further airway management, a tracheal stent had to be implanted. The patient is alive and well 28 months after liver transplantation. Invasive aspergillosis should be considered a possible etiology in liver transplant patients presenting with unspecific symptoms such as persistent dry cough. Optimal strategies for improved and early diagnosis as well as prophylaxis need to be defined.

  6. Internal carotid artery rupture caused by carotid shunt insertion. (United States)

    Illuminati, Giulio; Caliò, Francesco G; Pizzardi, Giulia; Vietri, Francesco


    Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Rupture

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    Our Director-General is indifferent to the tradition of concertation foreseen in our statutes and is "culturally" unable to associate the Staff Association with problem-solving in staff matters. He drags his heels as long as possible before entering into negotiations, presents "often misleading" solutions at the last minute which he only accepts to change once a power struggle has been established. Faced with this rupture and despite its commitment to concertation between gentlemen. The results of the poll in which the staff is invited to participate this week. We therefore need your support to state our claims to the Governing Bodies. The Staff Association proposes a new medium of communication and thus hopes to show that it is ready for future negotiations. The pages devoted to the Staff Association are presented in a more informative, reactive and factual manner and in line with the evolution of the social situation at CERN. We want to establish strong and continuous ties between the members of CERN and ou...

  8. Posterior capsular rupture causing posterior shoulder instability: a case report. (United States)

    Shah, Anup A; Butler, R Bryan; Fowler, Rachel; Higgins, Laurence D


    We report the case of a 20-year-old male competitive football player who was treated for a midsubstance posterior capsule rupture after a posterior dislocation from falling onto his shoulder. Conservative management for 5 months after the injury failed to improve his subjective symptoms, with the primary symptom being activity-related posterior shoulder pain. Advanced imaging findings and physical examination were consistent with posterior instability, thought to be due to a posterior labral tear. At the time of a diagnostic arthroscopy, the patient was found to have an oval-shaped rupture of the capsule that was neither a reverse humeral avulsion of the glenohumeral ligament lesion nor a posterior labral tear. The capsular tear was repaired through an all-arthroscopic technique with nonabsorbable sutures. The patient returned to his previous competitive function, had no pain, and had full motion at final follow-up without recurrence of instability or pain symptoms. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  9. Generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder. (United States)

    Tabaru, A; Endou, M; Miura, Y; Otsuki, M


    We report a case of generalized peritonitis caused by spontaneous intraperitoneal rupture of the urinary bladder. A 74-year-old female was admitted with abdominal pain and biochemical findings of acute renal failure (ARF). She had recently complained of macrohematuria. She had a past history of radiotherapy for uterine cervical cancer and Parkinson's disease treated with levodopa and amantadine. We diagnosed this case as intraperitoneal rupture of the bladder by cystogram. Biochemical findings of ARF might have resulted from urine reabsorption. Intraperitoneal rupture of the bladder should be considered in all cases of peritonitis, especially in patients with urological symptoms and features of ARF.

  10. Ruptura iatrogénica da traqueia: Caso clínico e indicações para tratamento conservador Iatrogenic tracheal rupture: A case report and indications for conservative management

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    Miguel S. Guerra


    Full Text Available As rupturas iatrogénicas traqueobrônquicas após entubação orotraqueal obrigam, habtualmente, a uma intervenção imediata. Tem sido descrito um crescente número de casos em que se optou, com sucesso, pelo tratamento não cirúrgico. Os autores descrevem um caso de uma mulher de 47 anos que sofreu uma ruptura traqueal iatrogénica, durante a entubação orotraqueal para uma cirurgia ortopédica com anestesia geral. Optou-se por um tratamento conservador com antibiótico de largo espectro, dada a estabilidade clínica da doente e o diagnóstico tardio com mais de 72 horas de evolução. A broncofibroscopia foi o exame de diagnóstico de selecção do tipo de tratamento e de confirmação da cicatrização da ruptura. Os autores fazem ainda uma revisão da literatura disponível sobre as indicações para tratamento conservador das rupturas traqueobrônquicas. O tratamento adequado baseia-se nos achados clínicos, radiológicos e broncoscópicos. A morbi-mortalidade aumenta quando o diagnóstico e o tratamento não são imediatos.Tracheal rupture after endotracheal intubation requires inmediate intervention. There have been an increasing number of reports that describe nonsurgical manangement of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Broncoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate

  11. Rare causes of closed rupture of the flexor tendon

    NARCIS (Netherlands)

    Stenekes, Martin W.; Ruttermann, Mike; Werker, Paul M. N.

    Closed injuries to the flexor tendon are relatively rare. We present three rare causes of closed injury to the flexor tendon. Early recognition and adequate treatment by a specialised hand surgeon are crucial for the prognosis of such cases. Delayed diagnosis and treatment often require secondary

  12. Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound

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    Sharad M. Malvadkar


    Full Text Available Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS which was later confirmed on contrast enhanced computed tomography (CECT. An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.

  13. A Rare Cause of Headache in the Emergency Department: Intraventricular Epidermoid Cyst Rupture With Hydrocephalus. (United States)

    Yigit, Mehmet; Seyithanoglu, Mehmet Hakan; Dundar, Tolga Turan; Sogut, Ozgur; Yigit, Eda


    Lateral intraventricular tumors are not frequently observed. Since these tumors grow linearly rather than exponentially, they grow gradually and thus do not cause mass effects and hydrocephalus. This study is the case report of a rare great volume left intraventricular epidermoid cyst rupture. The tumor was found to be associated with mass effect on neighboring structures and hydrocephalus.

  14. Spontaneous rupture of the right gastroepiploic artery: unusual cause of acute abdomen and shock

    Directory of Open Access Journals (Sweden)

    Bounekar Ali


    Full Text Available Abstract Introduction Spontaneous rupture of the right gastroepiploic artery is an extremely rare case which can be a cause of abdominal apoplexy. Case report We present a case of a 64-year old woman with a Spontaneous rupture of the right gastroepiploic artery with hemorrhagic shock that was successfully treated by emergency surgery. Conclusion Simultaneous restoration of circulating volume and rapid diagnosis are keys in determining the patient outcome in this situation. Though the mortality is high if untreated, the operation is relatively simple and carries a low risk.

  15. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation

    DEFF Research Database (Denmark)

    Leth, Peter Mygind; Knudsen, Peter Juel Thiis


    haematoma (1000 ml) in the pericardial sac. Cardiac hypertrophy (556 g) was observed in the patient, though no other cardiovascular abnormalities were found. Histological analysis showed cystic medial necrosis of the ascending aortic wall. A ruptured aneurysmal dilatation of the ascending aorta......Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic...

  16. Case of spontaneous splenic rupture caused by ectopic pregnancy in the spleen. (United States)

    Wu, Bao-Qiang; Zhu, Feng; Jiang, Yong; Sun, Dong-Lin


    Splenic ectopic pregnancy refers to the implantation of the oosperm in the spleen. If not diagnosed early, the results of this phenomenon would almost certainly be splenic rupture, which is equivalent to the spontaneous rupture of the spleen. If the patient has no history of trauma, it is difficult to diagnose this condition early and an explicit diagnosis is often obtained by exploratory laparotomy. We report the case of a 27-year-old woman who was admitted to the hospital due to abdominal pain and hemorrhagic shock. Under emergency general anesthesia, gynecologist and hepatobiliary surgeons worked together to conduct an exploratory laparotomy. It was confirmed during surgery that this was ectopic pregnancy in the spleen, which caused rupture of the spleen. Hence, splenectomy was conducted. Postoperative recovery was good. © 2017 Japan Society of Obstetrics and Gynecology.

  17. A case of generalized peritonitis due to a rupture of the bladder caused by radiation cystitis

    Energy Technology Data Exchange (ETDEWEB)

    Fujitake, Shin-ichi; Nozaki, Hideki; Shimizu, Minoru; Maeda, Yoshiyuki; Kataoka, Susumu [Meitetsu Hospital, Nagoya (Japan)


    An 83-year-old woman was admitted to the department of gastroenterology in our hospital with a diagnosis of adhesive ileus following operation for a uterine cancer on July 22, 1997. Conservative therapy was started, but three days later, peritoneal signs appeared and white blood cell count and CRP level increased. An emergency operation was performed. Upon laparotomy, there were a large volume of ascites and a rupture of the bladder of which wall had become fragile. It was thought that the cause of rupture might result from radiation cystitis because she received irradiation after operation for the uterine cancer. Ruptured site of the bladder was sutured. Possible causes of the ileus were thought to be intestinal paralysis due to generalized peritonitis and a narrowing of the ileum where inflammatory change was remarkable. For this, an excision of the ileum with ileostomy was performed. Thereafter a closure of the ileostomy and ileocolostomy were carried out. The patient had difficulty in management of evacuation for a while, but she was discharged on March 2, 1998. Spontaneous rupture of the bladder is rare. This paper presents such a rare case caused by radiation cystitis, together with 14 cases reported in Japan. It is thought that surgeons who manage acute abdomen may encounter the disease. (author)

  18. Nitrous oxide use and endotracheal tube rupture. (United States)

    Mosby, E L; Schelkun, P M; Vincent, S K


    Nitrous oxide is an important and widely used anesthetic agent. However, during lengthy surgical procedures, significant amounts of nitrous oxide diffuse into the endotracheal tube cuff, causing sequelae that may include increased cuff pressures, tracheal trauma, increased postoperative discomfort, and cuff rupture. In this paper, two cases are presented in which the endotracheal tube cuff used to deliver this anesthetic agent ruptured after more than four hours of surgery. Two simple means of limiting the diffusion of nitrous oxide into the cuff and thus preventing this occurrence are described.

  19. Labyrinthine window rupture as a cause of acute sensorineural hearing loss


    Nagai, Tomoyuki; Nagai, Midori


    Labyrinthine window rupture (LWR) is one cause of acute sensorineural hearing loss and need for early exploration is clear for good improved hearing. Acute sensorineural hearing loss of 60?dB or more treated from May 2006 to May 2010 were retrospectively analyzed. There were 21 ears of severe deafness, 18 ears of profound deafness, and 10 ears of total deafness. All patients were examined with temporal bone CT. Space-occupying lesions around the labyrinthine windows were suggestive images of ...

  20. The causes of difficult tracheal intubation and preoperative assessments in different age groups (United States)

    Moon, Hyoung-Yong; Kim, Jin-Seo; Koo, Gill Hoi; Kim, Jin-Yun; Woo, Young-Cheol; Jung, Yong Hun; Kang, Hyun; Shin, Hwa-Yong; Yang, So-Young


    Background We studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups. Methods Patients were divided into young (Cormack-Lehane (C-L) grade were assessed. The differences in airway assessment factors between difficult (C-L grade 3, 4) and easy (C-L grade 1, 2) intubation were then examined. Logistic regression analysis was also carried out to identify the extent to which airway assessment factors reflected difficult intubation. Results As aging, head and neck movement, thyromental distance, and interincisor gap decreased, the grade of dentition, Mallampati score, cervical joint rigidity and the ratio of Arné score > 11 increased. In the old and middle group, the incidence of difficult intubation was increased compared with the young group. Dentition in the young group, Mallampati score and interinsisor gap in the middle group and Mallampati score, cervical joint rigidity in the old group respectively predicted difficult intubation. Conclusions Compared to young individuals, middle-aged or elderly adults are likely to experience more difficulty in endotracheal intubation and its predictive factors could vary by age group. PMID:23646239

  1. Teflon-buttressed sutures plus pericardium patch repair left ventricular rupture caused by radiofrequency catheter ablation: A case report. (United States)

    Cao, Hao; Zhang, Qi; He, Yanzhong; Feng, Xiaodong; Liu, Zhongmin


    Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare. We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery. Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively. Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture.

  2. Ruptured Persistent Trigeminal Artery Causing Direct Cavernous Sinus Fistula Treated with Pipeline Embolization and Minimal Coiling. (United States)

    Yoon, Nam K; Awad, Al-Wala; Gee, James M; Taussky, Philipp


    Rupture of a persistent trigeminal artery associated with development of a cavernous sinus fistula in a traumatic setting is rare. These arteries are typically treated with coil embolization of the cavernous sinus. We present the case of a 42-year-old woman who developed a direct cavernous carotid fistula after a motor vehicle accident. Angiographic imaging revealed a rupture point of a persistent trigeminal artery as it connected with the cavernous segment of the internal carotid artery, causing a cavernous sinus fistula. Coiling of the cavernous sinus was abandoned after placement of 1 coil because of coil herniation into the internal carotid artery. A Pipeline embolization device was placed to oppose the coil against the intima and keep the lumen open. The combination of coil embolization and flow diversion acutely decreased the fistulous flow. Surprisingly, an angiographic follow-up at 6 months showed complete fistula occlusion despite placement of only 1 coil into the cavernous sinus. We report a rare case where undercoiling of the cavernous sinus occluded a cavernous sinus fistula because of the adjunct use of a Pipeline embolization device in the presence of a traumatic rupture of a persistent trigeminal artery. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Compensatory muscle activation caused by tendon lengthening post Achilles tendon rupture (United States)

    Suydam, Stephen M.; Buchanan, Thomas S.; Manal, Kurt; Silbernagel, Karin Gravare


    Purpose The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. Method The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 month post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during over-ground walking. Results Achilles lengths at 6 and 12 months post-surgery were significantly longer (p Achilles tendon rupture; no side to side difference was found in the healthy controls. The triceps surae muscles’ activations were fair to moderately correlated to the Achilles lengths (0.38 Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength an important treatment goal appears to be to minimize tendon elongation. Level of evidence Prognostic prospective case series. Level IV. PMID:23609529

  4. Abdominal compartment syndrome caused by ruptured abdominal aortic aneurysm in vena cava

    Directory of Open Access Journals (Sweden)

    Filipović Aleksandar


    Full Text Available Background. Abdominal compartment syndrome (ACS is a rapid increase in intra-abdominal pressure associated with multi-organs dysfunction. It is caused mostly by abdominal bleeding und massive volume compensation. Case report. We reported a 76-year-old patient admitted to the hospital with aortic abdominal aneurysm, 13.7 cm in diameter, ruptured in vena cava, which caused intraabdominal hypertension, the liver and kidney dysfunction, as well as circulation, respiration and metabolic disorders. Intraabdominal pressure was measured by bladder manometry. Central venous pressure and systemic arterial pressure were monitored continuously. Clinical signs were thrill and typical abdominal bruit. Aorto-caval fistula was diagnosed by the use of contrast computerized tomography. Caval endoaneurysmatic suture and aortobiiliac bypass with 18 × 9 mm Dacron prothesis were performed. Haemodynamic changes were mostly corrected during the surgery. The complete correction of haemodynamics, liver, kidney, respiration and metabolic changes was established in the next few weeks. Conclusion. The ACS was caused by rupture of abdominal aortic aneurysm in vena cava followed by edema of the abdominal organs, retroperitoneum, abdominal wall and ascites. Caval endoaneurysmatic suture and aortobiiliac bypass with 18 × 9 mm Dacron prothesis solved aortocaval fistula as well as all the organs and metabolic dysfunctions caused by ACS.

  5. Tracheal Carcinoma

    Directory of Open Access Journals (Sweden)

    Ashok K Chauhan


    Full Text Available Adenoid cystic carcinoma of the trachea is a rare primary tracheal malignancy. Obstructive symptoms such as dyspnoea, hoarseness of voice, dysphasia are commonly seen symptoms. Combined modality treatments including surgery and radiation therapy are considered as optimal treatment for these tumours. A case of adenoid cystic carcinoma in a 35 years old male patient who was treated successfully by surgical excision and external beam radiation therapy is presented.

  6. [Spontaneous retroperitoneal bleeding caused by rupture of the native kidney oncocytoma twelve years after renal transplantation]. (United States)

    Vrdoljak, Ana; Pasini, Josip; Kastelan, Zeljko; Hudolin, Tvrtko; Kes, Petar; Basić-Jukić, Nikolina


    Renal transplantation is the method of choice for renal replacement therapy in the majority of patients. Immunosuppressive drugs may increase the risk of developing malignancies. We present a case of a patient having undergone different renal replacement methods over 25 years. He had good graft function at 12 years of transplantation. Development of spontaneous retroperitoneal hematoma caused by rupture of the native kidney oncocytoma was complicated with sepsis and deterioration of graft function. We emphasize the importance of regular ultrasonography follow-up of native kidney, which is challenging because of fibrous changes.

  7. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)


    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  8. Spontaneous hemothorax caused by rupture of an intercostal artery aneurysm in neurofibromatosis Type I: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Chang Min; Na, Jae Beom; You, Jin Jong; Chung, Sung Hoon [Gyeongsang National Univ. College of Medicine, Pusan (Korea, Republic of)


    Neurofibromatosis type I (NF-1) is the most common neurocutaneous syndrome. Associated vascular abnormalities are arterial occlusion, aneurysm, ectasia and arteriovenous malformation. Spontaneous massive hemothorax due to rupture of an arterial aneurysm is rare but fatal. It is, therefore, essential to determine the location of an aneurysm and provide immediate surgical or the interventional treatment. We report a case of spotaneous hemothorax caused by rupture of an intercostal arterial aneurysm diagnosed by CT and angiography.

  9. Endocarditis with ruptured sinus of Valsalva aneurysm caused by nonvaccine Streptococcus pneumoniae serotype 21. (United States)

    Patra, Kamakshya P; Vanchiere, John A; Bocchini, Joseph A; Wu, Amy C; Jackson, Robert D; Kiel, Ernest A; Mello, Dennis


    Sinus of Valsalva aneurysm is a rare, catastrophic complication of endocarditis. We report an unusual case of ruptured sinus of Valsalva aneurysm associated with endocarditis that was caused by Streptococcus pneumoniae serotype 21. The patient, a 12-year-old girl, underwent surgical repair of the aneurysm and was given intravenous antibiotics for 6 weeks. She was doing well at the 6-week follow-up visit. This case is unusual because of the patient's young age at presentation, the absence of predisposing factors, and the isolation of a nonvaccine serotype 21, which revealed the epidemiologic changes of invasive pneumococcal disease. To our knowledge, this is the first reported case of endocarditis caused by this S. pneumoniae serotype.

  10. Airbag-Associated Severe Blunt Eye Injury Causes Choroidal Rupture and Retinal Hemorrhage: A Case Report

    Directory of Open Access Journals (Sweden)

    Shih Hao Wang


    Full Text Available A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV, intravitreal bevacizumab (1.25 mg/0.05 mL injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.

  11. Silicone granuloma from ruptured breast implants as a cause of cervical lymphadenopathy. (United States)

    Borghol, K; Gallagher, G; Skelly, B L


    A 56-year-old woman with a 10-year history of bilateral silicone breast implants presented to the ear, nose and throat outpatient clinic with a 2-month history of a right-sided neck lump. She was found to have a 1.3cm supraclavicular lymph node that gave the clinical impression of being reactive. Ultrasonography guided fine needle aspiration was inconclusive and initial review of subsequent computed tomography failed to identify a cause. This was followed by excisional biopsy of the lymph node, which revealed a silicone granuloma that was linked to a ruptured right-sided breast implant placed ten years previously. This case highlights the importance for otolaryngologists to consider silicone granuloma among the differential diagnoses of cervical lymphadenopathy in patients with a history of silicone breast implants. Recognising this differential diagnosis could avoid undue anxiety for patient and clinician regarding more serious pathology.

  12. A New Snowboard Injury Caused by "FLOW" Bindings A Complete Deltoid Ligament and Anterior Talofibular Ankle Ligament Rupture

    NARCIS (Netherlands)

    Haverkamp, Daniel; Hoornenborg, Daniel; Maas, Mario; Kerkhoffs, Gino


    We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and

  13. Hemoperitoneum Caused by Hepatic Necrosis and Rupture Following a Snakebite: a Case Report with Rare CT Findings and Successful Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Jae Hong; Yoo, Dong Gon; Choi, Soo Jung; Lee, Jong Hyeog; Park, Man Soo; Kwak, Jin Ho; Jung, Seung Mun; Ryu, Dae Shick [GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of)


    Snakebites are a relatively common occurrence worldwide and are estimated to affect greater than 2.5 million humans annually, of whom more than 100,000 will die. Imaging manifestations associated with this entity have rarely been described in the scientific literature. We recently obtained a successful clinical outcome after gelatin sponge sheet embolization of the hepatic artery in the case of a snakebite which caused hemoperitoneum associated with hepatic necrosis and rupture. Until now, this type of complication after a snakebite has not been reported in the literature. We report the computed tomographic and angiographic findings in a case of a snakebite resulting in hemoperitoneum caused by hepatic rupture and necrosis with active bleeding. In conclusion, snakebites have complex venomous effects. They may lead to various changes in hemostasis. In our case, snakebite-induced coagulopathy by a Korean viper resulted in hepatic necrosis and rupture with active bleeding. To our knowledge, this is the first published case about CT findings of hepatic necrosis and rupture with active bleeding after a snakebite and should be recognized as a possible complication following snakebites. We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.


    African Journals Online (AJOL)



    Jan 5, 2009 ... Natural tracheal may become defective due to, among other things, abnormal narrowing or fistulas, direct or indirect result of accidents or narrowing caused by inflammation. In an acute situation when direct anastomoses. (cross-connection) cannot be made, tracheal prostheses are often needed to bridge ...

  15. Type 1 Achilles tendon rupture caused by grooming trauma in a ...

    African Journals Online (AJOL)

    Achilles tendon rupture is uncommon in small animal practice. A 9-month-old, female, mixed breed dog (weighing 2.2kg) was referred to our hospital with a primary complaint of right hind limb lameness. Complete right Achilles tendon rupture was diagnosed by physical examination and radiography. The tendon was ...

  16. Tracheal Configuration as a Radiographic Predictor of Difficult ...

    African Journals Online (AJOL)

    Background: Goiters producing tracheal deviation or tracheal narrowing (TN) or both may cause difficult tracheal intubation (DTI). This study is to determine whether pre-operative assessment of trachea on neck radiograph can serve to predict DTI in goiters. Methods: Pre- thyroidectomy radiographs of 160 patients were ...

  17. Acute nonbacterial pleuritis caused by spontaneous rupture of metastatic pulmonary adenocarcinoma. (United States)

    Iwata, Takashi; Inoue, Kiyotoshi; Morita, Ryuhei; Tsukioka, Takuma; Yamoto, Masaya; Suehiro, Shigefumi


    Nonbacterial pleuritis caused by rupture of a metastatic adenocarcinoma is extremely rare and has not yet been reported. A 59-year-old man with a history of rectal cancer surgery 6 years earlier presented with a solitary lung mass in the periphery of the right lower lobe on computed tomography. Transbronchial biopsy disclosed a suspected metastatic adenocarcinoma, and he was admitted for pulmonary metastasectomy. He had been asymptomatic, but 4 weeks after the diagnostic bronchoscopy, the patient suddenly complained of a right back pain and dyspnea at rest; shortly after that, he developed a fever of 39 degrees C. A chest X-ray showed right pleural effusion, collapse of the right lower lobe, and elevation of the right diaphragmatic dome, but without pneumothorax. Emergent video-assisted thoracoscopy revealed a perforated tumor in the collapsed lower lobe, and a right lower lobectomy was carried out. The postoperative course was uneventful, and he was well without recurrent disease 2 years after pulmonary resection.

  18. Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Gunes Ali


    Full Text Available Abstract Background Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. Case report We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. Conclusion Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

  19. Laryngeal morbidity after tracheal intubation

    DEFF Research Database (Denmark)

    Sørensen, M K; Rasmussen, N; Kristensen, M S


    BACKGROUND: Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower...... in the shimmer values in that group implies that the Endoflex may be associated with less laryngeal morbidity....

  20. Conservative management of a major post-intubation tracheal injury and review of current management

    NARCIS (Netherlands)

    Mullan, Geoffrey P. J.; Georgalas, Christos; Arora, Asit; Narula, Anthony


    Tracheal rupture represents a rare but serious complication of intubation. We discuss a case of a major post-intubation rupture. After investigation with CT scan tracheoscopy and bronchoscopy a low tracheostomy was formed protecting the rupture from pressure changes associated with ventilation. The

  1. Hepatic Rupture Caused by Hemolysis, Elevated Liver Enzyme, and Low Platelet Count Syndrome: A Case Report with Computed Tomographic and Conventional Angiographic Findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Cheong Bok; Ahn, Jae Hong; Choi, Soo Jung; Lee, Jong Hyeog; Park, Man Soo; Jung, Seung Mun; Ryu, Dae Sik [Dept. of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of)


    The authors recently obtained successful clinical outcome after embolization of the hepatic artery and right inferior phrenic artery in a pregnant patient with hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome causing hepatic rupture. We report the computed tomographic and conventional angiographic findings in a case of HELLP syndrome, resulting in hepatic infarction and rupture with active bleeding.

  2. Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction

    Directory of Open Access Journals (Sweden)

    Josip Vincelj


    Full Text Available Aim To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle. Methods Transthoracic (TTE and transesophageal echocardiography (TEE was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male with complete ruptures of papillary muscle following acute myocardial infarction (AMI. Results Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case. Conclusion Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE.

  3. Spontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Verroiotou Maria


    Full Text Available Spontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially life-threatening condition if not diagnosed in time. A 17-year-old Greek female presented to the ER due to acute abdominal pain, mainly of the left upper quadrant. She had no recent report of trauma. The patient was pale, her blood pressure was 90/70 mmHg, and her pulse was 120 b/min. Clinical examination of the abdomen revealed muscle contraction and resistance. The patient was submitted to an ultrasound of the upper abdomen and to a CT scanning of the abdomen that revealed an extended intraperitoneal hemorrhage due to spleen rupture. Due to the patient’s hemodynamic instability, she was taken to the operation room and splenectomy was performed. Following a series of laboratory examinations, the patient was diagnosed to be positive for current cytomegalovirus infection. The postoperative course was uneventful, and in a two year follow-up the patient is symptom-free. Spontaneous spleen rupture due to Cytomegalovirus infection is a rare clinical entity, described in few case reports in the world literature and should always be taken into consideration in differential diagnosis of acute abdomen, especially in adolescents with no recent report of trauma.

  4. Nonculprit Plaque Characteristics in Patients With Acute Coronary Syndrome Caused by Plaque Erosion vs Plaque Rupture: A 3-Vessel Optical Coherence Tomography Study. (United States)

    Sugiyama, Tomoyo; Yamamoto, Erika; Bryniarski, Krzysztof; Xing, Lei; Lee, Hang; Isobe, Mitsuaki; Libby, Peter; Jang, Ik-Kyung


    Patients with culprit plaque rupture are known to have pancoronary plaque vulnerability. However, the characteristics of nonculprit plaques in patients with acute coronary syndromes caused by plaque erosion are unknown. To investigate the nonculprit plaque phenotype in patients with acute coronary syndrome according to culprit plaque pathology (erosion vs rupture) by 3-vessel optical coherence tomography imaging. In this observational cohort study, between August 2010 and May 2014, 82 patients with ACS who underwent preintervention optical coherence tomography imaging of all 3 major epicardial coronary arteries were enrolled at the Massachusetts General Hospital Optical Coherence Tomography Registry database. Analysis of the data was conducted between November 2016 and July 2017. Patients were classified into 2 groups based on the culprit lesion pathology: 17 patients with culprit plaque erosion and 34 patients with culprit plaque rupture. Thirty-one patients with the absence of culprit rupture or erosion were excluded from further analysis. Preintervention 3-vessel optical coherence tomography imaging. Plaque characteristics at the culprit and nonculprit lesions evaluated by optical coherence tomography. In 51 patients (37 men; mean age, 58.7 years), the characteristics of 51 culprit plaques and 216 nonculprit plaques were analyzed. In patients with culprit erosion, the mean (SD) number of nonculprit plaques per patient was smaller (3.4 [1.9] in erosion vs 4.7 [2.1] in rupture, P = .05). Patient-based analysis showed that none of 17 patients with culprit plaque erosion had nonculprit plaque rupture, whereas 26% of the patients (9 of 34) with culprit plaque rupture had nonculprit plaque rupture (P = .02). Plaque-based analysis showed that, compared with the culprit rupture group (n = 158), the culprit erosion group (n = 58) had lower prevalence of plaque rupture (0% vs 8%; P erosion had a smaller number of nonculprit plaques and the lower levels

  5. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Bhupesh Kumar


    Full Text Available Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  6. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease. (United States)

    Kumar, Bhupesh; Raj, Ravi; Jayant, Aveek; Kuthe, Sachin


    Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  7. [Renal angiomyolipoma rupture as a cause of lumbar pain: report of one case]. (United States)

    Cifuentes, Melissa; Calleja, Félix; Hola, José; Daviú, Antonio; Jara, Danilo; Vallejos, Humberto


    Renal angiomyolipoma is a benign tumor formed by smooth muscle, adipose tissue and blood vessels. It is commonly found incidentally and its clinical manifestations are pain and abdominal mass or spontaneous tumor rupture with retroperitoneal bleeding. The clinical presentation of a hemorrhagic shock secondary to a retroperitoneal hematoma is uncommon. We report a 40 year-old male who presented to the emergency room with lumbar pain and deterioration of hemodynamic parameters. The CT scan showed a left renal injury associated to an expansive retroperitoneal process. The abdominal exploration, vascular control of the renal pedicle and nephrectomy allowed a successful outcome.

  8. “Tennis leg”: gastrocnemius injury is a far more common cause than plantaris rupture

    Directory of Open Access Journals (Sweden)

    Joelle R. Harwin, BS


    Full Text Available We report a typical case of “tennis leg”, in which the main finding was a fluid collection between the medial head of the gastrocnemius and soleus muscles. Since the first clinical description of this entity in 1883, the injury has been attributed to rupture of the plantaris tendon. However, recent studies of this condition with sonography and magnetic resonance imaging have shown that most of these cases are actually due to injury to the gastrocnemius and/or soleus muscles, and up to 10% are due to deep venous thrombosis masquerading as muscle injury. The plantaris muscle and tendon are only rarely involved in this injury.

  9. Iatrogenic tracheal tear.

    LENUS (Irish Health Repository)

    Dias, A


    Large post intubation tracheal tears are usually detected intra-operatively due to unstable signs namely impaired ventilation and mediastinal emphysema and often require surgical management. Smaller tracheal tears are often missed during anaesthesia and recognized during the postoperative period. Conservative management should be considered in these latter cases.

  10. Ruptured Granulosa Cell Tumor of the Ovary as a Cause of Acute Abdomen in Postmenopausal Woman

    Directory of Open Access Journals (Sweden)

    Tufan Oge


    Full Text Available Acute abdomen with hemoperitoneum is a very rare entity in postmenopausal women due to gynecologic conditions. A 54-year-old, postmenopausal woman was brought to emergency department with severe abdominal pain. Physical examination revealed acute abdomen findings with 15 cm pelvic mass on the right adnexal region. Immediate exploratory laparotomy was performed. During laparotomy 1000 cc of bloodstained fluid, ruptured and actively bleeding large mass arising from right ovary was observed. Right salpingo-oopherectomy was performed in emergency conditions, and pathology report revealed an adult type of granulosa cell tumor. After this result, staging surgery was performed and patient was diagnosed as granulosa cell tumor stage 1 c. Cisplatin, etoposide, and bleomycin chemotherapy was given. Clinicians should be aware of granulosa cell tumors which may occur at any age and prone to rupture. Frozen section will be helpful in order to avoid incomplete surgeries especially in postmenopausal women presented with intra-abdominal bleeding.

  11. A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    P. Moori


    Full Text Available Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP, described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

  12. A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis. (United States)

    Moori, P; Nevins, E J; Wright, T; Bromley, C; Rado, Y


    Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP), described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT) scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS) at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

  13. Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage

    Directory of Open Access Journals (Sweden)

    Melissa Schwartz


    Full Text Available Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management.

  14. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon


    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  15. Successful Treatment of Anterior Tracheal Necrosis after Total Thyroidectomy Using Vacuum-Assisted Closure Therapy (United States)

    Philippe, Grégory; Pichon, Nicolas; Lerat, Justine; Amiel, Jean Bernard; Clavel, Marc; Mathonnet, Muriel


    Total thyroidectomy involving the adjacent structures of the trachea can cause tracheal damage such as early tracheal necrosis. The authors describe the first case of anterior tracheal necrosis following total thyroidectomy treated using vacuum-assisted closure device. After two weeks of VAC  therapy, there was no evidence of ongoing infection and the trachea was partially closed around a tracheotomy cannula, removed after 3 months. The use of a VAC  therapy to reduce and close the tracheal rent and to create a rapid granulation tissue over tracheal structure appeared as a good opportunity after anterior tracheal necrosis. PMID:21808730

  16. Successful Treatment of Anterior Tracheal Necrosis after Total Thyroidectomy Using Vacuum-Assisted Closure Therapy

    Directory of Open Access Journals (Sweden)

    Grégory Philippe


    Full Text Available Total thyroidectomy involving the adjacent structures of the trachea can cause tracheal damage such as early tracheal necrosis. The authors describe the first case of anterior tracheal necrosis following total thyroidectomy treated using vacuum-assisted closure device. After two weeks of VAC  therapy, there was no evidence of ongoing infection and the trachea was partially closed around a tracheotomy cannula, removed after 3 months. The use of a VAC  therapy to reduce and close the tracheal rent and to create a rapid granulation tissue over tracheal structure appeared as a good opportunity after anterior tracheal necrosis.

  17. Posterior tracheal diverticulosis. (United States)

    Madan, Karan; Das, Chandan J; Guleria, Randeep


    Multiple tracheal diverticulosis is a rare clinical entity. Tracheal diverticula are usually recognized radiologically as solitary right paratracheal air collections on thoracic computed tomography examination. They are usually asymptomatic but can occasionally present with persistent symptoms. We herein report the case of a 50-year-old male patient who underwent extensive evaluation for persistent cough. Multiple posterior right paratracheal air collections were recognized on thoracic multidetector computed tomography examination, which was confirmed as multiple-acquired posterior upper tracheal diverticula on flexible bronchoscopy. The patient improved with conservative medical management.

  18. Acute Subdural Hematoma and Subarachnoid Hemorrhage Caused by Ruptured Cortical Artery Aneurysm: Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Ahmad Shekarchizadeh


    Full Text Available The present report describes an acute subdural hematoma (ASDH associated with subarachnoid hemorrhage (SAH, due to ruptured cortical aneurysm. To our knowledge, extremely rare cases of this sort have been reported so far. A 23-year-old male patient without previous trauma presented with severe headache and rapidly decreasing level of consciousness to decerebrate status. Computed tomography (CT scan has demonstrated an ASDH together with SAH. Hematoma has immediately been evacuated without any evaluation by angiography. After evacuation of the thick subdural clot, a 10-mm aneurysm was revealed on a precentral artery of frontal cortex, which was ligated. However, after 35 days the patient discharged with left side hemiparesis and dysphasia, and just after several months of admission he got symptom free. Ruptured cortical aneurysm should be considered as one of the causes of spontaneous ASDH. Vascular anomaly investigations are suggested for these cases, thus CT angiography or digital subtraction angiography has to be considered if clinical condition allows.

  19. Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    Richard A. Schatz MD


    Full Text Available Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.

  20. A study of tracheal prostheses produced by composite laminate ...

    African Journals Online (AJOL)

    Natural tracheal may become defective due to, among other things, abnormal narrowing or fistulas, direct or indirect result of accidents or narrowing caused by inflammation. In an acute situation when direct anastomoses (cross-connection) cannot be made, tracheal prostheses are often needed to bridge the defects.

  1. [Design and study of carbon fiber tracheal prosthesis]. (United States)

    Qi, L; Liu, D; Han, Z; Wang, F


    32 healty adult dogs were selected for this experiment. 10 of them were subjected to the tracheal biomechanics test using indices including the relation between stretcher ratio (lambda) and stress (T), the squeeze stress (delta jy) of medical silk thread on trachea, the side stress (Ts) inducing the tracheal collapse, the functional maximum angle (psi max) of tracheal, and the sever area torsion angle (theta max) of tracheal functional maximum curved. According to the indices measured, two types of tracheal prosthesis were designed, and were made of carbon fiber and silicon. They were the straight tube type tracheal prosthesis and the bifurcate type tracheal prosthesis. The straight tube type tracheal prosthesis was studied with a design of two groups comprising a total of 11 dogs. In the experiment group (n = 6), the outer surface of the tube was not coated with silicon, the average survival period was 379.8 days. In the control group (n = 5), the outer surface of the tube was coated with silicon, the average survival period was 90.4 days. The bifurcate type tracheal prosthesis was studied in 11 dogs, the average survival period was 4.32 days. The main causes of death in the experiment were infection and anastomotic dehiscent.

  2. Intrasylvian hematoma caused by ruptured middle cerebral artery aneurysms predicts recovery from poor-grade subarachnoid hemorrhage. (United States)

    Fukuda, Hitoshi; Hayashi, Kosuke; Moriya, Takafumi; Nakashita, Satoru; Lo, Benjamin W Y; Yamagata, Sen


    Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p grade by multivariable analysis. ISH predicted good functional recovery from poor-grade aneurysmal SAH.

  3. Bleed caused by varicose veins rupture in a rare site in portal hypertension. Differential diagnosis with causes of acute hypovolemic shock in emergency.

    Directory of Open Access Journals (Sweden)

    Rosarino Procopio


    Full Text Available Portal hypertension is the increase in the pressure of the venous portal system, which receives around 1,500 mL/m of blood from the intestinum tenue, colon, spleen, and pancreas. A blocking of the flux or an increase in the resistance at any level of the portal tree results in an increase in the pressure in the system and the appearance of lateral circles between the portal vein and the inferior and superior, thus allowing for varicose veins to spread in the whole system. The present paper reports the case of a woman with liver cirrhosis, great ascites and bleeding out of varicose veins’ rupture at the spleen axis level, which presented the problem of differential diagnosis with other causes of hypovolemic shock. This cases resulted in the patient’s exitus.

  4. [Carbon-carbon materials and composites for experimental tracheal reconstruction]. (United States)

    Liu, Xin; Jiang, Zhao-yang; Qin, Yong


    The Carbon fiber reinforced carbon matrix composites were employed for reconstruction of large circumferential defect of the cervical trachea. The biocompatibility and biofunctionality of the new type carbonaceous tracheal prosthesis were evaluated, and the feasibility for cervical tracheal reconstruction discussed. Two types of carbonaceous tracheal prosthesis with different weaving methods of carbon fiber were used on eight healthy canines. Three to six tracheal cartilage rings were resected circumferentially. The 2 cm long tracheal prosthesis was transplanted into canines and the anastomosis was completed by end-to-end, tracheal-into-prosthesis and prosthesis-into-tracheal method. The function of breathing, eating and infection was observed after surgery. Four months later, the five survival canines were sacrificed and the prosthesis with surrounding tissues was removed for observation by optical microscopy and scanning electron microscopy. All dogs had cough symptom in different degree lasted 1 - 4 weeks after surgery. Two dogs with tracheal-into-prosthesis anastomosis showed eating disorders in different degree. One canine died due to airway obstruction caused by dislocation of prosthesis within three weeks after operation. Another two deaths in 11th week and 12th week were attributed to suffocation because of hypergranulation and scar formation. Prosthesis was surrounded by connective tissues and anchored firmly to the neighboring tissues. Most part of the luminal surface of tracheal prosthesis was not covered by respiratory mucosa. However, the inner layer showed scant re-epithelialization beyond the anastomosis. The implantation of the carbonaceous tracheal prosthesis can maintain the normal respiratory function of the experimental canines, but hypergranulation and scar formation around the end of the tracheal prosthesis and epithelium on the luminal surface of the prosthesis are questions still remained to be solved.

  5. Numerical Analysis on the Compressible Flow Characteristics of Supersonic Jet Caused by High-Pressure Pipe Rupture Using CFD

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jong-Kil; Yoon, Jun-Kyu [Gachon Univ., Sungnam (Korea, Republic of); Kim, Kwang-Chu [KEPCO-E& C, Kimchun (Korea, Republic of)


    A rupture in a high-pressure pipe causes the fluid in the pipe to be discharged in the atmosphere at a high speed resulting in a supersonic jet that generates the compressible flow. This supersonic jet may display complicated and unsteady behavior in general . In this study, Computational Fluid Dynamics (CFD) analysis was performed to investigate the compressible flow generated by a supersonic jet ejected from a high-pressure pipe. A Shear Stress Transport (SST) turbulence model was selected to analyze the unsteady nature of the flow, which depends upon the various gases as well as the diameter of the pipe. In the CFD analysis, the basic boundary conditions were assumed to be as follows: pipe of diameter 10 cm, jet pressure ratio of 5, and an inlet gas temperature of 300 K. During the analysis, the behavior of the shockwave generated by a supersonic jet was observed and it was found that the blast wave was generated indirectly. The pressure wave characteristics of hydrogen gas, which possesses the smallest molecular mass, showed the shortest distance to the safety zone. There were no significant difference observed for nitrogen gas, air, and oxygen gas, which have similar molecular mass. In addition, an increase in the diameter of the pipe resulted in the ejected impact caused by the increased flow rate to become larger and the zone of jet influence to extend further.

  6. Evaluation of histological changes after tracheal occlusion at different gestational ages in a fetal rat model

    Directory of Open Access Journals (Sweden)

    Rodrigo Melo Gallindo


    Full Text Available OBJECTIVES: To evaluate the histological changes of tracheal cartilage and epithelium caused by tracheal occlusion at different gestational ages in a fetal rat model. METHODS: Rat fetuses were divided into two groups: a External control, composed of non-operated rats, and b Interventional group, composed of rats operated upon on gestational day 18.5 (term = 22 days, divided into triads: 1 Tracheal occlusion, 2 Internal control and 3 Sham (manipulated but not operated. Morphological data for body weight, total lung weight and total lung weight/body weight ratio were collected and measured on gestational days 19.5, 20.5 and 21.5. Tracheal samples were histologically processed, and epithelial, chondral and total tracheal thicknesses were measured on each gestational day. RESULTS: The tracheal occlusion group exhibited an increase in total lung weight/body weight ratio (p<0.001. Histologically, this group had a thicker epithelial thickness (p<0.05 and thinner chondral (p<0.05 and total tracheal thicknesses (p<0.001. These differences were more prominent on gestational days 20.5 and 21.5. CONCLUSION: Tracheal occlusion changed tracheal morphology, increased epithelial thickness and considerably decreased total tracheal thickness. These changes in the tracheal wall could explain the development of tracheomegaly, recently reported in some human fetuses subjected to tracheal occlusion.

  7. Tracheal Stenosis Because of Wegener Granulomatosis Misdiagnosed as Asthma. (United States)

    O'Hear, Kelley E; Ingrande, Jerry; Brodsky, Jay B; Morton, John M; Sung, Chih-Kwang


    We describe a patient with Wegener granulomatosis whose complaint of wheezing was incorrectly attributed to asthma. Anesthesiologists must recognize that tracheal stenosis is extremely common in Wegener granulomatosis and can mimic other causes of wheezing.

  8. Effects of artificial tracheal fixation on tracheal epithelial regeneration and prevention of tracheal stenosis. (United States)

    Nakaegawa, Yuta; Nakamura, Ryosuke; Tada, Yasuhiro; Suzuki, Ryo; Takezawa, Toshiaki; Nakamura, Tatsuo; Omori, Koichi


    Tight fixation of the artificial trachea is important for epithelialization and tracheal stenosis. The authors have developed an artificial trachea and have used it for tracheal reconstruction. Although various studies on tracheal reconstruction have been conducted, no studies have examined the effect of artificial tracheal fixation on tracheal stenosis and regeneration. Therefore, the purpose of the present study was to evaluate the effect of artificial tracheal fixation. Preliminary animal experiment. Artificial tracheae were implanted into rabbits with partial tracheal defects. Tracheal stenosis and regeneration of the tracheal epithelium on the artificial tracheae were evaluated by endoscopic examination, scanning electron microscopic analysis, and histological examination. The artificial tracheae fixed to the tracheal defects were classified into three groups (0-point, 4-point, and 8-point) by the number of fixation points. At 14 and 28 days post-implantation, the luminal surface of the implantation area was mostly covered with epithelium in all fixation groups. However, a small amount of granulation tissue was observed in the 0-point fixation group at 14 days post-implantation. Moreover, tracheal stenosis did not occur in the 8-point fixation group, but stenosis was detected in the other groups.

  9. Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy. (United States)

    Floeth, Frank; Riemenschneider, Markus; Herdmann, Jörg


    Pure spinal epidural cavernous angiomas are extremely rare lesions, and their normal shape is that of a fusiform mass in the dorsal aspects of the spinal canal. We report a case of a lumbo-sacral epidural cavernous vascular malformation presenting with acute onset of right-sided S1 radiculopathy. Clinical aspects, imaging, intraoperative findings, and histology are demonstrated. The patient, a 27-year-old man presented with acute onset of pain, paraesthesia, and numbness within the right leg corresponding to the S1 segment. An acute lumbosacral disc herniation was suspected, but MRI revealed a cystic lesion with the shape of a balloon, a fluid level and a thickened contrast-enhancing wall. Intraoperatively, a purple-blue tumor with fibrous adhesions was located between the right S1 and S2 nerve roots. Macroscopically, no signs of epidural bleedings could be denoted. After coagulation of a reticular venous feeder network and dissection of the adhesions the rubber ball-like lesion was resected in total. Histology revealed a prominent venous vessel with a pathologically thickened, amuscular wall surrounded by smaller, hyalinized, venous vessels arranged in a back-to-back position typical for the diagnosis of a cavernous angioma. Lumina were partially occluded by thrombi. The surrounding fibrotic tissue showed signs of recurrent bleedings. There was no obvious mass hemorrhage into the surrounding tissue. In this unique case, the pathologic mechanism was not the usual rupture of the cavernous angioma with subsequent intraspinal hemorrhage, but acute mass effect by intralesional bleedings and thrombosis with subsequent increase of volume leading to nerve root compression. Thus, even without a sudden intraspinal hemorrhage a spinal cavernous malformation can cause acute symptoms identical to the clinical features of a soft disc herniation.

  10. Interventional and surgical treatment of a hemothorax caused by a ruptured vertebral artery in a patient with neurofibromatosis type I

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hoon; Kim, Dong Hun; Kim, Dong Hyun; Seo, Hong Joo [Chosun University College of Medicine, Gwangju (Korea, Republic of)


    We report a case of a massive hemothorax arising from a ruptured vertebral artery aneurysm in a patient with neurofibromatosis type 1 suffering from sudden onset of dyspnea. The vertebral artery aneurysm was treated with endovascular coil embolization. Then, an open thoracotomy was performed to evacuate the hematoma.

  11. [Maternal and fetal morbidity in patients with premature rupture of the membrane after 27-week gestation. Causes and costs]. (United States)

    Nava Flores, Jorge; Enríquez Miranda, Ma Cecilia; Hernández-Valencia, Marcelino


    Premature rupture of the membranes (PROM) occurs in a third of the childbirths preterm, this represents 8% of all pregnancies, with same morbidity and mortality in developing and developed countries, PROM is the more common cause of neonatal morbidity and mortality, making this obstetric complication a worldwide problem of health, since it contributes to the economic problem for the cost risen in medical attention for both, mothers and live birth. PROM is considered a mutifactorial entity. This study was carried out in the Hospital de Ginecología y Obstetricia of the Centro Médico "La Raza" in Mexico City, where women entered in serial form with pregnancies from 27 to 34 weeks of gestation and spontaneous PROM, without any other pathology. 120 patients were included, with 26.8 +/- 5.9 year-old age. The gestational age with more frequency of PROM were from 30 to 33 weeks, 22.5% of the patients had 4 days with PROM, 6 of this cases arrived up to 13 days with this complication at delivery. 2.5% of the patients presented deciduitis, with adequated response to the use of antibiotics. When analyzing the hospital stay, a stay was observed from 4 to 7 days (5.26 +/- 1.96 M +/- SD), with a total cost for maternal stay of 2 millions 445,650 pesos. Those babies born had an average of 23 days of hospital stay and the total cot of the days of stay was 4 millions 963,978 pesos. Other costs were the attention of maternal and pediatrics specialty, the obstetric resolution of the pregnancy, obstetric ultrasonography and crystallographies. Thus, the total costs of the attention of this complication in these patients with PROM was of 10 millions 296,988 pesos. The international reference is the American dollar that was in 10 pesos for dollar to the moment of this study. The maternal morbidity is low to that described in previous studies, but in spite of the exhaustive efforts on the prevention, prediction, diagnosis and treatment, the premature rate due to PROM has not diminished

  12. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Hirose Hitoshi


    Full Text Available Abstract Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for early identification of potential complications.

  13. Fiber optic tracheal detection device (United States)

    Souhan, Brian E.; Nawn, Corinne D.; Shmel, Richard; Watts, Krista L.; Ingold, Kirk A.


    Poorly performed airway management procedures can lead to a wide variety of adverse events, such as laryngeal trauma, stenosis, cardiac arrest, hypoxemia, or death as in the case of failed airway management or intubation of the esophagus. Current methods for confirming tracheal placement, such as auscultation, direct visualization or capnography, may be subjective, compromised due to clinical presentation or require additional specialized equipment that is not always readily available during the procedure. Consequently, there exists a need for a non-visual detection mechanism for confirming successful airway placement that can give the provider rapid feedback during the procedure. Based upon our previously presented work characterizing the reflectance spectra of tracheal and esophageal tissue, we developed a fiber-optic prototype to detect the unique spectral characteristics of tracheal tissue. Device performance was tested by its ability to differentiate ex vivo samples of tracheal and esophageal tissue. Pig tissue samples were tested with the larynx, trachea and esophagus intact as well as excised and mounted on cork. The device positively detected tracheal tissue 18 out of 19 trials and 1 false positive out of 19 esophageal trials. Our proof of concept device shows great promise as a potential mechanism for rapid user feedback during airway management procedures to confirm tracheal placement. Ongoing studies will investigate device optimizations of the probe for more refined sensing and in vivo testing.

  14. Rehabilitation of the gas pipeline that had a rupture in service caused by SCC (Stress Corrosion C raking); Rehabilitacion al servicio de un gasoducto que ha sufrido una ruptura en servicio por SCC

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Fernando; Carzoglio, Eduardo; Hryciuk, Pedro [TGN - Transportadora de Gas del Norte S.A. (Argentina). Depto. de Integridad


    TGN had a rupture in service on Gasoducto Troncal Norte. After initial evaluation of the causes of the rupture it was concluded that it had been caused by Stress Corrosion Cracking (SCC). Subsequent investigation in the area of the rupture revealed that colonies of cracks, typical of SCC were found in pipes located near the rupture. In order to put back in service the pipeline in a safety condition, SCC mitigation activities were performed. A decision was made to conduct a hydro test along approximately 30 kilometers of pipe. The stages of the works, the problems faced and the solutions found are dealt with, as well as the conclusions reached upon completion of the works which allowed a better understanding of SCC phenomenon. The methodology for the identification of those areas susceptible to SCC is also described. (author)

  15. Surgical Treatment for Patients With Tracheal and Subgllotic Stenosis

    Directory of Open Access Journals (Sweden)

    Nematollah Mokhtari


    Full Text Available Background:Iatrogenic airway injury after endotracheal intubation and tracheotomy remains a serious clinical problem.In this study we reviewed post-intubation and traumatic tracheal stenosis in 47 patients with a special attention to the cause,hense surgical treatment of the stenosis was performed and the results compared with the literatures.Methods:Since February 1995 through January 2005 a total of 47 patients with tracheal stenosis and subgllotic as a result of tracheostomy or intubation in a single   institution, were explored in this study and examined for the outcomes of stenosis   management.There were 39 tracheal and 8 infraglottic stenosis. Our management strategy for stenosis was end-to-end anastomosis, and cartilage graft tracheoplasty. Results: Our management strategy for treatment of tracheal stenosis with resection and end-to-end anastomosis was associated with good outcomes. Patients were   treated by tracheal or partial laryngotracheal resection. The overall success rate was 93% with the complication rate of 18%. A second operation was required on 2 patients (4%.Conclusions: Long term tracheal tubes or intubation tubes and poor quality material tubes were the most common causes of these respiratory strictures .Our current procedures of choice for tracheal stenosis is sleeve resection with end- to -end anastomosis for short- segment stenoses (up to six rings. Cartilaginous homograft was performed when the loss the cartilage limited to the anterior part of trachea. The most common late complication was the formation of the granulations at the suture line.Granulation tissues can usually be managed with Laser or bronchoscopic removal.  

  16. Globe Rupture

    Directory of Open Access Journals (Sweden)

    Reid Honda


    Full Text Available History of present illness: A 46-year-old male presented to the emergency department (ED with severe left eye pain and decreased vision after tripping and striking the left side of his head on the corner of his wooden nightstand. The patient arrived as an inter-facility transfer for a suspected globe rupture with a protective eye covering in place; thus, further physical examination of the eye was not performed by the emergency physician in order to avoid further leakage of aqueous humor. Significant findings: The patient’s computed tomography (CT head demonstrated a deformed left globe, concerning for ruptured globe. The patient had hyperdense material in the posterior segment (see green arrow, consistent with vitreous hemorrhage. CT findings that are consistent with globe rupture may include a collapsed globe, intraocular air, or foreign bodies. Discussion: A globe rupture is a full-thickness defect in the cornea, sclera, or both.1 It is an ophthalmologic emergency. Globe ruptures are almost always secondary to direct perforation via a penetrating mechanism; however, it can occur due to blunt injury if the force generated creates sufficient intraocular pressure to tear the sclera.2 Globes most commonly rupture at the insertions of the intraocular muscles or at the limbus. They are associated with a high rate of concomitant orbital floor fractures.2,3 Possible physical examination findings include a shallow anterior chamber on slit-lamp exam, hyphema, and an irregular “teardrop” pupil. Additionally, a positive Seidel sign, which is performed by instilling fluorescein in the eye and then examining for a dark stream of aqueous humor, is indicative of a globe rupture.4 CT is often used to assess for globe rupture; finds of a foreign body, intraocular air, abnormal contour or volume of the globe, or disruption of the sclera suggest globe rupture.2 The sensitivity of CT scan for diagnosis of globe rupture is only 75%; thus, high clinical

  17. Ruptured Spleen (United States)

    ... the left upper abdomen or the left lower chest, such as might happen during sporting mishaps, fistfights and car crashes. An injured spleen may rupture soon after the abdominal trauma or, in some cases, days or even weeks ...

  18. Tracheal rupture after misplacement of Sengstaken-Blakemore tube ...

    African Journals Online (AJOL)

    A 62-year-old man was admitted in our hospital's emergency room for hematemesis. He had a known history of alcoholic liver cirrhosis with severe esophagitis and ... The patient underwent surgery and the trachea was successfully repaired. The Sengstaken-Blakemore was withdrawn and esophagoscopy was performed ...

  19. Case Series Of Ruptured Jamaican Berry Aneurysms

    African Journals Online (AJOL)

    was predominant. There were no cerebro-vascular spasms postoperatively. Greek -- -- ANEURYSMA (Ana= up or across, eurys = wide or broad). Key Words: Subarachnoid Haemorrhage, Cerebro-Vascular Spasms. rupture spontaneously into the subarachnoid space, causing subarachnoid haemorrhage. Rupture could.


    African Journals Online (AJOL)



    Jan 5, 2009 ... Polytetrafluoroethylene has also been extensively studied as a material of choice for tracheal prosthesis. Thin-walled venous (Gore-. Tex) prosthesis, reinforced with rings (Trojan. ,. 1985), incorporating a microporous Teflon tracheal prosthesis in rabbits (Bottema. , 1986), ringed PTFE graft for dog's tracheal.

  1. Tracheal Sounds Acquisition Using Smartphones

    Directory of Open Access Journals (Sweden)

    Bersain A. Reyes


    Full Text Available Tracheal sounds have received a lot of attention for estimating ventilation parameters in a non-invasive way. The aim of this work was to examine the feasibility of extracting accurate airflow, and automating the detection of breath-phase onset and respiratory rates all directly from tracheal sounds acquired from an acoustic microphone connected to a smartphone. We employed the Samsung Galaxy S4 and iPhone 4s smartphones to acquire tracheal sounds from N = 9 healthy volunteers at airflows ranging from 0.5 to 2.5 L/s. We found that the amplitude of the smartphone-acquired sounds was highly correlated with the airflow from a spirometer, and similar to previously-published studies, we found that the increasing tracheal sounds’ amplitude as flow increases follows a power law relationship. Acquired tracheal sounds were used for breath-phase onset detection and their onsets differed by only 52 ± 51 ms (mean ± SD for Galaxy S4, and 51 ± 48 ms for iPhone 4s, when compared to those detected from the reference signal via the spirometer. Moreover, it was found that accurate respiratory rates (RR can be obtained from tracheal sounds. The correlation index, bias and limits of agreement were r2 = 0.9693, 0.11 (−1.41 to 1.63 breaths-per-minute (bpm for Galaxy S4, and r2 = 0.9672, 0.097 (–1.38 to 1.57 bpm for iPhone 4s, when compared to RR estimated from spirometry. Both smartphone devices performed similarly, as no statistically-significant differences were found.

  2. Management of a case of double aortic arch with tracheal compression complicated with postoperative tracheal restenosis

    Directory of Open Access Journals (Sweden)

    Hemang Gandhi


    Full Text Available Tracheal stenosis in association with the double aortic arch (DAA is uncommon; however, it carries a high risk of morbidity, mortality, and restenosis. Although surgery is the mainstay of managing a case of the DAA with tracheal stenosis, management of tracheal restenosis requires a multidisciplinary approach. In this case report, we present our successful experience in managing a child of DAA with tracheal stenosis who developed tracheal restenosis after sliding tracheoplasty of trachea.

  3. Menthol inhibiting parasympathetic function of tracheal smooth muscle. (United States)

    Wang, Hsing-Won; Liu, Shao-Cheng; Chao, Pin-Zhir; Lee, Fei-Peng


    Menthol is used as a constituent of food and drink, tobacco and cosmetics nowadays. This cold receptor agonist has been used as a nasal inhalation solution in the daily life. The effect of menthol on nasal mucosa in vivo is well known; however, the effect of the drug on tracheal smooth muscle has been rarely explored. Therefore, during administration of the drug for nasal symptoms, it might also affect the trachea via oral intake or inhalation. We used our preparation to test the effectiveness of menthol on isolated rat tracheal smooth muscle. A 5 mm long portion of rat trachea was submersed in 30 ml Krebs solution in a muscle bath at 37ºC. Changes in tracheal contractility in response to the application of a parasympathetic mimetic agent were measured using a transducer connected to a Pentium III computer equipped with polygraph software. The following assessments of menthol were performed: (1) effect on tracheal smooth muscle resting tension; (2) effect on contraction caused by 10 -6 M methacholine as a parasympathetic mimetic; (3) effect of the drug on electrically induced tracheal smooth muscle contractions. Results indicated that addition of a parasympathetic mimetic to the incubation medium caused the trachea to contract in a dose-dependent manner. Addition of menthol at doses of 10 -5 M or above elicited a relaxation response to 10 -6 M methacholine-induced contraction. Menthol could also inhibit electrical field stimulation (EFS) induced spike contraction. However, it alone had a minimal effect on the basal tension of trachea as the concentration increased. We concluded that the degree of drug-induced tracheal contraction or relaxation was dose-dependent. In addition, this study indicated that high concentrations of menthol might actually inhibit parasympathetic function of the trachea.

  4. Congenital Tracheal Stenosis in a Patient with Cleft Lip

    African Journals Online (AJOL)

    Cleft lip with or without cleft palate are the commonest craniofacial birth defects, and indeed, amongst the ... are no reports of Cleft lip/palate with tracheal stenosis in the literature. We present a case of a five month old .... and MRI of the chest are used to delineate anatomy, particularly detection of extrinsic causes of stenosis.

  5. Tracheal quadrifurcation associated with congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Bhat, Venkatraman; Gadabanahalli, Karthik; Ahmad, Ozaire [Narayana Multispeciality Hospital and Mazumdar Shaw Cancer Center, Department of Radiology, Bangalore (India)


    Tracheal anomalies are known in association with congenital cardiac defects. Some of the well-described anomalies include accessory (displaced) tracheal bronchus with variants, tracheal trifurcation and accessory cardiac bronchus. Here we describe a case of tracheal quadrifurcation associated with complex congenital heart disease. Illustration of complex airway anatomy was simplified by the use of multidetector CT using a variety of image display options. Awareness of this complex anomaly will expand our knowledge of tracheal anomalies and equip the anesthesia and surgical team for better airway management. (orig.)

  6. Micromechanical properties and collagen composition of ruptured human achilles tendon

    DEFF Research Database (Denmark)

    Hansen, Philip; Kovanen, Vuokko; Hölmich, Per


    The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive.......The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive....

  7. Novel Visceral-Anastomosis-First Approach in Open Repair of a Ruptured Type 2 Thoracoabdominal Aortic Aneurysm: Causes behind a Mortal Outcome

    Directory of Open Access Journals (Sweden)

    Einar Dregelid


    Full Text Available Case reports to analyze causes and possible prevention of complications in a new setting are important. We present an open repair of a ruptured type 2 thoracoabdominal aortic aneurysm in a 78-year-old man. Lower-body perfusion through a temporary extracorporeal axillobifemoral arterial prosthesis shunt was combined with the use of a branch to the permanent aortic prosthesis to enable rapid visceral revascularization using a visceral-anastomosis-first approach. The patient died due to transfusion-induced capillary leak syndrome and left colon necrosis; the latter was probably caused by a combination of back-bleeding from lumbar arteries causing a steal effect, an accidental shunt obstruction, and hemodynamic instability towards the end of the operation. The visceral-anastomosis-first approach did not contribute to the complications. This approach reduces the time when visceral organs are perfused only via collateral arteries to the time needed for suturing the visceral anastomoses. This may be important when collateral perfusion is marginal.

  8. Rupture of the ilio-psoas tendon after a total hip arthroplasty: an unusual cause of radio-lucency of the lesser trochanter simulating a malignancy

    Directory of Open Access Journals (Sweden)

    Pitcher J David


    Full Text Available Abstract Avulsion fracture or progressive radiolucency of lesser trochanter is considered a pathognomic finding in patients with malignancies. Although surgical release of the iliopsoas tendon may be required during a total hip arthroplasty (THA, there is no literature on spontaneous rupture of the ilio-psoas tendon after a THA causing significant functional impairment. We report here such a case, which developed progressive radiolucency of the lesser trochanter over six years after a THA, simulating a malignancy. The diagnosis was confirmed by MRI. Because of the chronic nature of the lesion, gross retraction of the tendon into the pelvis, and low demand of our patient, he was treated by physiotherapy and gait training. Injury to the ilio-psoas tendon can occur in various steps of the THA and extreme care should be taken to avoid this injury. Prevention during surgery is better, although there are no reports of repair in the THA setting. This condition should be considered in patients who present with progressive radioluceny of the lesser trochanter, especially in the setting of a hip/pelvic surgery. Awareness and earlier recognition of the signs and symptoms of this condition will aid in diagnosis and will direct appropriate management.

  9. Tracheal stoma necrosis: a case repor

    Directory of Open Access Journals (Sweden)

    Pak S


    Full Text Available Acute tracheal dilatation, due to an overinflated cuff, has been reported early in the course of mechanical ventilation through an endotracheal tube. Tracheal stoma necrosis is a rare complication, but such can accompany acute tracheal dilation. Herein, we report a case of tracheal necrosis 9 days following tracheostomy placement in a 71-year old woman associated with overinflation of the tracheal tube cuff. This case report aims to 1 add to the scant body of knowledge about the diagnosis and management for the patients with tracheal stoma necrosis and 2 raise awareness for error-traps in interpreting diagnostic images, specifically satisfaction of search error, inattentional blindness error, and alliterative error.

  10. Traumatic rupture of diaphragm. (United States)

    Shah, R; Sabanathan, S; Mearns, A J; Choudhury, A K


    Traumatic diaphragmatic rupture remains a diagnostic challenge, and associated injuries determine the outcome in those diagnosed early, whereas that of latent cases is dependent on the consequence of the diaphragmatic rupture: namely, the diaphragmatic hernia. To analyze the clinical and radiologic features and the therapeutic implications, we reviewed 980 patients reported in the English-language literature. This injury affects predominantly males (male:female = 4:1) in the third decade of life, and is often caused by blunt trauma (75%). There were 1,000 injuries, of which 685 (68.5%) were left-sided, 242 (24.2%) right-sided, 15 (1.5%) bilateral, and 9 (0.9%) pericardial ruptures; 49 cases were unclassified. Chest (43.9%) and splenic (37.6%) trauma were the most common associated injuries. The diagnosis was made preoperatively in 43.5% of cases, whereas in 41.3% it was made at exploration or at autopsy and on the remaining 14.6% of the cases the diagnosis was delayed. The mortality was 17% in those in whom acute diagnosis was made, and the majority of the morbidity in the group that underwent operation was due to pulmonary complications. Uniform diagnosis depends on a high index of suspicion, careful scrutiny of the chest roentgenogram in patients with thoracoabdominal or polytrauma, and meticulous inspection of the diaphragm when operating for concurrent injuries. Repeated evaluation for days after injury is necessary to discern injury in patients not requiring laparotomy. Acute diaphragmatic injuries are best approached through the abdomen, as more than 89% of patients with this injury have an associated intraabdominal injury. Patients with diaphragmatic rupture presenting in the latent phase have adhesion between the herniated abdominal and intrathoracic organs, and thus the rupture is best approached via a thoracotomy.

  11. Ruptured Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Jessica Andrusaitis


    Full Text Available History of present illness: A 69-year-old male with poorly controlled hypertension presented with 1 hour of severe low back pain that radiated to his abdomen. The patient was tachycardic and had an initial blood pressure of 70/40. He had a rigid and severely tender abdomen. The patient’s history of hypertension, abnormal vital signs, severity and location of his pain were suspicious for a ruptured abdominal aortic aneurysm (AAA. Therefore, a computed tomography angiogram (CTA was ordered. Significant findings: CTA demonstrated a ruptured 7.4 cm infrarenal abdominal aortic aneurysm with a large left retroperitoneal hematoma. Discussion: True abdominal aortic aneurysm is defined as at least a 3cm dilatation of all three layers of the arterial wall of the abdominal aorta.1 An estimated 15,000 people die per year in the US of this condition.2 Risk factors for AAA include males older than 65, tobacco use, and hypertension.1,3,4 There are also congenital, mechanical, traumatic, inflammatory, and infectious causes of AAA.3 Rupture is often the first manifestation of the disease. The classic triad of abdominal pain, pulsatile mass, and hypotension is seen in only 50% of ruptured AAAs.5 Pain (abdominal, groin, or back is the most common symptom. The most common misdiagnoses of ruptured AAAs are renal colic, diverticulitis, and gastrointestinal hemorrhage.6 Bedside ultrasonography is the fastest way to detect this condition and is nearly 100% sensitive.1 One study showed that bedside ultrasounds performed by emergency physicians had a sensitivity of .94 [95% CI = .86-1.0] and specificity of 1 [95% CI = .98-1.0] for detecting AAAs.7 CTA has excellent sensitivity (approximately 100% and yields the added benefit of facilitating surgical planning and management.1 Without surgical treatment, a ruptured AAA is almost uniformly fatal, and 50% of those who undergo surgery do not survive.1 Early resuscitation and coordination with vascular surgery should be

  12. Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study. (United States)

    Hu, Sining; Zhu, Yinchun; Zhang, Yingying; Dai, Jiannan; Li, Lulu; Dauerman, Harold; Soeda, Tsunenari; Wang, Zhao; Lee, Hang; Wang, Chao; Zhe, Chunyang; Wang, Yan; Zheng, Gonghui; Zhang, Shaosong; Jia, Haibo; Yu, Bo; Jang, Ik-Kyung


    Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied. We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion ( P erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1-year follow-up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events. Unfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  13. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P


    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  14. Estimating rupture distances without a rupture (United States)

    Thompson, Eric; Worden, Charles


    Most ground motion prediction equations (GMPEs) require distances that are defined relative to a rupture model, such as the distance to the surface projection of the rupture (RJB) or the closest distance to the rupture plane (RRUP). There are a number of situations in which GMPEs are used where it is either necessary or advantageous to derive rupture distances from point-source distance metrics, such as hypocentral (RHYP) or epicentral (REPI) distance. For ShakeMap, it is necessary to provide an estimate of the shaking levels for events without rupture models, and before rupture models are available for events that eventually do have rupture models. In probabilistic seismic hazard analysis, it is often convenient to use point-source distances for gridded seismicity sources, particularly if a preferred orientation is unknown. This avoids the computationally cumbersome task of computing rupture-based distances for virtual rupture planes across all strikes and dips for each source. We derive average rupture distances conditioned on REPI, magnitude, and (optionally) back azimuth, for a variety of assumed seismological constraints. Additionally, we derive adjustment factors for GMPE standard deviations that reflect the added uncertainty in the ground motion estimation when point-source distances are used to estimate rupture distances.

  15. Analysis of rupture area of aftershocks caused by twin earthquakes (Case study: 11 April 2012 earthquakes of Aceh-North Sumatra)

    Energy Technology Data Exchange (ETDEWEB)

    Diansari, Angga Vertika, E-mail:; Purwana, Ibnu; Subakti, Hendri [Academy of Meteorology and Geophysics, Jalan Perhubungan I no.5 Tangerang 15221 (Indonesia)


    The 11 April 2012 earthquakes off-shore Aceh-North Sumatra are unique events for the history of Indonesian earthquake. It is unique because that they have similar magnitude, 8.5 Mw and 8.1 Mw; close to epicenter distance, similar strike-slip focal mechanism, and occuring in outer rise area. The purposes of this research are: (1) comparing area of earthquakes base on models and that of calculation, (2) fitting the shape and the area of earthquake rupture zones, (3) analyzing the relationship between rupture area and magnitude of the earthquakes. Rupture area of the earthquake fault are determined by using 4 different formulas, i.e. Utsu and Seki (1954), Wells and Coppersmith (1994), Ellsworth (2003), and Christophersen and Smith (2000). The earthquakes aftershock parameters are taken from PGN (PusatGempabumiNasional or National Earthquake Information Center) of BMKG (Indonesia Agency Meteorology Climatology and Geophysics). The aftershock epicenters are plotted by GMT’s software. After that, ellipse and rectangular models of aftershock spreading are made. The results show that: (1) rupture areas were calculated using magnitude relationship which are larger than the the aftershock distributions model, (2) the best fitting model for that earthquake aftershock distribution is rectangular associated with Utsu and Seki (1954) formula, (3) the larger the magnitude of the earthquake, the larger area of the fault.

  16. Congenital Tracheal Stenosis in a Patient with Cleft Lip

    African Journals Online (AJOL)

    Congenital tracheal stenosis (CTS) is a rare condition characterised by different patterns of tracheal narrowing. The pathological hallmark is the presence of complete tracheal rings, with or without associated anomalies. We present a case of asymptomatic CTS in a patient with unilateral cleft lip. Tracheal stenosis was.

  17. Ultrasonographic evaluation of tracheal collapse in dogs (United States)

    Eom, Kidong; Moon, Kumjung; Seong, Yunsang; Oh, Taeho; Yi, Sungjoon; Lee, Keunwoo


    Tracheal ultrasonography was performed to measure the width of the tracheal ring shadow and to assess the clinical relevance of these measurements for identifying tracheal collapse. The first tracheal ring width (FTRW) and thoracic inlet tracheal ring width (TITRW) were measured on both expiration and inspiration. The mean of the FTRW width (129 dogs) was greater in expiration (10.97 ± 1.02 mm, p = 0.001) than that in inspiration (9.86 ± 1.03 mm). For 51 normal dogs, the mean of the TITRW width was greater in expiration (9.05 ± 1.52 mm, p = 0.001) than in inspiration (8.02 ± 1.43 mm). For 78 tracheal collapse dogs, the mean of the TITRW width was greater in expiration (15.89 ± 1.01 mm, p = 0.001) than in inspiration (14.85 ± 1.17 mm). The TITRW/FTRW ratio of the normal dogs was higher (p = 0.001) in expiration (0.81 ± 0.09) than that in inspiration (0.79 ± 0.10). When compared between the normal and tracheal collapse dogs, the TITRW/FTRW ratio was also increased (p = 0.001) both in expiration (1.54 ± 0.09) and inspiration (1.47 ± 0.08), respectively. Based on these results, the cutoff level of the TITRW/FTRW ratio was statistically analyzed according to the receiver operating characteristic curve and it could be set at 1.16 in expiration and at 1.13 in inspiration. We have demonstrated that tracheal ultrasonography is a useful technique for the evaluation of tracheal collapse and it can be a supportive tool together with the radiographic findings for making the correct diagnosis. PMID:19043316

  18. Functional optical imaging of tracheal health (Conference Presentation) (United States)

    Gil, Daniel A.; Sharick, Joe T.; Gamm, Ute A.; Choma, Michael A.; Skala, Melissa C.


    The health of the tracheal mucosa is an important, but poorly understood, aspect of critical care medicine. Many critical care patients are mechanically ventilated through an endotracheal tube that can cause local inflammation and blunt damage to the ciliated epithelial cells lining the trachea. These cilia clear mucus and infectious agents from the respiratory tract, so impaired ciliary function may lead to increased susceptibility to respiratory infection. Therefore, a minimally-invasive method to monitor mucosal health and ciliary function in intubated patients would be valuable to critical care medicine. Optical metabolic imaging (OMI) can quantitatively assess the metabolic state of cells by measuring the fluorescence intensities of endogenous metabolic co-enzymes NAD(P)H and FAD. OMI is especially attractive for assessing tracheal health because OMI is label-free, and ciliary function is tightly linked to the levels of NAD(P)H and FAD. In this study, we apply widefield OMI to ex vivo mouse tracheae (n=6), and demonstrate that the optical redox ratio (fluorescence intensity of NAD(P)H divided by the intensity of FAD) is sensitive to changes in the cellular metabolism of the tracheal mucosa. We observed a 46% increase in the redox ratio 20 minutes after treatment with 10mM of sodium cyanide (pcellular respiration. In addition to being a proof-of-concept demonstration, Pseudomonas aeruginosa, an important cause of morbidity and mortality in CF patients and in the ICU, produces hydrogen cyanide. Our results support the development of minimally-invasive fiber-optic probes for in vivo monitoring of tracheal health.

  19. Postanaesthetic tracheal strictures in three rabbits. (United States)

    Grint, N J; Sayers, I R; Cecchi, R; Harley, R; Day, M J


    Within an 11-day period, three rabbits were anaesthetized for neutering. All were endotracheally intubated with 12 cm long, 2.5 mm (inner diameter [ID]) polyvinylchloride (PVC) tubes. All rabbits developed clinical signs of dyspnoea and upper respiratory tract obstruction, 17-21 days later. One rabbit was found dead; the other two were treated, but one was euthanized and one died. At necropsy examination, focal chronic inflammation and significant localized narrowing of the tracheal lumen was found in all cases. The affected sites corresponded to the position of the bevel of the endotracheal tube (ETT) during anaesthesia. Histopathology could not differentiate between a traumatic or chemical cause for the narrowing. Possible causes include trauma by the bevel of the ETT when turning the rabbit or preparing the surgical site or a chemical burn from incorrect disinfection or inadequate rinsing of the tubes. Iatrogenic tracheitis should be considered as a cause of dyspnoea, when clinical signs arise 2-3 weeks after anaesthesia.

  20. Closing a Tracheal Defect with an Omental Pedicled Gastric Flap; A Technical Note (United States)

    Rupprecht, Holger; Ghidau, Marius; Gaab, Katharina


    Due to an adenocarcinoma of the right upper lobe with infiltration of the main bronchus a 49-years-old female patient underwent an upper bilobectomy with sleeve resection. After two completed chemotherapy bouts and signs of sepsis another thoracotomy was inevitable.  As a complicating factor a supracarinal, necrotic and perforating lesion of the trachea appeared. The defect can be initially repaired with a suture and covered with azygos vein material. However surgical revision showed an enlargement of the tracheal necrosis. Then the lesion was occluded with a diaphragmatic pedicled flap. Nevertheless after the operation a tracheal insufficiency with massive ventilation leakage was observed. It was generated by the death of the diaphragmatic flap. As an ultimate therapeutic measure a transplantation of a pedicled omental gastric flap was performed, which in case of a failure of the conventional operative techniques, is an additional option in closing tracheal defects caused by infections. Especially in cases of massive infected thoracic cavity and tracheal necrosis omentum majus is, compared to muscle flaps, the better biological tissue to close and heal the tracheal defect. This case report firstly describes a successfully closure of a tracheal defect using the technique mentioned above. PMID:28508001

  1. Risk factors for tracheal necrosis after total pharyngolaryngectomy. (United States)

    Fujiki, Masahide; Miyamoto, Shimpei; Sakuraba, Minoru; Nagamatsu, Shogo; Hayashi, Ryuichi


    Tracheal necrosis is a severe complication of total pharyngolaryngectomy (TPL). The purpose of this retrospective study was to identify risk factors for tracheal necrosis after TPL. We performed a retrospective chart review of 177 patients who had undergone TPL. The preoperative, operative, and postoperative variables were examined, and possible risk factors for tracheal necrosis were subjected to univariate analysis and multivariate logistic regression. Tracheal necrosis occurred in 35 patients (19.8%), and tracheoesophageal fistula subsequently developed in 3 of these patients. Multivariate logistic regression analysis identified total esophagectomy and diabetes mellitus as significant risk factors for tracheal necrosis after TPL. The findings of this study will be useful for assessing the risk of tracheal necrosis after TPL. In patients at high risk for tracheal necrosis, efforts should be made to preserve the tracheal circulation and to prevent life-threatening sequelae if tracheal necrosis occurs. © 2014 Wiley Periodicals, Inc.

  2. Splenic rupture masquerading ruptured ectopic pregnancy | Kigbu ...

    African Journals Online (AJOL)

    ... pallor, abdominal tenderness, shifting dullness with positive pregnancy test gave a clinical diagnosis of ruptured ectopic pregnancy. At laparotomy, an intrauterine gestation with normal tubes and ovaries with complete splenic rupture were found. She had total splenectomy. Highland Medical Research Journal Vol.

  3. Spontaneous Rupture of Pyometra

    Directory of Open Access Journals (Sweden)

    Fatemeh Mallah


    Full Text Available Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.

  4. Subchronic exposure to diisocyanates increases guinea pig tracheal smooth muscle responses to acetylcholine. (United States)

    Marek, W; Potthast, J; Marczynski, B; Mensing, T; Baur, X


    In order to study the threshold concentrations of isocyanates (IC) for induction of lung disorders, constrictive responses of tracheal smooth muscles to acetylcholine (ACH) in guinea pigs with and without diisocyanate [toluene diisocyanate (TDI), hexamethylene diisocyanate (HDI) and diphenylmethane diisocyanate (MDI)] exposure were investigated. An IC-induced increase in smooth muscle responsiveness was studied by measuring cumulative ACH dose responses (10(-10) to 10(-4) M ACH). Basal ACH dose-response curves, measured twice in intervals of 1 h using tracheal preparations of 11 guinea pigs previously not exposed to IC, were reproducible. Subchronic in vivo exposures to TDI, HDI, and MDI atmospheres of 10 and 20 parts per billion (ppb) on 5 consecutive days led to significantly (p < 0.05) increased ACH responsiveness of tracheal smooth muscle, whereas concentrations of 2.5 and 5 ppb were not effective. Exposure to HDI atmospheres of 10 ppb for 1, 2, 4, or 8 weeks resulted in a time-dependent increase in ACH responses (p < 0.05) of guinea pig tracheal smooth muscle. Increased tracheal muscle responses to ACH were transient since tracheal preparations from animals exposed to 10 and 20 ppb MDI for 4 weeks and with an exposure-free interval of 8 weeks before preparation did not show enlarged ACH responses, which were present in preparations at the end of the exposure period (p < 0.05). Exposure to low IC concentrations as present in workplaces cause increased ACH responsiveness of guinea pig tracheal smooth muscle. The increased responsiveness of the airways seems to be largely reversible, since normal responses were found after 8 weeks of IC avoidance. Reversibility of IC-induced airway hyperresponsiveness is of great occupational and preventive medical importance. Workers with acquired airway hyperresponsiveness might escape lung damage if the changes are detected in an early stage before alterations in lung function are in a chronic stage.

  5. Stent-induced tracheal stenosis can be predicted by IL-8 expression in rabbits. (United States)

    Arellano-Orden, Elena; Serrano, Carolina; Montes-Worboys, Ana; Sánchez-López, Verónica; Laborda, Alicia; Lostalé, Fernando; Lahuerta, Celia; Rodríguez-Panadero, Francisco; de Gregorio, Miguel Ángel


    Bare metal stents may cause complications like fibrous encapsulation, granulation and tracheal stenosis. We investigated the behaviour of three commercially available stents in vivo (rabbits) and in vitro (coculture of those stents with epithelial and fibroblast cell lines). Also, we investigated whether development of tracheal stenosis could be predicted by any biological marker. The tracheae of 30 rabbits were implanted with either nitinol stents, with or without paclitaxel elution, or a cobalt-based stent. An additional ten rabbits underwent mock implantation (controls). Serial peripheral venous blood samples were taken throughout the study, and several cytokines measured. Animals were euthanized on day 90, with immediate tracheal endoscopy and lavage performed, then necropsy. Rabbits with cobalt-based stent exhibited more inflammation and the highest stenosis incidence, with reduced survival. Both in vivo and in vitro, this stent induced higher IL-8 levels than nitinol stents. Most important, the presence of stent-induced tracheal stenosis was closely associated to increase in IL-8 expression in blood just 1 day after tracheal stent implantation: a 1·19-fold increase vs. baseline had 83% sensitivity, 83% specificity, 77% positive predictive value, 88% negative predictive value and 83% accuracy to predict development of stenosis. The cobalt-based stent had the highest incidence of tracheal inflammation and stenosis. On the other hand, the paclitaxel-eluting nitinol stent did not prevent those complications and provoked a marked reaction compared with the bare nitinol stent. Early increase in IL-8 expression in blood after stent implantation could predict development of tracheal stenosis in rabbits. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  6. Bladder Rupture and Urine Fistula Between-Bladder and Supracondylary Pin Tract After Pelvis Fracture: A Case Report

    National Research Council Canada - National Science Library

    Zekeriya Oztemur


    One of the most important complications of pelvic fractures is bladder rupture. Potential complications of pelvic fractures caused by bladder ruptures are vesicovaginal, vesicorectal, vesicouterine and urethrorectal fistulas...

  7. [Postero-internal menisco-capsular disinsertions associated with chronic instabilities of the knee caused by rupture of the anterior cruciate ligament]. (United States)

    Lemaire, M; Combelles, F; Miremad, C; Van Vooren, P


    Posterior menisco-capsular tears of the medial compartment of the knee can be considered as a complication of rupture of the anterior cruciate ligament and the consequent medial instability. The lesion is more a capsular lesion than a true meniscal one and it is related to an excessive stress on the oblique fibres of the ligament of Hughston attached to the meniscus. The diagnosis is based on arthrography made with meticulous technique. The lesion must be differentiated from true meniscal tears because it can be sutured. One hundred and twenty five such lesions have been operated on and reviewed after a follow-up of an average of two years. The technique must be very precise to prevent any secondary lesion due to surgery and to avoid any plaster cast immobilisation. The results have been satisfactory in 69 p. 100. They should be improved with more accurate surgical technique and with more precise indications.

  8. Effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation. (United States)

    Talakoub, Reihanak; Khodayari, Azita; Saghaei, Mahmood


    Pressor response to laryngoscopy and tracheal intubation includes rises in blood pressure and heart rate. This response may be harmful in the presence of cerebral or myocardial diseases. Although different preventive measures have been developed the choice of the agent or method has not been defined clearly. Hypocapnia is commonly used in anesthesia practice for different indications. It depresses the cardiovascular system and lowers the cardiac output. This study investigated the effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation in three groups of healthy adult patients with different levels of end tidal CO2. The blood pressure and heart rate were recorded during induction of general anesthesia before and after laryngoscopy and tracheal intubation. The pressor responses to laryngoscopy and tracheal intubation in hypocapnic and normocapnic groups were comparable. Moderate degrees of controlled hyperventilation caused relatively more fluctuation in blood pressure during induction of anesthesia. It can be concluded that controlled hyperventilation has no beneficial effect upon the pressor response to laryngoscopy and tracheal intubation.

  9. [A 2-month-old child with complex tracheal hypoplasia]. (United States)

    De Cloedt, L; Papadopoulos, J; Corouge, P; Khalil, T; Van Laer, P


    We describe the case of a 2-month-old child with complex tracheal hypoplasia with bilateral bronchial hypoplasia and left pulmonary hypoplasia. Tracheal hypoplasia is complex when it is associated with critical stenosis, cricoid stenosis, bronchial hypoplasia, tracheal bronchus, or esophageal atresia with severe tracheomalacia. Slide tracheoplasty is the gold standard treatment for the complex tracheal hypoplasia. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  10. Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter

    DEFF Research Database (Denmark)

    Sorensen, Jesper Roed; Lauridsen, Jeppe Faurholdt; Døssing, Helle


    Objective: A large goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign nodular goiter. Methods: Magnetic....... Conclusions: In patients with symptomatic benign nodular goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment....

  11. A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Directory of Open Access Journals (Sweden)

    Birkholz Torsten


    Full Text Available A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

  12. Post-intubation tracheal injury: report of three cases and literature review. (United States)

    Medina, Carlos Remolina; Camargo, José de Jesus; Felicetti, José Carlos; Machuca, Tiago Noguchi; Gomes, Bruno de Moraes; Melo, Iury Andrade


    Post-intubation tracheal injury is a rare and potentially fatal complication. Among the most common causes, cuff overinflation and repetitive attempts of orotracheal intubation in emergency situations are paramount. Diagnosis is based on clinical and radiological suspicion, confirmed by fiberoptic bronchoscopy. Both conservative and surgical management apply, and the decision-making process depends on the patient profile (comorbidities, respiratory stability), characteristics of the lesion (size and location) and the time elapsed between the occurrence of the injury and the diagnosis. We report the cases of three patients presenting tracheal laceration due to traumatic orotracheal intubation, two submitted to surgical treatment and one submitted to conservative treatment.

  13. Tracheal injury during extraction of an esophageal foreign body: Repair utilizing venovenous ECMO

    Directory of Open Access Journals (Sweden)

    Shunpei Okochi, MD


    Full Text Available Extracorporeal membrane oxygenation (ECMO is a form of life support with an ever-expanding range of indications. Veno-venous (VV ECMO is often utilized to support children with respiratory compromise, and has been employed successfully in the acute setting of traumatic tracheobronchial injury as well as during elective tracheal surgery. We present a successful case of VV ECMO used in the perioperative management of a tracheal repair for a traumatic laceration caused by attempts to retrieve an esophageal foreign body. While this mechanism of injury appears to be rare, we believe that VV-ECMO allowed for the optimal management of this child and should be considered for other extensive tracheal injuries in children.

  14. Fractal avalanche ruptures in biological membranes (United States)

    Gözen, Irep; Dommersnes, Paul; Czolkos, Ilja; Jesorka, Aldo; Lobovkina, Tatsiana; Orwar, Owe


    Bilayer membranes envelope cells as well as organelles, and constitute the most ubiquitous biological material found in all branches of the phylogenetic tree. Cell membrane rupture is an important biological process, and substantial rupture rates are found in skeletal and cardiac muscle cells under a mechanical load. Rupture can also be induced by processes such as cell death, and active cell membrane repair mechanisms are essential to preserve cell integrity. Pore formation in cell membranes is also at the heart of many biomedical applications such as in drug, gene and short interfering RNA delivery. Membrane rupture dynamics has been studied in bilayer vesicles under tensile stress, which consistently produce circular pores. We observed very different rupture mechanics in bilayer membranes spreading on solid supports: in one instance fingering instabilities were seen resulting in floral-like pores and in another, the rupture proceeded in a series of rapid avalanches causing fractal membrane fragmentation. The intermittent character of rupture evolution and the broad distribution in avalanche sizes is consistent with crackling-noise dynamics. Such noisy dynamics appear in fracture of solid disordered materials, in dislocation avalanches in plastic deformations and domain wall magnetization avalanches. We also observed similar fractal rupture mechanics in spreading cell membranes.

  15. Thyroidectomy improves tracheal anatomy and airflow in patients with nodular goiter. A prospective cohort study

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Lauridsen, Jeppe Killerich; Døssing, Helle

    Background: A large goiter may cause compression of the trachea and lead to respiratory insufficiency. We aimed at investigating the effects of thyroidectomy on tracheal anatomy and airflow in patients with benign nodular goiter, employing a prospective observational study. Methods: Magnetic...

  16. Thyroidectomy improves tracheal anatomy and airflow in patients with nodular goiter

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Lauridsen, Jeppe Killerich; Døssing, Helle

    Objectives: A large goiter may cause compression of the trachea and lead to respiratory insufficiency. We aimed at investigating the effects of thyroidectomy on tracheal anatomy and airflow in patients with benign nodular goiter, employing a prospective observational study. Methods: Magnetic...

  17. Characteristics of patients with spontaneous splenic rupture. (United States)

    Kocael, Pinar Cigdem; Simsek, Osman; Bilgin, Ismail Ahmet; Tutar, Onur; Saribeyoglu, Kaya; Pekmezci, Salih; Goksoy, Ertugrul


    In the present study, we aim to share our clinical experience in patients with spontaneous splenic rupture. Splenic rupture without trauma is known as spontaneous splenic rupture. The major problems in the management of spontaneous splenic rupture are missed or delayed diagnosis due to the lack of trauma in most cases. The records of all patients, who were admitted to Cerrahpaşa Medical Faculty, Istanbul University, were retrospectively reviewed from January 2000 to March 2013. Twelve patients were admitted to the emergency department and they were diagnosed with spontaneous splenic rupture. The mean age was 47.6 years. All patients had complaints of abdominal pain. The mean hematocrit value was 22%. Radiologic assessment revealed hemoperitoneum and/or subcapsular hematoma in 8 patients while splenic abscess was diagnosed in 2 patients. Eleven patients underwent splenectomy whereas one was managed conservatively. The most common cause of spontaneous splenic rupture was determined to be use of anticoagulants. Etiology was considered to be idiopathic in 1 patient. Two patients died in the postoperative period. Although rare, spontaneous splenic rupture must be suspected in emergency patients who have used especially anticoagulants and antiaggregants and who have had no recent history of trauma. One of the important causes of mortality is missed or delayed diagnosis.

  18. Spontaneous Splenic Rupture in Melanoma

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    Hadi Mirfazaelian


    Full Text Available Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

  19. Thermoforming of tracheal cartilage: viability, shape change, and mechanical behavior. (United States)

    Chae, Yongseok; Protsenko, Dmitriy; Holden, Paul K; Chlebicki, Cara; Wong, Brian J F


    Trauma, emergent tracheostomy, and prolonged intubation are common causes of severe deformation and narrowing of the trachea. Laser technology may be used to reshape tracheal cartilage using minimally invasive methods. The objectives of this study were to determine: (1) the dependence of tracheal cartilage shape change on temperature and laser dosimetry using heated saline bath immersion and laser irradiation, respectively, (2) the effect of temperature on the mechanical behavior of cartilage, and (3) tissue viability as a function of laser dosimetry. Ex vivo rabbit trachea cartilage specimens were bent and secured around a cylinder (6 mm), and then immersed in a saline bath (45 and 72 degrees C) for 5-100 seconds. In separate experiments, tracheal specimens were irradiated with a diode laser (lambda = 1.45 microm, 220-400 J/cm(2)). Mechanical analysis was then used to determine the elastic modulus in tension after irradiation. Fluorescent viability assays combined with laser scanning confocal microscopy (LSCM) were employed to image and identify thermal injury regions. Shape change transition zones, between 62 and 66 degrees C in the saline heating bath and above power densities of 350 J/cm(2) (peak temperatures 65+/-10 degrees C) for laser irradiation were identified. Above these zones, the elastic moduli were higher (8.2+/-4 MPa) than at lower temperatures (4.5+/-3 MPa). LSCM identified significant loss of viable chondrocytes within the laser-irradiation zones. Our results indicate a change in mechanical properties occurs with laser irradiation and further demonstrates that significant thermal damage is concurrent with clinically relevant shape change in the elastic cartilage tissues of the rabbit trachea using the present laser and dosimetry parameters. (c) 2008 Wiley-Liss, Inc.

  20. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture (United States)

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila


    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  1. Les stenoses tracheales acquises: Experiencede l ...

    African Journals Online (AJOL)

    Dyspnea and dysphonia were the major functional symptoms. Initial endoscopy showed a double tracheal stenosis in one case. ... endoscopy represents now a major alternative in their management. Nevertheless, prevention should be considered, given that most stenoses are iatrogenic due to traumatic or prolonged

  2. Chorioamnionitis caused by Serratia marcescens in a healthy pregnant woman with preterm premature rupture of membranes: A rare case report and review of the literature. (United States)

    Erenberg, Miriam; Yagel, Yael; Press, Fernanda; Weintraub, Adi Y


    The incidence of chorioamnionitis varies widely. The highest incidence is reported in preterm deliveries. Among preterm deliveries, chorioamnionitis usually occurs after preterm premature rupture of membranes (PPROM). To date, only five cases of chorioamnionitis due to Serratia marcescens were reported. Here we present a case of a pregnant woman with chorioamnionitis due to Serratia marcescens who delivered a premature neonate at 28 weeks and four days of gestation. We also conducted a review of the literature in order to identify and characterize the clinical presentation and outcomes of this rare infection. A 36 year old female (gravida 9, para 6) was admitted with cervical effacement of 16mm and intact membranes at gestational age of 25 weeks and five days. One week following her admission PPROM was noticed. Treatment with the standard antibiotic regimen for PPROM was initiated. Thirteen days after the diagnosis of PPROM (28 weeks and four days) she developed chills, abdominal pain, sub febrile fever, tachycardia, leukocytosis and fetal tachycardia, and a clinical diagnosis of chorioamnionitis was made. An urgent CS was performed. In the first post-operative day the patient developed surgical sight infection. Cultures obtained from the purulent discharge of the wound, as well as cultures from the placenta and uterine cavity that were obtained during surgery grew Serratia marcescens. The patient was treated with Meropenem for six days, with a good clinical response. We present a rare case of nosocomialy acquired Serratia marcescens chorioamnionitis in a patient with PPROM. This case emphasizes the need for good infection control measures. Our favorable outcome together with the scares reports in the literature, add insight into this type of rare infection. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Intubação traqueal Tracheal intubation

    Directory of Open Access Journals (Sweden)

    Toshio Matsumoto


    keywords intubation, tracheal intubation, child, rapid sequence intubation and pediatric airway. SUMMARY OF THE FINDINGS: Airway management in children is related to their physiology and anatomy, in addition to specific factors (inherent pathological conditions, such as malformations or acquired conditions which have a decisive influence on success. Principal indications are in order to maintain the airway patent and to control ventilation. Laryngoscopy and tracheal intubation cause cardiovascular alterations and affect airway reactivity. The use of tubes with cuffs is not prohibited, as long as the correct size for the child is chosen. A difficult airway can be identified against the Mallampati scale and by direct laryngoscopy. Rapid sequence intubation is being recommended more and more often in pediatrics, since it facilitates the procedure and presents fewer complications. Tracheal intubation should be carried out in an adequate manner in special circumstances (eaten recently, neurological dysfunction, unstable spinal column, upper airway obstruction, laryngotracheal injuries, injuries to the eyeball. Extubation should be meticulously planned, since there is chance of failure and a need for reintubation. CONCLUSIONS: Tracheal intubation of children requires knowledge, skill and experience, since, if the procedure is carried out by inexperienced pediatricians, it can result in life-threatening complications.

  4. Viscoelastic Properties of Human Tracheal Tissues. (United States)

    Safshekan, Farzaneh; Tafazzoli-Shadpour, Mohammad; Abdouss, Majid; Shadmehr, Mohammad B


    The physiological performance of trachea is highly dependent on its mechanical behavior, and therefore, the mechanical properties of its components. Mechanical characterization of trachea is key to succeed in new treatments such as tissue engineering, which requires the utilization of scaffolds which are mechanically compatible with the native human trachea. In this study, after isolating human trachea samples from brain-dead cases and proper storage, we assessed the viscoelastic properties of tracheal cartilage, smooth muscle, and connective tissue based on stress relaxation tests (at 5% and 10% strains for cartilage and 20%, 30%, and 40% for smooth muscle and connective tissue). After investigation of viscoelastic linearity, constitutive models including Prony series for linear viscoelasticity and quasi-linear viscoelastic, modified superposition, and Schapery models for nonlinear viscoelasticity were fitted to the experimental data to find the best model for each tissue. We also investigated the effect of age on the viscoelastic behavior of tracheal tissues. Based on the results, all three tissues exhibited a (nonsignificant) decrease in relaxation rate with increasing the strain, indicating viscoelastic nonlinearity which was most evident for cartilage and with the least effect for connective tissue. The three-term Prony model was selected for describing the linear viscoelasticity. Among different models, the modified superposition model was best able to capture the relaxation behavior of the three tracheal components. We observed a general (but not significant) stiffening of tracheal cartilage and connective tissue with aging. No change in the stress relaxation percentage with aging was observed. The results of this study may be useful in the design and fabrication of tracheal tissue engineering scaffolds.

  5. The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture

    Directory of Open Access Journals (Sweden)

    Ju-Hee Park


    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

  6. Premature rupture of membranes (United States)

    ... this page: // Premature rupture of membranes To use the sharing features on this page, ... When the water breaks early, it is called premature rupture of membranes (PROM). Most women will go into labor on ...

  7. ACL Rupture in Collegiate Wrestler

    Directory of Open Access Journals (Sweden)

    Lindsay A. Palmer


    ACL and hamstring. After completing five months of physical therapy, the patient joined a college wrestling team in August 2013. The athletic training staff at the university started him on a quadriceps and hamstring strengthening rehabilitation program for about one month. The staff also worked on continuous flexion and extension of the knee to where the patient could feel comfortable with doing activities with his knee. The patient continues to participate in daily stretching and strengthening protocols for his quadriceps and hamstring bilaterally. Deviation from the Expected/Uniqueness: The patient still participated on a fully ruptured ACL for seven months with just complaining of minimal pain and discomfort. The athlete chose to complete two seasons of activities instead of receiving surgery immediately. The ratio of people who rupture their ACL is about 5 in every 100,000 people. It is interesting that the high school clinician could not diagnose the injury until the patient received an MRI two months post-injury. The patient was also told by doctors that he only uses about 50% of his ACL on a daily basis compared to anyone else who uses their ACL about 95%. The patient felt comfortable with the ACL ruptured and changed any discomfort by just wearing a brace. Conclusions: Not many people can play on a ruptured ACL for seven months before receiving any surgical repairs. We need to keep this in mind as Athletic Trainers so we are not sending our athletes back on the field and possibly causing them more damage. The athlete continues stretching protocols daily.

  8. Computed tomographic imaging of dogs with primary laryngeal or tracheal airway obstruction. (United States)

    Stadler, Krystina; Hartman, Susan; Matheson, Jodi; O'Brien, Robert


    Seventeen dogs with clinical signs attributable to nonneoplastic obstruction of the larynx, trachea, or large bronchi underwent computed tomography (CT) imaging. In 16 of the 17 dogs, CT was performed without general anesthesia using a positioning device. Fifteen of these 16 dogs were imaged without sedation or general anesthesia. Three-dimensional (3D) internal rendering was performed on each image set based on lesion localization determined by routine image planes. Visual laryngeal examination, endoscopy, video fluoroscopy, and necropsy were used for achieving the cause of the upper airway obstruction. The CT and 3D internal rendering accurately indicated the presence and cause of upper airway obstruction in all dogs. CT findings indicative of laryngeal paralysis included failure to abduct the arytenoid cartilages, narrowed rima glottis, and air-filled laryngeal ventricles. Laryngeal collapse findings depended on the grade of collapse and included everted laryngeal saccules, collapse of the cuneiform processes and corniculate processes, and narrowed rima glottis. Trachea abnormalities included hypoplasia, stenosis, or collapse syndrome. The CT findings in tracheal hypoplasia consisted of a severely narrowed lumen throughout the entire length. Tracheal stenosis was represented by a circumferential decrease in tracheal lumen size limited to one region. Tracheal collapse syndrome was diagnosed by severe asymmetric narrowing. Lobar bronchi collapse appeared in CT images as a narrowed asymmetric lumen diameter. CT imaging of unanesthetized dogs with upper airway obstruction compares favorably with traditional definitive diagnostic methods. © 2011 Veterinary Radiology & Ultrasound.

  9. Neuropeptides degranulate serous cells of ferret tracheal glands

    Energy Technology Data Exchange (ETDEWEB)

    Gashi, A.A.; Borson, D.B.; Finkbeiner, W.E.; Nadel, J.A.; Basbaum, C.B.


    To determine whether serous or mucous cells in tracheal submucosal glands respond to the neuropeptides substance P (SP) and vasoactive intestinal peptide (VIP). The authors studied the peptide-induced changes in gland cell morphology accompanying release of TVSO4-labeled macromolecules from tracheal explants of ferrets. Explants were labeled for 1 h in medium containing TVSO4 and washed for 3.5 additional hours. Base-line secretion in the absence of drugs declined between 1.5 and 3.5 h after the pulse. Between 2.5 and 3.5 h, the average percent change in counts per minute recovered per sample period was not significantly different from zero. Substance P and VIP added 4 h after labeling each increased greatly the release of TVSO4-labeled macromolecules above base line. Bethanechol, a muscarinic-cholinergic agonist, increased secretion by an average of 142% above base line. Light and electron microscopy of the control tissues showed glands with narrow lumens and numerous secretory granules. Glands treated with SP or VIP had enlarged lumens and the serous cells were markedly degranulated. These phenomena were documented by morphometry and suggest that SP and VIP cause secretion from glands at least partially by stimulating exocytosis from serous cells.

  10. [Tracheal deformity observed in tracheostomized Duchenne muscular dystrophy patients who can speak with appropriately inflated cuff of tracheal tube]. (United States)

    Shinoe, T; Kawai, M


    Respiratory failure occurring during late adolescence is a major cause of death in Duchenne muscular dystrophy (DMD). A number of respiratory assistance techniques including tracheostomy and positive pressure mechanical ventilation have been utilized not only to prolong DMD patients' life but also to improve quality of their life. It is surprising that most of the tracheostomized DMD patients can speak under positive pressure ventilatory assistance. Preserved functions of glosso-pharyngo-laryngeal muscles in these patients presumably make it possible to control the air leak around tracheal tube, which does not necessitate tight inflation of the tube cuff. Recently we noticed that some patients are still able to speak even when the cuff is fully inflated. In order to understand the mechanism of this phenomenon, we visualized the topographical relationship between trachea and the tube cuff using computed tomography by filling the cuff with aqueous contrast medium. We obtained following findings: 1) Trachea is flat and deviated from normal midline position, and 2) the tube cuff is located eccentrically in trachea resulting in compression of one side of the inner wall and leaving open space on the other side. We conclude that the tracheal malposition and deformity underlie this strange phenomenon and tight inflation of the cuff to prevent air leak may result in unfavorable complications in DMD patients.

  11. Rupture uterus-eight year retrospective analysis. of

    African Journals Online (AJOL)

    Rupture uterus-eight year retrospective analysis. of causes an :11anagement outcome in Adigrat. Hospital, Tigray egion, Ethiopia. Amanael Gessessewl, Menpiste M Melese2. D. Abstract. Background: Ruptured uterus is a common cause of maternal and perinatal mortality and morbidity. Further studies may help in the ...

  12. Ruptured Hydatid Cyst with an Unusual Presentation

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    Deepak Puri


    Full Text Available Ruptured pulmonary hydatid cyst may sometimes cause complications like empyema, bronchopleural fistula, and collapsed lung. These complications may mislead the diagnosis and treatment if prior evidence of cyst has not been documented before rupture. We present a case of a young male who presented with complete collapse of left lung with pyopneumothorax and bronchopleural fistula which was misdiagnosed as pulmonary tuberculosis. He was referred to us from peripheral hospital for pneumonectomy when his condition did not improve after six months of antitubercular chemotherapy and intercostals drainage. On investigation, CT scan revealed significant pleural thickening and massive pneumothorax restricting lung expansion. Decortication of thickened parietal and visceral pleura revealed a ruptured hydatid endocyst, and repair of leaking bronchial openings in floor of probable site of rupture in left upper lobe helped in the complete expansion of the collapsed lung followed by uneventful recovery.

  13. Medical image of the week: tracheal perforation

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    Parsa N


    Full Text Available A 45 year old Caucasian man with a history of HIV/AIDS was admitted for septic shock secondary to right lower lobe community acquired pneumonia. The patient’s respiratory status continued to decline requiring emergency intubation in a non-ICU setting. Four laryngoscope intubation attempts were made including an inadvertent esophageal intubation. Subsequent CT imaging revealed a tracheal defect (Figure 1, red arrow with communication to the mediastinum and air around the trachea consistent with pneumomediastinum (Figure 2, orange arrow and figure 3, yellow arrow. Pneumopericardium (figure 4, blue arrow was also evident post-intubation. The patient’s hemodynamic status remained stable. Two days following respiratory intubation subsequent chest imaging revealed resolution of the pneumomediastinum and pneumopericardium and patient continued to do well without hemodynamic compromise or presence of subcutaneous emphysema. Post-intubation tracheal perforation is a rare complication of traumatic intubation and may be managed with surgical intervention or conservative treatment (1.

  14. Relaxing action of adrenergic β2-agonists on guinea-pig skinned tracheal muscle

    Directory of Open Access Journals (Sweden)

    Kayo Nemoto


    Full Text Available Although adrenergic β2-agonist-induced smooth muscle relaxation has been attributed to increased intracellular cyclic AMP (cAMP, a relaxation response has been observed at low β2-agonist concentrations that do not cause increased cAMP To elucidate the mechanism of tracheal muscle relaxation induced by low concentrations of β2-agonists, we used a guinea-pig skinned tracheal smooth muscle preparation to examine the effects on the contractile protein system. The isotonic contraction of β-escin-treated skinned tracheal muscle from guinea-pig was measured. When the intracellular Ca2+ concentration was maintained at 1 μmol/L in the presence of guanosine 5′-triphosphate (GTP; 100 μmol/L, neither isoproterenol (10nmol/L nor salbutamol (60 nmol/L affected Ca2+ sensitivity, but a significant decrease in Ca2+ sensitivity was observed in the presence of okadaic acid (1 μmol/L. The decrease in Ca2+ sensitivity was a slow response and was blocked by pretreatment with propranolol (1 μmol/L. Forskolin (1 μmol/L did not affect Ca2+ sensitivity. These results suggest that adrenergic b 2-agonists may activate protein phosphatase through an unknown pathway involving the β2-receptor, which enhances dephosphorylation of the myosin light chain and/or thin filament proteins, resulting in relaxation of the tracheal smooth muscle.

  15. Achilles Tendon Rupture (United States)

    ... Achilles tendon rupture. Obesity. Excess weight puts more strain on the tendon. Prevention To reduce your chance of developing Achilles tendon problems, follow these tips: Stretch and strengthen calf muscles. Stretch your calf until you feel a noticeable ...

  16. Chronic Achilles Tendon Rupture (United States)

    Maffulli, Nicola; Via, Alessio Giai; Oliva, Francesco


    Background: The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries. Methods: This is a review article about diagnosis and management of chronic Achilles tendon ruptures. Minimally invasive Achilles tendon reconstruction is discussed. Results: The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results. Conclusion: The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate. PMID:29081863

  17. Gene therapy of c-myc suppressor FUSE-binding protein-interacting repressor by Sendai virus delivery prevents tracheal stenosis.

    Directory of Open Access Journals (Sweden)

    Daisuke Mizokami

    Full Text Available Acquired tracheal stenosis remains a challenging problem for otolaryngologists. The objective of this study was to determine whether the Sendai virus (SeV-mediated c-myc suppressor, a far upstream element (FUSE-binding protein (FBP-interacting repressor (FIR, modulates wound healing of the airway mucosa, and whether it prevents tracheal stenosis in an animal model of induced mucosal injury. A fusion gene-deleted, non-transmissible SeV vector encoding FIR (FIR-SeV/ΔF was prepared. Rats with scraped airway mucosae were administered FIR-SeV/ΔF through the tracheostoma. The pathological changes in the airway mucosa and in the tracheal lumen were assessed five days after scraping. Untreated animals showed hyperplasia of the airway epithelium and a thickened submucosal layer with extensive fibrosis, angiogenesis, and collagen deposition causing lumen stenosis. By contrast, the administration of FIR-SeV/ΔF decreased the degree of tracheal stenosis (P < 0.05 and improved the survival rate (P < 0.05. Immunohistochemical staining showed that c-Myc expression was downregulated in the tracheal basal cells of the FIR-SeV/ΔF-treated animals, suggesting that c-myc was suppressed by FIR-SeV/ΔF in the regenerating airway epithelium of the injured tracheal mucosa. The airway-targeted gene therapy of the c-myc suppressor FIR, using a recombinant SeV vector, prevented tracheal stenosis in a rat model of airway mucosal injury.

  18. Surgical resection of a primary tracheal fibrosarcoma in a dog. (United States)

    Mahler, S P; Mootoo, N F A; Reece, J L M; Cooper, J E


    A four-year-old, entire male Rottweiler was presented with a history of respiratory distress. A tracheal mass was diagnosed on thoracic radiographs and tracheoscopy. Surgical excision of three tracheal rings incorporating the tumour was performed. The mass was found to be a low-grade fibrosarcoma. Twenty-four months later, the owner reported that there was no recurrence of respiratory distress and the dog appeared to be doing well clinically. This case of primary tracheal fibrosarcoma suggests that this type of tumour should be listed in the differential diagnoses for tracheal neoplasia in dogs and that surgical treatment alone may be curative.

  19. Spontaneous Achilles tendon rupture in alkaptonuria (United States)

    Alajoulin, Omar A.; Alsbou, Mohammed S.; Ja’afreh, Somayya O.; Kalbouneh, Heba M.


    Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations. PMID:26620992

  20. Analysis of 42 patients who underwent tracheal resection

    Directory of Open Access Journals (Sweden)

    Gönül Sağıroğlu


    Full Text Available Objectives: We aimed to analyze the etiology, diagnostic and surgical methods, complications and mortality of the patients who underwent tracheal resection for tracheal stenosis.Materials and methods: Between January 2006 and January 2010, 42 patients who underwent tracheal resection and reconstruction was retrospectively analyzed in terms of age, sex, co-morbid disease, etiology of tracheal stenosis, symptoms, the location of stenosis, surgical approach, incision techniques, length of resected segment, types of different suture materials, length of anesthesia and surgery, the ratio of prolonged intubation, morbidities and mortality ratios were analyzed.Results: There were 26 men and 16 female with the mean age was 48 (9-79 years. The etiology was tracheal stenos in 30 patients, tracheal tumor in 10 patients, trauma and congenital tracheal stenos in one each. Symptoms were dispnea, cough, stridor and hemoptysis. Surgical technique was performed through cervical incision (n=36 and cervical incision plus partial sternotomy (n=4 in patients with high tracheal stenosis where the stenosis is lower then complete sternotomy was performed. The mean tracheal segmental resection was 4.1 cm (2-5.2 cm. The morbidities were respiratory insufficiency, secretion retention and atelectasis, pneumonia, sepsis and tracheal re-stenosis. The postoperative mortality was seen in 4 (%9.5 patients.Conclusion: The most important issue leading to complication during tracheal surgery is the ventilation and aspiration towards bronchus. The intense collaboration between surgeon, anesthesiologist and intensive care physician is a necessity in order to reduce complication rates and mortality.


    Directory of Open Access Journals (Sweden)



    Full Text Available The membranes surrounding the amniotic cavity are composed from amnion and chorion, tightly adherent layers which are composed of several cell types, including epithelial cells, trophoblasts cells and mesenchyme cells, embedded in a collagenous matrix. They retain amniotic fluid, secret substances into the amniotic fluid, as well as to the uterus and protect the fetus against upward infections from urogenital tract. Normally, the membranes it breaks during labor. Premature rupture of the amniotic sac (PRAS is defined as rupture of membranes before the onset of labor. Premature rupture of the fetal membrane, which occurs before 37 weeks of gestation, usually, refers to preterm premature rupture of membranes. Despite advances in the care period, premature rupture of membranes and premature rupture of membranes preterm continue to be regarded as serious obstetric complications. On the term 8% - 10% of pregnant women have premature rupture of membranes; these women are at increased risk of intrauterine infections, where the interval between membrane rupture and expulsion is rolled-over. Premature rupture of membranes preterm occurs in approximately 1% of all pregnancies and is associated with 30% -40% of preterm births. Thus, it is important to identify the cause of pre-term birth (after less than 37 completed weeks of "gestation" and its complications, including respiratory distress syndrome, neonatal infection and intraventricular hemorrhage. Objectives: the development of the protocol of the clinical trial on patients with impending preterm birth, study clinical and statistical on the socio-demographic characteristics of patients with imminent preterm birth; clinical condition of patients and selection of cases that could benefit from the application of interventional therapy; preclinical investigation (biological and imaging of patients with imminent preterm birth; the modality therapy; clinical investigation of the effectiveness of short

  2. Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Erdoğan Çetinkaya


    Full Text Available Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp. are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved.

  3. Ruptured Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Valentina Park


    Full Text Available History of present illness: A 21-year-old female presented with sudden onset suprapubic abdominal pain associated with dysuria. The patient also experienced near syncope during bowel movements three times three days ago without falling or losing consciousness. She denied fever, nausea, and vomiting. She stated that she was five weeks pregnant by last menstrual period. She had an ultrasound a few weeks before that showed no intrauterine pregnancy, but she had not followed up for additional testing. Significant findings: The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00. A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10. Discussion: Ectopic pregnancies are a leading cause of maternal morbidity and mortality, as well as decreased fertility.1,2 Differentiating between an ectopic pregnancy and a normal early pregnancy may be difficult, since ultrasound and quantitative beta-hCG may show inconclusive results.3,4 Patients who have used fertility treatment may further complicate the picture because they are at risk for heterotypic pregnancies.5 Ectopic pregnancies most commonly implant in the fallopian tube, but may alternatively implant in the ovary, cervix, abdomen, or uterine cornua.4 Ultrasonography may show an empty uterus, adnexal mass, pelvic free fluid, or an extra-uterine gestational sac, yolk sac, and/or embryo.6 Treatment options for ectopic pregnancy include surgery or methotrexate.2,4 Some patients may be candidates for close outpatient surveillance if the diagnosis is unclear or in very limited cases for early, non-ruptured ectopic pregnancies.2,4

  4. Tracheal bronchus and pulmonary, hepatic and renal vascular ...

    African Journals Online (AJOL)

    CASE REPORT. SAJR June 2013 Vol. 17 No. 2 59. We present a case of a symptomatic 5-month-old girl who had a type II right-sided tracheal bronchus on computed tomography (CT), which was later confirmed on bronchography. Tracheal bronchus is a rare tracheobronchial anomaly where an ectopic bronchus arises ...


    NARCIS (Netherlands)


    A case is reported in which qualitatively, grossly abnormal fetal breathing movements turned out to be indicative of complete tracheal atresia. Fetal breathing movements were vigorous and jerky and of large amplitude; similarly abnormal movements were observed after birth. At postmortem tracheal

  6. Access to the tracheal pulmonary pathway in small rodents

    Directory of Open Access Journals (Sweden)

    Roberto S. A. Ribeiro


    Full Text Available ABSTRACT The tracheal pulmonary route is used in diverse experimental models for the study of drugs, infectious agents, and diseases. In view of its importance and associated difficulties, the present article proposes to give research groups up-to-date information on techniques to access the tracheal pulmonary pathway of small rodents.

  7. Haemodynamic response to laryngoscopy with and without tracheal ...

    African Journals Online (AJOL)

    Haemodynamic response to laryngoscopy with and without tracheal intubation. P Smith, F.J Smith, P.J Becker. Abstract. Introduction Tracheal intubation is accompanied by an increased blood pressure and heart rate. The aim of this study was to find the most important source of this haemodynamic response, namely ...

  8. Synchrotron imaging of the grasshopper tracheal system : morphological and physiological components of tracheal hypermetry.

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    Greenlee, K. J.; Henry, J. R.; Kirkton, S. D.; Westneat, M. W.; Fezzaa, K.; Lee, W.; Harrison, J. F.; North Dakota State Univ.; Arizona State Univ.; Union Coll.; Field Museum of Natural History


    As grasshoppers increase in size during ontogeny, they have mass specifically greater whole body tracheal and tidal volumes and ventilation than predicted by an isometric relationship with body mass and body volume. However, the morphological and physiological bases to this respiratory hypermetry are unknown. In this study, we use synchrotron imaging to demonstrate that tracheal hypermetry in developing grasshoppers (Schistocerca americana) is due to increases in air sacs and tracheae and occurs in all three body segments, providing evidence against the hypothesis that hypermetry is due to gaining flight ability. We also assessed the scaling of air sac structure and function by assessing volume changes of focal abdominal air sacs. Ventilatory frequencies increased in larger animals during hypoxia (5% O{sub 2}) but did not scale in normoxia. For grasshoppers in normoxia, inflated and deflated air sac volumes and ventilation scaled hypermetrically. During hypoxia (5% O{sub 2}), many grasshoppers compressed air sacs nearly completely regardless of body size, and air sac volumes scaled isometrically. Together, these results demonstrate that whole body tracheal hypermetry and enhanced ventilation in larger/older grasshoppers are primarily due to proportionally larger air sacs and higher ventilation frequencies in larger animals during hypoxia. Prior studies showed reduced whole body tracheal volumes and tidal volume in late-stage grasshoppers, suggesting that tissue growth compresses air sacs. In contrast, we found that inflated volumes, percent volume changes, and ventilation were identical in abdominal air sacs of late-stage fifth instar and early-stage animals, suggesting that decreasing volume of the tracheal system later in the instar occurs in other body regions that have harder exoskeleton.

  9. Tracheal agenesis: A report of two cases

    Directory of Open Access Journals (Sweden)

    A V Desai


    Full Text Available Tracheal agenesis is an extremely rare congenital anomaly involving the respiratory system. It is generally associated with anomalies of other systems. Antenatal diagnosis of this condition is difficult; therefore, it presents as a medical emergency in the labor room. Intubation in these babies is difficult. As many of these babies are born prematurely, respiratory distress syndrome (RDS adds to the management difficulties. Here, we describe two babies with this lethal anomaly and RDS where esophageal intubation and surfactant therapy proved beneficial. Furthermore, described are other associated anomalies.

  10. Traumatic rupture of the diaphragm | Jamabo | Sahel Medical Journal

    African Journals Online (AJOL)

    Those treated for traumatic rupture of the diaphragm were selected and analyzed for age, gender, cause of injury, associated injuries sustained and mode of treatment. ... There were associated injuries in all cases and they involved the spleen, rib fractures, liver and lungs. ... Keywords: blunt trauma, diaphragmatic rupture

  11. Antibiotics after preterm premature rupture of the membranes. (United States)

    Singh, Katherine; Mercer, Brian


    Preterm premature rupture of the membranes remains a common cause of preterm deliveries and neonatal morbidities. The goal of this study is to review the evidence with regard to the antibiotic treatment after preterm premature rupture of the membranes, long-term outcomes related to antibiotic treatment, and possible complications with treatment. Future research goals are also discussed.

  12. Animal models for plaque rupture: a biomechanical assessment

    NARCIS (Netherlands)

    van der Heiden, Kim; Hoogendoorn, Ayla; Daemen, Mat J.; Gijsen, Frank J. H.


    Rupture of atherosclerotic plaques is the main cause of acute cardiovascular events. Animal models of plaque rupture are rare but essential for testing new imaging modalities to enable diagnosis of the patient at risk. Moreover, they enable the design of new treatment strategies to prevent plaque

  13. Postinfarction left ventricular free wall rupture repaired successfully. (United States)

    Tireli, Emin; Kalko, Yusuf; Kafali, Eylül; Basaran, Murat


    Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and a frequent cause of death. A 49-year-old man was successfully treated for a left ventricular free wall rupture that occurred on the third day after an anterior myocardial infarction. Concomitant myocardial revascularization was performed.

  14. Spontaneous Pre-Labour Rupture of Membranes at Term ...

    African Journals Online (AJOL)

    BACKGROUND: Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery. OBJECTIVE: To compare the ...

  15. Ruptured jejunal artery aneurysm (United States)

    Costa, Sílvia; Costa, Alexandre; Pereira, Tiago; Maciel, Jorge


    Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs. PMID:23771962

  16. Failure to predict difficult tracheal intubation for emergency caesarean section. (United States)

    Basaranoglu, Gokcen; Columb, Malachy; Lyons, Gordon


    Difficult tracheal intubation following induction of general anaesthesia for caesarean section is a cause of morbidity and mortality. Our aim was to evaluate five bedside predictors that might identify women with potential intubation difficulty immediately prior to emergency caesarean section. Women requiring emergency caesarean section with general anaesthesia and tracheal intubation who had been assessed by the same experienced anaesthesiologist preoperatively were included in this study. Mallampati score, sternomental distance, thyromental distance, interincisor gap and atlantooccipital extension were all measured. The same anaesthesiologist performed laryngoscopy and graded the laryngeal view according to Cormack and Lehane. Exact logistic regression was used to identify significant independent predictors for difficult intubation (Cormack and Lehane grades ≥ 3) with two-sided P value less than 0.05 considered as significant. In 3 years, 239 women were recruited. Cormack and Lehane grades of 2 or less (easy) were found in 225 and grade of at least 3 (difficult) in 14 women. Patients' characteristics (age, height, weight, BMI or weight gain) were not significantly associated with difficulty of intubation. The incidence of difficult intubation was 1/17 women [95% confidence interval (CI) from 1/31 to 1/10]. A positive result from any of the five predictors combined had a sensitivity of 0.21 (95%CI 0.05-0.51), a specificity of 0.92 (95%CI 0.88-0.96), a positive predictive value of 0.15 (95%CI 0.032-0.38) and a negative predictive value of 0.95 (95%CI 0.91-0.97) for a Cormack and Lehane grade of at least 3 at laryngoscopy. Airway assessment using these tests cannot be relied upon to predict a difficult intubation at emergency caesarean section as the low sensitivity means that 79% (95%CI 49-95) of difficult intubations will be missed.

  17. A case of splenic torsion and rupture presenting as ruptured ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Somdatta Lahiri


    Full Text Available Splenic torsion with rupture of spleen is an extremely rare phenomenon. The clinical picture mimics several common conditions which are causes of acute abdomen and so it is seldom detected pre-operatively. An 18 year old female patient was admitted with an acute abdomen and shock. The provisional diagnosis was of a ruptured ectopic pregnancy. Peri-operatively we found a spontaneous rupture of the spleen following torsion along with early intrauterine pregnancy. Splenectomy was carried out and patient recovered well. Our report confirms that this rare entity can present as an acute abdomen which is very difficult to diagnose preoperatively and can masquerade as ruptured ectopic pregnancy in women of childbearing age group.

  18. Investigation of phthalate release from tracheal tubes. (United States)

    Morton, W J; Muller, C T; Goodwin, N; Wilkes, A R; Hall, J E


    Phthalates are chemicals used extensively in the manufacture of plastics for their desirable physical characteristics. In addition to enhancing the performance of plastics, phthalates have a number of undesirable effects, principally endocrine disruptor effects, that may have adverse effects on reproductive development and functioning. As a result, they have been banned from the manufacture of children's toys. Despite this, they continue to be used in the manufacture of medical devices, including anaesthetic equipment. This study aimed to assess phthalate release from five brands of tracheal tube. Using gas chromatography-mass spectrometry, we analysed phthalate concentrations from samples of ultra pure water in which tracheal tubes had been submerged. Phthalate concentration increased from 6.7 to 149 μg.l(-1) over a period of 4.8 days. Phthalate release from anaesthetic equipment has not previously been documented over short time periods and raises the possibility of iatrogenic endocrine disruption with routine anaesthesia. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  19. Atherosclerotic plaque rupture: local or systemic process?

    NARCIS (Netherlands)

    Lutgens, Esther; van Suylen, Robert-Jan; Faber, Birgit C.; Gijbels, Marion J.; Eurlings, Petra M.; Bijnens, Ann-Pascale; Cleutjens, Kitty B.; Heeneman, Sylvia; Daemen, Mat J. A. P.


    It is generally established that the unstable plaque is the major cause of acute clinical sequelae of atherosclerosis. Unfortunately, terms indicating lesions prone to plaque instability, such as "vulnerable plaque," and the different phenotypes of unstable plaques, such as plaque rupture, plaque

  20. Gastric pneumatosis and rupture caused by lactobezoar.

    NARCIS (Netherlands)

    Bos, M.E.; Wijnen, R.M.H.; Blaauw, I. de


    BACKGROUND: Lactobezoar is a compact mass of inspissated, undigested milk. Most often it is located in the stomach but it may also be located in other parts of the intestine. It is the most common type of bezoar in infancy. Reported herein are two cases of this rare condition mimicking necrotizing

  1. Spontaneous rupture of multifocal hepatocellular carcinoma: case report

    Directory of Open Access Journals (Sweden)

    Özen Ö


    Full Text Available Özkan Özen, Alptekin Tosun, Çiğdem Akgül Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey Abstract: Hemoperitoneum due to nontraumatic liver rupture is rare. The most common cause of nontraumatic rupture of the liver is hepatocellular carcinoma (HCC. The other causes of nontraumatic liver ruptures are peliosis hepatis, polyarteritis nodosa, systemic lupus erythematosus, preeclampsia, metastatic carcinoma, and other primary liver tumors. In this report, we present the computed tomography findings of spontaneous liver rupture in a 52-year-old male patient due to multifocal HCC, with the diagnosis proven by surgical specimen. Keywords: computed tomography, hemoperitoneum, liver, nontraumatic liver rupture

  2. Spontaneous uterine rupture

    African Journals Online (AJOL)

    had had hysteroscopy and repeated curettage7, but it happened during labor and not before labor as in our case. Diagnosis of spontaneous uterine rupture during pregnancy occuring on a scarred uterus can be made by ultrasound scan in which case there can be protrusion of membranes at the site of the scar8. If possible ...

  3. Traumatic aortic ruptures

    NARCIS (Netherlands)

    Balm, R.; Hoornweg, L. L.


    Most patients with a traumatic aortic rupture (TAR) were involved in high velocity motor vehicle accidents. initial management of these patients should be according to the guidelines of the advanced trauma life support group (ATLS). Patients with a suspected TAR are preferably managed by controlled

  4. Ruptured Eardrum (Perforated Eardrum) (United States)

    ... your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is ... ruptured, the skin debris can pass into your middle ear and form a cyst. A ... a friendly environment for bacteria and contains proteins that can damage ...

  5. Rupture, waves and earthquakes (United States)

    UENISHI, Koji


    Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but “extraordinary” phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable. PMID:28077808

  6. Rupture, waves and earthquakes. (United States)

    Uenishi, Koji


    Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but "extraordinary" phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable.

  7. Rupture of mitral valve chordae in hypertrophic cardiomyopathy. (United States)

    Boissier, Florence; Achkouty, Guy; Bruneval, Patrick; Fabiani, Jean-Noël; Nguyen, Anh Tuan; Riant, Elisabeth; Desnos, Michel; Hagège, Albert


    While occasional reports of mitral valve chordal rupture have been described in hypertrophic cardiomyopathy, the exact prevalence and characteristics of this event in a large medical cohort have not been reported. To assess the prevalence of mitral valve chordal rupture in hypertrophic cardiomyopathy and the clinical, echocardiographic, surgical and histological profiles of those patients. We searched for patients with mitral valve chordal rupture diagnosed by echocardiography among all electronic files of patients admitted to our centre for hypertrophic cardiomyopathy between 2000 and 2010. Among 580 patients admitted for hypertrophic cardiomyopathy, six patients (1%, 5 men, age 68-71 years) presented with mitral valve chordal rupture, symptomatic in five cases, always involving the posterior mitral leaflet. In all cases, echocardiography before rupture showed mitral valve systolic anterior motion, with anterior (and not posterior) leaflet elongation compared with a random sample of patients with non-obstructive hypertrophic cardiomyopathy (P=0.006) (and similar to that observed in obstructive hypertrophic cardiomyopathy). Significant resting left ventricular outflow tract obstruction was always present before rupture and disappeared after rupture in the five cases requiring mitral valve surgery for severe mitral regurgitation. Histological findings were consistent with extensive myxomatous degeneration in all cases. Mitral valve chordal rupture is: infrequent in hypertrophic cardiomyopathy; occurs in aged patients with obstructive disease; involves, essentially, the posterior mitral leaflet; and causes, in general, severe mitral regurgitation requiring surgery. Myxomatous degeneration may be the substrate for rupture in these patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Risk factors affecting chronic rupture of the plantar fascia. (United States)

    Lee, Ho Seong; Choi, Young Rak; Kim, Sang Woo; Lee, Jin Yong; Seo, Jeong Ho; Jeong, Jae Jung


    Prior to 1994, plantar fascia ruptures were considered as an acute injury that occurred primarily in athletes. However, plantar fascia ruptures have recently been reported in the setting of preexisting plantar fasciitis. We analyzed risk factors causing plantar fascia rupture in the presence of preexisting plantar fasciitis. We retrospectively reviewed 286 patients with plantar fasciitis who were referred from private clinics between March 2004 and February 2008. Patients were divided into those with or without a plantar fascia rupture. There were 35 patients in the rupture group and 251 in the nonrupture group. The clinical characteristics and risk factors for plantar fascia rupture were compared between the 2 groups. We compared age, gender, the affected site, visual analog scale pain score, previous treatment regimen, body mass index, degree of ankle dorsiflexion, the use of steroid injections, the extent of activity, calcaneal pitch angle, the presence of a calcaneal spur, and heel alignment between the 2 groups. Of the assessed risk factors, only steroid injection was associated with the occurrence of a plantar fascia rupture. Among the 35 patients with a rupture, 33 had received steroid injections. The odds ratio of steroid injection was 33. Steroid injections for plantar fasciitis should be cautiously administered because of the higher risk for plantar fascia rupture. Level III, retrospective comparative study.

  9. [Conservative management of tracheal rupture in a child after blunt trauma]. (United States)

    Kucuk, Gonul; Ates, Ufuk; Gollu, Gulnur; Yagmurlu, Aydin


    La rotura traqueal tras una contusión es rara, aunque potencialmente mortal. En general, se recomienda el tratamiento quirúrgico para la rotura traqueal, aunque también se ha informado recientemente el abordaje conservador en los pacientes con signos vitales y parámetros respiratorios estables. El objetivo de este estudio es informar sobre un caso de rotura traqueal tras una contusión en el cuello producto de un accidente de bicicleta que se trató de manera conservadora. Sociedad Argentina de Pediatría.

  10. Benign tracheal stenosis a case report and up to date management. (United States)

    Karapantzos, Ilias; Karapantzou, Chrysa; Zarogoulidis, Paul; Tsakiridis, Kosmas; Charalampidis, Charalampos


    Benign tracheal stenosis is situation that occurs usually after stress is applied to a certain area in the trachea during the intubation of a patient or inflammation caused during an infection. In the current case report we will present a 65-year-old man with a benign tracheal stenosis due to a 15-day intubation with a high pressure and low volume intubation tube. Current methodology was applied in his case with an excellent result with a 1-year follow up. Cryotherapy, electrocautery-knife, balloon dilation and semi-rigid bronchoscopic technique were applied. Currently there are several techniques that can be used by pulmonary physicians or ear, nose and throat experts. It remains for the treating physician to choose its method based on his training, equipment and tissue damage.

  11. Etude Par Ponction Tracheale De La Flore Bacterienne Des Pneumopathies Infectieuses. (United States)

    Schoutens, E; Koster, J P; Arouete, A; Tombroff, M; Yourassowsky, E


    The authors analyse the bacteriological data gathered by 100 successive tracheal Punctures and compare these results to those obtained by sputum cultures, which had either been collected by routine or when withdrawing the catheter for tracheal aspiration. This plain and not hazardous technique allows to draw the following conclusions : 1) The culture of routinely collected sputum at the patient's bed-side often misleads the physician (6 times on 10) whereas newly expectorated sputum brought immediately to the laboratory more truly shows the tracheo-bronchic flora (valuable results in 75 % of the cases). 2) The tracheal puncture, which reduces the causes of errors, due to the contamination of the sputum by the rhino-pharyngeal flora, to a minimum, particularly is indicated in the following cases : patients who do not expectorate (including suspects of pulmonary tuberculosis), instantly earnest pneumopathia, bad response to applied antibiotic therapy, tests of the true efficiency of an antibiotic therapy. 3) The bacteriological study of these punctures performed on patients, who caused therapeutical problems and who had been submitted to antibiotic therapies evidenced the following data : 40 % of the punctures were sterile, 39 % showed one single germ (18 Gram negative, 16 Gram positive, 2 BK, 3 aspergillus), 15 % showed 2 simultaneous germs and 6 % were not significant.

  12. Effects of acute respiratory virus infection upon tracheal mucous transport

    Energy Technology Data Exchange (ETDEWEB)

    Gerrard, C.S.; Levandowski, R.A.; Gerrity, T.R.; Yeates, D.B.; Klein, E.

    Tracheal mucous velocity was measured in 13 healthy non-smokers using an aerosol labelled with /sup 99m/Tc and a multidetector probe during respiratory virus infections. The movement of boluses of tracheal mucous were either absent or reduced in number in five subjects with myxovirus infection (four influenza and one respiratory syncytial virus) within 48 hr of the onset of symptoms and in four subjects 1 wk later. One subject with influenza still had reduced bolus formation 12-16 wk after infection. Frequent coughing was a feature of those subjects with absent tracheal boluses. In contrast, four subjects with rhinovirus infection had normal tracheal mucous velocity at 48 hr after the onset of symptoms (4.1 +/- 1.3 mm/min). Tracheal mucous velocity was also normal (4.6 +/- 1.1 mm/min) in four subjects in whom no specific viral agent could be defined but had typical symptomatology of respiratory viral infection. During health tracheal mucous velocity was normal (4.8 +/- 1.6 mm/min) in the eleven subjects who had measurements made. Disturbances in tracheal mucous transport during virus infection appear to depend upon the type of virus and are most severe in influenza A and respiratory syncytial virus infection.

  13. Isolated Total Rupture of Extraocular Muscles. (United States)

    Chen, Jingchang; Kang, Ying; Deng, Daming; Shen, Tao; Yan, Jianhua


    Total rupture of extraocular muscles is an infrequent clinical finding. Here we conducted this retrospective study to evaluate their causes of injury, clinical features, imaging, surgical management, and final outcomes in cases of isolated extraocular muscle rupture at a tertiary center in China. Thirty-six patients were identified (24 men and 12 women). Mean age was 34 years (range 2-60). The right eye was involved in 21 patients and the left 1 in 15. A sharp object or metal hook was the cause of this lesion in 16 patients, sinus surgery in 14 patients, traffic accident in 3 patients, orbital surgery in 2 patients, and conjunctive tumor surgery in 1 patient. The most commonly involved muscles were medial (18 patients) and inferior rectus muscles (13 patients). The function of the ruptured muscles revealed a scale of -3 to -4 defect of ocular motility and the amount of deviation in primary position varied from 10 to 140 PD (prism diopter). Computerized tomography (CT) confirmed the presence of ruptured muscles. An end-to-end muscle anastomosis was performed and 3 to 5 mm of muscle was resected in 23 patients. When the posterior border of the injured muscle could not be identified (13 patients), a partial tendon transposition was performed, together with recession of the antagonist in most patients, whereas a recession of the antagonist muscle plus a resection of the involved muscle with or without nasal periosteal fixation was performed in the remaining patients. After an average of 16.42 months of follow-up an excellent result was achieved in 23 patients and results of 13 patients were considered as a failure. In most patients, the posterior border of the ruptured muscle can be identified and an early surgery can be performed to restore function. Alternatively, a partial tendon transposition should be performed. When muscular rupture is suspected, an early orbital CT is required to confirm this possibility, which can then verify the necessity for an early surgical

  14. Trypsin as enhancement in cyclical tracheal decellularization: Morphological and biophysical characterization

    Energy Technology Data Exchange (ETDEWEB)

    Giraldo-Gomez, D.M., E-mail: [Posgrado en Ciencia e Ingeniería de Materiales, Universidad Nacional Autónoma de México (UNAM), Unidad de Posgrado Edificio “C” 1er Piso, Circuito de Posgrados, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D. F., México (Mexico); Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México (UNAM), Circuito Exterior, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D.F., México (Mexico); Leon-Mancilla, B. [Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Edificio “D” Planta Baja, Circuito Interior, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D.F., México (Mexico); Del Prado-Audelo, M.L. [Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México (UNAM), Circuito Exterior, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, C.P. 04510, México D.F., México (Mexico); and others


    There are different types of tracheal disorders (e.g. cancer, stenosis and fractures). These can cause respiratory failure and lead to death of patients. Several attempts have been made for trachea replacement in order to restore the airway, including anastomosis and implants made from synthetic or natural materials. Tracheal allotransplantation has shown high rejection rates, and decellularization has emerged as a possible solution. Decellularization involves the removal of antigens from cells in the organ or tissue, leaving a matrix that can be used as 3D cell-scaffold. Although this process has been used for tracheal replacement, it usually takes at least two months and time is critical for patients with tracheal disorders. Therefore, there is necessary to develop a tracheal replacement process, which is not only effective, but also quick to prepare. The aim of this research was to develop a faster trachea decellularization protocol using Trypsin enzyme and Ethylenediaminetetraacetic acid (EDTA) as decellularization agents. Three protocols of cyclic trachea decellularization (Protocols A, B, and C) were compared. Following Protocol A (previously described in the literature), 15 consecutive cycles were performed over 32 days. Protocol B (a variation of Protocol A) — EDTA being added — with 15 consecutive cycles performed over 60 days. Finally, Protocol C, with the addition of Trypsin as a decellularization agent, 5 consecutive cycles being performed over 10 days. For the three protocols, hematoxylin–eosin (H&E) staining and DNA residual content quantification were performed to establish the effectiveness of the decellularization process. Scanning Electron Microscopy (SEM) was used to observe the changes in porosity and microarrays. To evaluate the structural matrices integrity, Thermogravimetric Analysis (TGA) and biomechanical test were used. None of the protocols showed significant alteration or degradation in the components of the extracellular matrix

  15. Gastric Rupture and Necrosis in Prader-Willi Syndrome (United States)

    Stevenson, David A.; Heinemann, Janalee; Angulo, Moris; Butler, Merlin G.; Loker, Jim; Rupe, Norma; Kendell, Patrick; Cassidy, Suzanne B.; Scheimann, Ann


    Hyperphagia and obesity are common features in individuals with Prader-Willi syndrome (PWS). Demographic and cause of death data from individuals with PWS were obtained through a national support organization. Four reports of unexpected mortality due to gastric rupture and necrosis were found in 152 reported deaths, accounting for 3% of the causes of mortality. Four additional individuals were suspected to have gastric rupture. Vomiting and abdominal pain, although rare in PWS, were frequent findings in this cohort. The physician should consider an emergent evaluation for gastric rupture and necrosis in individuals with PWS who present with vomiting and abdominal pain. PMID:17667731

  16. Regional pulmonary edema caused by acute mitral insufficiency after rupture of chordae tendinae with prolaps of the posterior mitral valve; Regionales Lungenoedem bei akuter Mitralinsuffizienz nach Chordae-tendineae-Abriss mit Prolaps des posterioren Mitralsegels

    Energy Technology Data Exchange (ETDEWEB)

    Mauser, M.; Wiedemer, B.; Fleischmann, D. [Klinikum Lahr (Germany). Medizinische Klinik; Billmann, P. [Klinikum Lahr (Germany). Inst. fuer Radiologie; Ennker, J. [Herzzentrum Lahr/Baden (Germany). Abt. fuer Herzchirurgie


    An unilateral or predominantly lobar pulmonary edema is an unusual clinical or radiological finding, often misdiagnosed as one of the more common causes of focal lung disease. We report 2 cases of a regional pulmonary edema caused by the acute onset of a severe mitral insufficiency after the rupture of chordae tendinae resulting in a prolaps of the posterior mitral leaflet. In both cases the regional pulmonary edema was initially misdiagnosed as a pneumonic infiltration, which delayed the cardiological diagnostical procedures and the surgical intervention. The mechanism of the regional edema is an excentric regurgitation jet into the left atrium, which is usually directed to the orifice of the right upper lobe pulmonary vein which increases the hydrostatic vascular pressure in the corresponding lung segment. For the confirmation of the diagnosis, transesophageal echogradiographye is helpful in documenting the direction of the regurgitant flow and detecting differential gradients between the right and left pulmonary venous systems. The pulmonary infiltrations, which persisted for several weeks, dissappeared within a few days after surgical mitral-valve-reconstruction in both cases. (orig.) [German] Ein einseitiges oder ueberwiegend lobaeres Lungenoedem ist ein seltener klinischer und radiologischer Befund, der haeufig initial zur Fehldiagnose einer weitaus haeufigeren fokaleren Lungenerkrankung fuehrt. Wir berichten ueber 2 Faelle, bei denen nach Auftreten einer akuten Mitralinsuffizienz auf dem Boden eines Sehnenfadenabrisses am posterioren Mitralsegel ein regionales Lungenoedem zunaechst als pneumonisches Infiltrat fehlgedeutet wurde, was die weitere kardiologische Diagnostik und chirurgische Therapie verzoegerte. Wie in den wenigen in der Literatur beschriebenen Faellen findet sich hierbei ein exzentrischer Regurgitationsjet in den linken Vorhof, der ueblicherweise auf die Einmuendung der rechten oberen Pulmonalvene gerichtet ist und in dem dazugehoerigen

  17. The effects of equine rhinovirus, influenza virus and herpesvirus infection on tracheal clearance rate in horses. (United States)

    Willoughby, R; Ecker, G; McKee, S; Riddolls, L; Vernaillen, C; Dubovi, E; Lein, D; Mahony, J B; Chernesky, M; Nagy, E


    The response of horses exposed to three common respiratory viruses was studied by measuring tracheal mucociliary clearance rates in the trachea. Tracheal clearance rates (TCR) were determined before, during illness and following recovery in horses exposed to equine rhinovirus (ERhV-2), equine influenza virus (EIV) and equine herpesvirus (EHV-4) by means of lateral scintigraphs made following an injection of technetium-99m sulphide colloid into the tracheal lumen. In six horses exposed to ERhV-2, TCR remained within normal limits. Exposure to EIV resulted in reduced TCR in six of seven horses, with TCR remaining below the 95% confidence limits of normal values for each horse for up to 32 days despite the resolution of clinical signs. Moderate changes were observed in six horses exposed to EHV-4, but significant reductions in TCR were evident in three animals. Measurement of TCR was a useful, minimally-invasive technique which demonstrated that respiratory viruses may cause persistent changes in TCR, even though clinical signs are not evident.

  18. Combined approach for spontaneous rupture of hepatocellular carcinoma. (United States)

    Rossetto, Anna; Adani, Gian Luigi; Risaliti, Andrea; Baccarani, Umberto; Bresadola, Vittorio; Lorenzin, Dario; Terrosu, Giovanni


    Ruptured hepatocellular carcinoma is a rare, emergency occurrence in western countries with high mortality risk. A number of hypotheses have been formulated in order to explain the precise mechanism that leads to hepatocellular carcinoma (HCC) rupture: sub-capsular location, dimensions, portal hypertension, tumour necrosis, local increase of venous pressure due to the outflow reduction caused by neoplastic invasion, and the presence of a previous vascular injury which might predispose to HCC rupture. There is still a debate in the literature concerning the best approach in cases of HCC rupture. Surgery is the first option for treatment of acute abdominal bleeding. However the advent of endovascular treatments widens the range of possible therapies for acute bleeding control and subsequent ablation purposes. We report a case of hemoperitoneum from spontaneous rupture of undiagnosed HCC, that was treated successfully by emergency surgical resection followed by transarterial chemo-embolization for local recurrence.

  19. [Etiopathogenesis and biodynamics of closed laryngo-tracheal injuries]. (United States)

    Colombo, E; Murruni, G


    The blunt laryngotracheal trauma, once quite a rare phenomenon, has become quite relevant today, particularly because of the great increase in automotive traffic. It was, therefore, felt knowledge of the etiopathogenesis and biodynamics of this form of trauma is important for proper diagnosis and treatment. After having noted that the literature in this regard is generally incomplete and fragmentary, the authors felt it worth compiling the various etiopathogenesis and biodynamic factors involved; characteristics of blunt laryngotracheal trauma. Three basic elements of this form of trauma were studied. These are: trauma subject, trauma forces and impact plane. The biodynamic mechanisms responsible for the damage caused to the laryngotracheal skeleton and its soft parts have been analyzed. Finally, a case study was made including 99 cases drawn from international literature and 23 cases which had come under observation by the authors. The purpose of this analysis was to determine the frequency of various etiologies in relation to trauma type and site. The difficulties involved in drawing these simple data from the literature is underlined. This stems from the fact that often the various authors report overall data failing to give the etiology and site of individual cases. Traffic accidents have proved to be the cause of 80% of all such traumas and 90% of those with fracture, dislocation or separation of the laryngotracheal skeleton. The most serious lesions are to be seen in cases of frontal trauma. In the elastic cartilage of young people, the elastic snapback is of particular significance in the genesis of damage to the soft tissues. The most frequently encountered lesion is fracture of the thyroid cartilage alone while fracture of the cricoid alone is quite unusual. Fractures or detachment within the cricoid-tracheal area is quite common. In 85% of the cases cricoid cartilage involvement is associated with that of the tracheal cartilage. The authors assert that


    NARCIS (Netherlands)

    Kaye, Benjamin M; Boroffka, Susanne A E B; Haagsman, Annika N; Haar, Gert Ter


    Tracheal hypoplasia is commonly seen in English Bulldogs affected with brachycephalic airway syndrome. Previously published diagnostic criteria for tracheal hypoplasia in this breed have been a radiographic tracheal diameter:tracheal inlet ratio (TD:TI) < 0.12 or a tracheal diameter:third rib

  1. The normal growth of the tracheal wall in human foetuses


    Szpinda, Micha?; Daroszewski, Marcin; Szpinda, Anna; Wo?niak, Alina; Mila-Kierzenkowska, Celestyna; Flisi?ski, Piotr; Wi?niewski, Marcin


    Introduction Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age. Material and methods Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14...

  2. The normal growth of the tracheal wall in human foetuses. (United States)

    Szpinda, Michał; Daroszewski, Marcin; Szpinda, Anna; Woźniak, Alina; Mila-Kierzenkowska, Celestyna; Flisiński, Piotr; Wiśniewski, Marcin


    Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age. Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14-25 weeks was examined. No significant male-female differences were found. The values of tracheal wall thickness ranged from 0.36 ±0.01 mm for the 14-week group to 1.23 ±0.17 mm for the 25-week group of gestation, according to the linear function y = -0.823 + 0.083 × age ± 0.087. The tracheal lumen rate, expressed as the proximal internal-to-external cross-sectional area ratio, decreased from 42.61 ±1.11% to 26.78 ±4.95%, according to the function y = 62.239 - 1.487 × age ±3.119. The tracheal wall volume rose from 16.28 ±4.18 mm(3) in fetuses aged 14 weeks to 269.22 ±29.26 mm(3) in fetuses aged 25 weeks, according to the quintic function y = 0.000052 × age(4.894). The tracheal wall parameters show no sexual dimorphism. The tracheal wall grows linearly in its length, and according to a quintic function in its volume. A relative decrease in the tracheal lumen at the expense of an increase in both the wall thickness and wall volume of the trachea is found during gestation.

  3. [Clinical study on 67 cases with uterine rupture]. (United States)

    Xiaoxia, Bai; Zhengping, Wang; Xiaofu, Yang


    To investigate the incidence, etiology, diagnosis, treatment and outcome of uterus rupture. From January 1999 to May 2013, clinical data of 67 cases with uterine rupture in Woman's Hospital, School of Medicine, Zhejiang University were studied retrospectively. A total of 67 cases of uterine rupture with 21(+2)-39(+2) gestational weeks out of 128 599 deliveries were recorded giving an incidence of uterine rupture was 0.052 1% (67/128 599) . Cesarean scar rupture were found in 59 cases (88%, 59/67) and noncesarean scar rupture were found in 8 cases (12%, 8/67). The causes of uterine rupture include 60 cases of scar uterus (59 cesarean scar cases and 1 myomyectomy scar case), 2 cases of assisted delivery operation trauma, 2 cases of malformed uterus, 3 cases of unknown causes (all with artificial abortion history).Non obstructive dystocia and improper oxytocin use were found to be related with uterine rupture.Fifty-two cases of cesarean scar spontaneous incomplete rupture were found and repaired during repeated cesarean delivery without maternal and fetal complications. The remaining 15 cases need emergency rescue operation for fetal distress or dead fetus, severe acute abdomen, prepartum or postpartum vaginal bleeding even maternal hypovolemia; 6/15 uterine rupture cases were diagnosed with the history, clinical symptoms and signs, 3/15 cases with ultrasonic found dead fetus in the peritoneal cavity before exploratory laparotomy and 6 cases were diagnosed just during laparotomy.Hysterectomy was done in 10/15 cases and uterine repair in 5/15 cases; there was no maternal death and 12 perinatal fetal death (5 cases of mid-late pregnancy termination for deformed fetus) of the 15 uterine rupture cases.One case with hysterectomy was complicated with stress pancreatitis and dysfunction of liver and kidney and discharged 20 days after operation, the remaining 14 cases were discharged 5-7 days postpartum.One case with repaired malformed uterus got pregnancy 4 years later and

  4. Hemoperitoneum secondary to an spontaneous rupture of the spleen mimmicking a duodenal perforated ulcera: A case report. (United States)

    Ruiz-Tovar, Jaime; Díaz, Gustavo; Alias, David; Jiménez-Fuertes, Montiel; Durán, Manuel


    Spontaneous rupture of the spleen without traumatic cause is an unfrequent entity, usually related with pathologic spleens. We present a case of spontaneous rupture of an histologically normal spleen with splenomegalia secondary to smoking habit. The hemoperitoneum caused by the spontaneous rupture of the spleen mimmicked a hollow viscera perforation.

  5. Tracheal cartilaginous sleeve association with syndromic midface hypoplasia. (United States)

    Stater, Brian J; Oomen, Karin P Q; Modi, Vikash K


    We report 2 new cases of tracheal cartilaginous sleeve and perform a systematic literature review of all documented cases of this condition. We aim to increase awareness of this anomaly and provide recommendations for both intraoperative and postoperative management of patients with tracheal cartilaginous sleeve undergoing tracheostomy. We studied the clinical records of 2 children with tracheal cartilaginous sleeves and short tracheas treated at our institution. One of these patients had Beare-Stevenson syndrome, and the other had Crouzon syndrome. Both patients required tracheostomy for persistent upper airway obstruction, and both required custom-length tracheostomy tubes. Bronchoscopy and needle localization were beneficial in performing tracheostomy on these patients. All documented cases of tracheal cartilaginous sleeve in the literature were found to be associated with midface hypoplasia secondary to syndromic craniosynostosis. Seventy-five percent of cases required tracheostomy. Tracheal cartilaginous sleeve can be associated with Beare-Stevenson syndrome. In infants with midface hypoplasia associated with a craniosynostosis syndrome undergoing tracheostomy, the surgeon must be prepared to encounter and manage tracheal cartilaginous sleeve intraoperatively. Bronchoscopy and needle localization can be beneficial when performing tracheostomy in these patients. Customized, shorter-length tracheostomy tubes should be considered for these patients.

  6. Hydro-ethanolic Extract of Portulaca oleracea Affects Beta-adrenoceptors of Guinea Pig Tracheal Smooth Muscle. (United States)

    Boskabady, Mohammad Hossein; Hashemzehi, Milad; Khazdair, Mohammad Reza; Askari, Vahid Reza


    Thestimulatory effect of the extract of Portulaca oleracea (P. olerace) on β-adrenoceptor of tracheal smooth muscle was examined.To examine β-adrenoceptor stimulatory effect, concentration response curve to isoprenaline was obtained in pre-contracted tracheal smooth muscle in the presence of three concentrations of aqueous-ethanolic extract, propranolol, and saline. Values of EC50 (the effective concentration of isoprenaline, causing 50% of maximum response) and dose ratio-1(CR-1) were measured. This effect was tested innon-incubated tracheal smooth muscle (group 1) and incubated tissues with chlorpheniramine (group 2). Concentration-response curves to isoprenaline in the presence of two higher concentrations of the extract in group 1 and all three concentrations in group 2 showed leftward shifts compared to isoprenaline curves produced in the presence of saline in both groups. EC50 obtained in the presence of propranolol was significantly higher than that of saline in both groups of experiments (pextract in group 1 and lower concentration in group 2 were non-significantly but those obtained of medium and high extract concentrations in the group 2 were significantly (pextract in groups1 and 2 were significantly lower than that of propranolol (pextract on ß 2-adrenoceptors of tracheal smooth muscle.

  7. [Achilles tendon rupture]. (United States)

    Thermann, H; Hüfner, T; Tscherne, H


    The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques.

  8. Untreated silicone breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten


    were evaluated. Comparisons were also made for self-reported breast symptoms occurring during the study period and for changes in serum values of antinuclear antibodies, rheumatoid factor, and cardiolipin antibodies immunoglobulin G and immunoglobulin M. The majority of the women with implant rupture...... that implant rupture is a relatively harmless condition, which only rarely progresses and gives rise to notable symptoms. Even so, because of a small risk of silicone spread, the authors suggest that women with implant ruptures be followed clinically, if not operated on. Because implant ruptures often occur...

  9. Simultaneous bilateral Achilles tendon ruptures associated with statin medication despite regular rock climbing exercise. (United States)

    Carmont, Michael R; Highland, Adrian M; Blundell, Christopher M; Davies, Mark B


    Ruptures of the Achilles tendon are common however simultaneous ruptures occur less frequently. Eccentric loading exercise programmes have been used to successfully treat Achilles tendinopathy. We report a case of simultaneous bilateral Achilles tendon rupture in a patient predisposed to rupture due to longstanding raised serum lipoprotein and recently introduced therapeutic statin medication. The patient was also a keen rock climber and had regularly undertaken loading exercise. This case illustrates that the therapeutic effect of mixed loading exercises for the Achilles tendon may not be adequate to overcome the predisposition to rupture caused by hyperlipidaemia and statin medication.

  10. Fetal MRI in experimental tracheal occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Wedegaertner, Ulrike [Department of Diagnostic and Interventional Radiology, Universitaetsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg (Germany)]. E-mail:; Schroeder, Hobe J. [Experimental Gynecology, Department of Obstetrics and Prenatal Medicine, Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany); Adam, Gerhard [Department of Diagnostic and Interventional Radiology, Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany)


    Congenital diaphragmatic hernia (CDH) is associated with a high mortality, which is mainly due to pulmonary hypoplasia and secondary pulmonary hypertension. In severely affected fetuses, tracheal occlusion (TO) is performed prenatally to reverse pulmonary hypoplasia, because TO leads to accelerated lung growth. Prenatal imaging is important to identify fetuses with pulmonary hypoplasia, to diagnose high-risk fetuses who would benefit from TO, and to monitor the effect of TO after surgery. In fetal imaging, ultrasound (US) is the method of choice, because it is widely available, less expensive, and less time-consuming to perform than magnetic resonance imaging (MRI). However, there are some limitations for US in the evaluation of CDH fetuses. In those cases, MRI is helpful because of a better tissue contrast between liver and lung, which enables evaluation of liver herniation for the diagnosis of a high-risk fetus. MRI provides the ability to determine absolute lung volumes to detect lung hypoplasia. In fetal sheep with normal and hyperplastic lungs after TO, lung growth was assessed on the basis of cross-sectional US measurements, after initial lung volume determination by MRI. To monitor fetal lung growth after prenatal TO, both MRI and US seem to be useful methods.

  11. Untreated silicone breast implant rupture. (United States)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten; Sletting, Susanne; Høier-Madsen, Mimi; Fryzek, Jon P; McLaughlin, Joseph K; Kjøller, Kim; Wiik, Allan; Friis, Søren


    Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether untreated ruptures are associated with changes over time in magnetic resonance imaging findings, serologic markers, or self-reported breast symptoms. A baseline magnetic resonance imaging examination was performed in 1999 on 271 women who were randomly chosen from a larger cohort of women having cosmetic breast implants for a median period of 12 years (range, 3 to 25 years). A follow-up magnetic resonance imaging examination was carried out in 2001, excluding women who underwent explantation in the period between the two magnetic resonance imaging examinations (n = 44). On the basis of these examinations, the authors identified 64 women who had at least one ruptured implant at the first magnetic resonance imaging examination and, for comparison, all women who had intact implants at both examinations (n = 98). Magnetic resonance images from the two examinations were compared and changes in rupture configuration were evaluated. Comparisons were also made for self-reported breast symptoms occurring during the study period and for changes in serum values of antinuclear antibodies, rheumatoid factor, and cardiolipin antibodies immunoglobulin G and immunoglobulin M. The majority of the women with implant rupture had no visible magnetic resonance imaging changes of their ruptured implants. For 11 implants (11 percent) in 10 women, the authors observed progression of silicone seepage, either as a conversion from intracapsular into extracapsular rupture (n = 7), as progression of extra-capsular silicone (n = 3), or as increasing herniation of the silicone within the fibrous capsule (n = 1); however, in most cases, these changes were minor. Some changes could be ascribed to trauma, but

  12. Balloon removal after fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia. (United States)

    Jiménez, Julio A; Eixarch, Elisenda; DeKoninck, Philip; Bennini, João R; Devlieger, Roland; Peralta, Cleisson F; Gratacos, Eduard; Deprest, Jan


    Isolated congenital diaphragmatic hernia defect allows viscera to herniate into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. Antenatal measurement of lung size and liver herniation can predict survival after birth. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion under local anesthesia. This in utero treatment requires a second intervention to reestablish the airway, either before birth or at delivery. To describe our experience with in utero endotracheal balloon removal. This is a retrospective analysis of prospectively collected data on consecutive patients with congenital diaphragmatic hernia treated in utero by fetal endoscopic tracheal occlusion from 3 centers. Maternal and pregnancy-associated variables were retrieved. Balloon removal attempts were categorized as elective or emergency and by technique (in utero: ultrasound-guided puncture; fetoscopy; ex utero: on placental circulation or postnatal tracheoscopy). We performed 351 balloon insertions during a 144-month period. In 9 cases removal was attempted outside fetal endoscopic tracheal occlusion centers, 3 of which were deemed impossible and led to neonatal death. We attempted 302 in-house balloon removals in 292 fetuses (217 elective [71.8%], 85 emergency [28.2%]) at 33.4 ± 0.1 weeks (range: 28.9-37.1), with a mean interval to delivery of 16.6 ± 0.8 days (0-85). Primary attempt was by fetoscopy in 196 (67.1%), by ultrasound-guided puncture in 62 (21.2%), by tracheoscopy on placental circulation in 30 (10.3%), and postnatal tracheoscopy in 4 cases (1.4%); a second attempt was required in 10 (3.4%) cases. Each center had different preferences for primary technique selection. In elective removals, we found no differences in the interval to delivery between fetoscopic

  13. Tsunami generation by ocean floor rupture front propagation: Hamiltonian description

    Directory of Open Access Journals (Sweden)

    V. I. Pavlov


    Full Text Available The Hamiltonian method is applied to the problem of tsunami generation caused by a propagating rupture front and deformation of the ocean floor. The method establishes an alternative framework for analyzing the tsunami generation process and produces analytical expressions for the power and directivity of tsunami radiation (in the far-field for two illustrative cases, with constant and gradually varying speeds of rupture front propagation.

  14. Acute partial rupture of the common extensor tendon


    Kachrimanis, G.; Papadopoulou, O.


    Rupture of the common extensor tendon is the most common acute tendon injury of the elbow. The authors describe a case of a patient with a clinical history of tendinopathy caused by functional overload of the common extensor tendon, treated also with infiltrations of steroids, and subsequent partial rupture of the tendon during sport activity. The diagnosis was made clinically and at ultrasound (US) examination; US follow-up after some time showed the healing of the lesion. This case confirms...

  15. Endotracheal tubes for critically ill patients: an in vivo analysis of associated tracheal injury, mucociliary clearance, and sealing efficacy. (United States)

    Li Bassi, Gianluigi; Luque, Nestor; Martí, Joan Daniel; Aguilera Xiol, Eli; Di Pasquale, Marta; Giunta, Valeria; Comaru, Talitha; Rigol, Montserrat; Terraneo, Silvia; De Rosa, Francesca; Rinaudo, Mariano; Crisafulli, Ernesto; Peralta Lepe, Rogelio Cesar; Agusti, Carles; Lucena, Carmen; Ferrer, Miguel; Fernández, Laia; Torres, Antoni


    Improvements in the design of the endotracheal tube (ETT) have been achieved in recent years. We evaluated tracheal injury associated with ETTs with novel high-volume low-pressure (HVLP) cuffs and subglottic secretions aspiration (SSA) and the effects on mucociliary clearance (MCC). Twenty-nine pigs were intubated with ETTs comprising cylindrical or tapered cuffs and made of polyvinylchloride (PVC) or polyurethane. In specific ETTs, SSA was performed every 2 h. Following 76 h of mechanical ventilation, pigs were weaned and extubated. Images of the tracheal wall were recorded before intubation, at extubation, and 24 and 96 h thereafter through a fluorescence bronchoscope. We calculated the red-to-green intensity ratio (R/G), an index of tracheal injury, and the green-plus-blue (G+B) intensity, an index of normalcy, of the most injured tracheal regions. MCC was assessed through fluoroscopic tracking of radiopaque markers. After 96 h from extubation, pigs were killed, and a pathologist scored injury. Cylindrical cuffs presented a smaller increase in R/G vs tapered cuffs (P = .011). Additionally, cuffs made of polyurethane produced a minor increase in R/G (P = .012) and less G+B intensity decline (P = .022) vs PVC cuffs. Particularly, a cuff made of polyurethane and with a smaller outer diameter outperformed all cuffs. SSA-related histologic injury ranged from cilia loss to subepithelial inflammation. MCC was 0.9 ± 1.8 and 0.4 ± 0.9 mm/min for polyurethane and PVC cuffs, respectively (P < .001). HVLP cuffs and SSA produce tracheal injury, and the recovery is incomplete up to 96 h following extubation. Small, cylindrical-shaped cuffs made of polyurethane cause less injury. MCC decline is reduced with polyurethane cuffs.

  16. Engineered Tissue–Stent Biocomposites as Tracheal Replacements (United States)

    Zhao, Liping; Sundaram, Sumati; Le, Andrew V.; Huang, Angela H.; Zhang, Jiasheng; Hatachi, Go; Beloiartsev, Arkadi; Caty, Michael G.; Yi, Tai; Leiby, Katherine; Gard, Ashley; Kural, Mehmet H.; Gui, Liqiong; Rocco, Kevin A.; Sivarapatna, Amogh; Calle, Elizabeth; Greaney, Allison; Urbani, Luca; Maghsoudlou, Panagiotis; Burns, Alan; DeCoppi, Paolo


    Here we report the creation of a novel tracheal construct in the form of an engineered, acellular tissue–stent biocomposite trachea (TSBT). Allogeneic or xenogeneic smooth muscle cells are cultured on polyglycolic acid polymer–metal stent scaffold leading to the formation of a tissue comprising cells, their deposited collagenous matrix, and the stent material. Thorough decellularization then produces a final acellular tubular construct. Engineered TSBTs were tested as end-to-end tracheal replacements in 11 rats and 3 nonhuman primates. Over a period of 8 weeks, no instances of airway perforation, infection, stent migration, or erosion were observed. Histological analyses reveal that the patent implants remodel adaptively with native host cells, including formation of connective tissue in the tracheal wall and formation of a confluent, columnar epithelium in the graft lumen, although some instances of airway stenosis were observed. Overall, TSBTs resisted collapse and compression that often limit the function of other decellularized tracheal replacements, and additionally do not require any cells from the intended recipient. Such engineered TSBTs represent a model for future efforts in tracheal regeneration. PMID:27520928

  17. Synthetic Tracheal Mucus with Native Rheological and Surface Tension Properties (United States)

    Hamed, R.; Fiegel, J.


    In this study the development of a model tracheal mucus with chemical composition and physical properties (bulk viscoelasticity and surface tension) matched to that of native tracheal mucus is described. The mucus mimetics were formulated using components that are abundant in tracheal mucus (glycoproteins, proteins, lipids, ions and water) at concentrations similar to those found natively. Pure solutions were unable to achieve the gel behavior observed with native mucus. The addition of a bi-functional crosslinking agent enabled control over the viscoelastic properties of the mucus mimetics by tailoring the concentration of the crosslinking agent and the duration of crosslinking. Three mucus mimetic formulations with different bulk viscoelastic properties, all within the normal range for non-diseased tracheal mucus, were chosen for investigation of surfactant spreading at the air-mimetic interface. Surfactant spread quickly and completely on the least viscoelastic mimetic surface, enabling the surface tension of the mimetic to be lowered to match native tracheal mucus. However, surfactant spreading on the more viscoelastic mimetics was hindered, suggesting that the bulk properties of the mimetics dictate the range of surface properties that can be achieved. PMID:23813841

  18. Tracheal reconstruction with a synthetic material in a porcine model. (United States)

    Pearson, S E; Rimell, F; Stelow, E B; Pernell, K


    The technique of tracheal reconstruction with costal cartilage or a pericardial patch has resulted in successful management of many patients with tracheal stenosis. Yet, it is often difficult, if not impossible, to harvest enough cartilage in a neonate. Pericardial patches are flimsy and can collapse. This pilot study evaluated the use of absorbable plates made of an alloplastic material, Lactosorb, as a substitute for cartilage on a growing porcine trachea. The rectangular plates were fashioned into an inverted U and placed into the airway through an anterior tracheal split. This placement resulted in granulation formation and failure. The plates were then fashioned into an I configuration and placed inside and outside the tracheal lumen. This attempt also resulted in failure, secondary to respiratory distress. Finally, the plates were fashioned into an inverted U and placed outside the trachea. In 67% of the subjects, the distraction was maintained and growth continued for the duration of the study. The stent was completely absorbed, with minimal scar or granulation tissue, in 4 months. In 1 subject, the stent migrated, and 1 subject died of a mucous plug. This study suggests that Lactosorb has no role in intraluminal stenting, but that it may be a viable alternative to a pericardial patch or cartilage in tracheal reconstruction when it is placed outside the airway lumen in a young animal.

  19. Biceps Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Daniel M Polvino


    Full Text Available History of present illness: A 55-year-old male presented to the emergency department with a chief complaint of right arm pain. Five days prior to arrival, he attempted to lift himself up on his van and experienced what he described as a “rubber band snapping” in his right arm. He reported severe pain at the time that persisted but lessened in severity. Additionally, he reported increasing bruising over the proximal right arm. He had no history of prior right arm or shoulder injury. Significant findings: Physical exam was significant for ecchymosis and mild swelling of the right bicep. When the right arm was flexed at the elbow, a prominent mass was visible and palpable over the right bicep. Right upper extremity strength was 4/5 with flexion at the elbow. Discussion: The biceps brachii muscle is comprised of a long and short head, which share a common attachment at the bicipital tuberosity on the radius. The short head originates from the coracoid process of the scapula and the long head originates from the supraglenoid tubercle.1 Biceps tendon rupture has been found to occur at a rate of 0.53/100,000 over five years, and is three times more likely to occur in men than women.2 Risk factors for biceps tendon rupture include male sex, old age, increased body mass index, smoking, and pre-existing shoulder pathology.3,4 Diagnosis of biceps tendon rupture is typically a clinical diagnosis utilizing inspection and palpation as well as special testing such as the Speed’s and/or Yergason’s tests. Ultrasound may be used to aid in diagnosis; in full-thickness tears, ultrasound was found to have a sensitivity of 88% and a specificity of 98%. However, in partial thickness tears ultrasound has a sensitivity of 27% and a specificity of 100%.5 Often considered the gold standard in diagnosis, MRI has been found to have a sensitivity of only 67% and specificity of 98% in detecting complete tears6. Treatment initially consists of rest, ice, compression

  20. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon; Beak, Jung Hwan; Oh, Yeon Mok; Ha, Eun Ju; Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)


    We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

  1. A 46-year-old man with tracheomegaly, tracheal diverticulosis, and bronchiectasis: Mounier-Kuhn syndrome

    Directory of Open Access Journals (Sweden)

    Ashish K Jaiswal


    Full Text Available Lower respiratory tract infection is one of the common causes of morbidity in India which is occasionally undiagnosed. In this regard tracheobronchomegaly is one of those conditions which masquerade as chronic bronchitis and bronchiectasis and are usually undiagnosed. It is a well-defined clinical and radiologic entity characterized by marked dilatation of the trachea and the central bronchi and is frequently associated with recurrent lower respiratory tract infection. Tracheobronchomegaly has been described by a variety of names, including Mounier-Kuhn syndrome, tracheal diverticulosis, tracheobronchiectasis, tracheocele, tracheomalacia, and tracheobronchopathia malacia.

  2. Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

    LENUS (Irish Health Repository)

    Salah, Nazar


    Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.

  3. [Difficult laryngoscopy and tracheal intubation: observational study]. (United States)

    Andrade, Rebeca Gonelli Albanez da Cunha; Lima, Bruno Luís Soares; Lopes, Douglas Kaíque de Oliveira; Couceiro Filho, Roberto Oliveira; Lima, Luciana Cavalcanti; Couceiro, Tania Cursino de Menezes

    Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack-Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery. A cross-sectional study in which 133 adult patients undergoing elective surgery requiring tracheal intubation were analyzed. The accuracy and specificity of the modified Mallampati test and jaw-thrust maneuver were assessed by correlating them with difficult laryngoscopy (Cormack-Lehane Degrees 3 and 4). In the 133 patients evaluated the difficult intubation rate found was 0.8%; there was association between the two predictive tests proposed (p=0.012). The values of 94.5% for specificity and 95.4% for accuracy were found for the jaw-thrust maneuver and for the modified Mallampati test, the values found were 81.1% and 81.2%, respectively. Kappa agreement identified a result of 0.240 between jaw-thrust maneuver and Cormarck-Lehane, which was considered reasonable. On the other hand, a poor agreement (κ=0.06) was seen between modified Mallampati test and Cormarck-Lehane test. The jaw-thrust maneuver presented superior accuracy and agreement than the modified Mallampati test, showing the ability to identify a difficult airway. It is necessary to emphasize the association of tests in the evaluation of patients, emphasizing their complementarity to minimize the negative consequences of repeated laryngoscopies. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Short-lived Supershear Rupture (United States)

    Fukuyama, E.; Xu, S.; Yamashita, F.; Mizoguchi, K.; Takizawa, S.; Kawakata, H.


    Fukuyama and Olsen (2002) computed the supershear rupture initiation, propagation and termination process due to a passage of high stress drop area (called asperity) using a boundary integral equation method. They found that supershear rupture continued to propagate after the passage through high stress drop area but it died after a certain propagation distance, which depends on the elastic energy released at the high stress drop area. Here, we could reproduce a similar phenomenon in the laboratory. We conducted large-scale biaxial friction experiments using a pair of meter-scaled metagabbro rock specimens (VP=6.9km/s, VS=3.6km/s) at the National Research institute for Earth Science and Disaster Prevention (NIED). We observed several stick slip rupture events that initiated close to an asperity and immediately became supershear ruptures. But after propagating certain distance they died out and co-existing subshear ruptures became prominent. If we look into details, during the supershear rupture, we could see a sequence of rupture acceleration, its short rest and re-acceleration. This feature reminds us of a sequential breakage of small high stress patches as predicted by Fukuyama and Madariaga (2000). These observations might be interpreted under a concept of energy balance where the energy transmission from strain energy released by the asperity to fracture energy consumed at the crack tip was not instantaneously balanced in space. This could be related to the fact that earthquake rupture velocity is rather smooth reported from the finite fault analysis of large earthquakes with seismic waveforms. References Fukuyama, E. and R. Madariaga (2000) Dynamic propagation and interaction of a rupture front on a planar fault, PAGEOPH, 257, 1959-1979. Fukuyama, E. and K.B. Olsen (2002) A condition for super-shear rupture propagation in a heterogeneous stress field, PAGEOPH, 159, 2047-2056.

  5. Rule and rupture

    DEFF Research Database (Denmark)

    Lund, Christian


    Treating the ‘state’ as a finished product gets in the way of understanding it. The state is always in the making. This article, which acts as the Introduction to a special issue, argues that political authority is (re-)produced through the process of successfully defining and enforcing rights...... to community membership and rights of access to important resources. Claims to rights prompt the exercise of authority. Struggles over property and citizenship are therefore as much about the scope and constitution of political authority as they are about access to resources and membership of a political...... — is constitutive of state power. Thus this essay argues that various moments of rupture (following periods of conflict, of colonial domination, of socialist, liberal, or authoritarian regimes, et cetera) allow us to see that rights do not simply flow from authority but also constitute it. Authority and rights...

  6. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira


    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  7. Comparison between tracheal ratio methods used by three observers at three occasions in English Bulldogs


    Ingman, Jessica; Näslund, Veronica; Hansson, Kerstin


    Background Tracheal hypoplasia is a congenital condition described in mainly brachycephalic breeds and is one component of the brachycephalic obstructive airway syndrome (BOAS). Two radiographic methods have been described to evaluate the dimensions of the tracheal diameter in dogs and to distinguish between hypoplastic and non-hypoplastic tracheas: the tracheal lumen diameter to thoracic inlet distance ratio (TD/TI) and the ratio between the thoracic tracheal luminal diameter and the width o...

  8. Rupture of hepatic hemangioma with hemoperitoneum due to spontaneous gallbladder perforation: A unique case report. (United States)

    Ke, Qing-Hong; Zhang, Chun-Jun; Huang, Hai-Feng


    Hemangiomas are common benign tumors of the liver. Spontaneous rupture is a rare complication, occurring most commonly in giant hemangiomas. Rupture of a hemangioma with hemoperitoneum is a serious development and can be fatal if not managed promptly.The present study reports the unique case of a man who experienced rupture and hemorrhage of a hepatic hemangioma (HH) due to perforation of the gallbladder fundus. After en block resection of the hemangioma and gallbladder using the Pringle maneuver, the patient made an uneventful recovery without complications.To our knowledge, spontaneous rupture of HH secondary to gallbladder perforation has not been reported in the literature. This case highlights a unique, rare cause of ruptured HH and the need to consider appropriate treatment for some hemangiomas to avoid this potentially fatal complication. The current case may provide additional support for treatment of HH due to the potential for spontaneous rupture. For patients with ruptured HH, enucleation with the Pringle maneuver is recommended.

  9. Tracheal Papilloma with Exceptionally Longer Interval of Recurrence

    Directory of Open Access Journals (Sweden)

    Teruya Komatsu


    Full Text Available A case of recurrent respiratory papilloma of the trachea was reviewed in accordance with other literature. A 66-year-old man with the chief complaint of haemoptysis was referred to our department for meticulous checkup. According to his past medical history of laser ablation for laryngeal and tracheal papilloma, recurrence of the papilloma was first suspected and confirmed by bronchoscopic biopsy. The recurrent papilloma, of about 5 mm in diameter, was located at the same endotracheal lesion, left side of the middle trachea, where the former first and second tracheal papillomas had been detected and treated with Nd-YAG laser. Under general anaesthesia with endotracheal intubation, the patient underwent bronchoscopic resection of the recurrent papilloma with KTP laser. The bronchoscopic resection was uneventful, as was the postoperative course. In this report, the clinical manifestations of and therapeutic approach for tracheal papilloma are reviewed.

  10. Cell renewal in adjoining intestinal and tracheal epithelia of Manduca. (United States)

    Nardi, James B; Bee, Charles Mark; Miller, Lou Ann; Mathur, Divya; Ohlstein, Benjamin


    Cell renewal continuously replaces dead or dying cells in organs such as human and insect intestinal (midgut) epithelia; in insects, control of self-renewal determines insects' responses to any of the myriad pathogens and parasites of medical and agricultural importance that enter and cross their midgut epithelia. Regenerative cells occur in the midgut epithelia of many, if not all, insects and are probably derived from a distinctive population of stem cells. The control of proliferation and differentiation of these midgut regenerative cells is assumed to be regulated by an environment of adjacent cells that is referred to as a regenerative cell niche. An antibody to fasciclin II marks cell surfaces of tracheal regenerative cells associated with rapidly growing midgut epithelia. Tracheal regenerative cells and their neighboring midgut regenerative cells proliferate and differentiate in concert during the coordinated growth of the midgut and its associated muscles, nerves and tracheal cells. Published by Elsevier Ltd.

  11. Subpatch roughness in earthquake rupture investigations

    National Research Council Canada - National Science Library

    Zielke, O; Mai, P. M


    ...) and strongly affect the rupture process at corresponding scales. Numerical rupture simulations provide a framework to quantitatively investigate the relationship between a fault's roughness and its seismic characteristics...

  12. Ruptured intracranial dermoid cyst: a case report

    Directory of Open Access Journals (Sweden)

    Ajla Rahimić Čatić


    Full Text Available Intracranial dermoid cysts are congenital, usually nonmalignant lesions with an incidence of 0.5% of all intracranial tumors. They tend to occur in the midline sellar, parasellar, or frontonasal regions. Although theirnature is benign, dermoid cysts have a high morbidity and mortality risk, especially when rupture occurs. A 40 year old woman presented with head injury after she experienced sudden loss of consciousness. She hada history of headache, loss of consciousness; her past medical history was not remarkable. The patient had no complaints of nausea, vomiting, or seizures. Vital signs were stable, neurologic defi cit was not identifi ed.Computed tomography (CT and magnetic resonance imaging (MRI showed right temporobasal zone with fat droplets within right fi ssure Sylvii and interhemispheric fi ssure indicating a rupture of a dermoid cyst. Craniotomy and cyst resection were done, and diagnosis was confirmed with pathological examination following surgery. After surgery the patient did not recover. Cerebral ischemia from chemical meningitis was fatal forour patient. Headache as a symptom has many causes. It is rarely due to chemical meningitis arising from a ruptured dermoid cyst. This case report illustrated the importance of investigating a cause of the headache,CT and MRI being diagnostic methods. In this way, mortality as well as morbidity from complications such as chemical arachnoiditis can be significantly reduced if imaging is done early in these patients.

  13. Gravid med spontan ruptur af arteria uterina

    DEFF Research Database (Denmark)

    Jònsdòttir, Fjòla; Pinborg, Anja; Wilken-Jensen, Charlotte


    Pregnant women with acute abdominal pain are a clinical challenge. We present a rare but potential life-threatening condition of a pregnant woman with acute abdominal pain. The woman was in gestational week 37 with severe abdominal pain and was admitted to the labour ward. She became haemo-dynami......-dynamic instable 24 hours after vaginal delivery, and emergency laparotomi revealed a spontaneous rupture of the right uterine artery. Spontaneous rupture of the uterine artery is rare but should be considered as a possible cause of acute abdominal pain in pregnant women.......Pregnant women with acute abdominal pain are a clinical challenge. We present a rare but potential life-threatening condition of a pregnant woman with acute abdominal pain. The woman was in gestational week 37 with severe abdominal pain and was admitted to the labour ward. She became haemo...

  14. Death of a 6-month-old due to a tracheal bronchus. (United States)

    Hansen-Welches, Lauren; Slabach, Rachel; Landrum, Jeffry E; Prahlow, Joseph A


    The death of an infant younger than 1 year requires a thorough scene investigation and autopsy. Most infant deaths investigated by forensic pathologists can be placed into 2 general categories: sudden infant death syndrome and accidental asphyxial deaths. Despite the fact that most infant deaths occur within these 2 categories, it is important to remember that other entities may be responsible for death. In this report, we present a developmental pulmonary abnormality that was ultimately responsible for the death of an infant. A 6-month-old male infant with a prior history of pneumonia was brought to an emergency department for evaluation of fever. Antibiotics were prescribed, and the child was discharged and sent home with instructions to his mother to follow up with his pediatrician. Later that evening, the infant seemed to be in respiratory distress. His mother again transported him to the emergency department, where, on arrival, he became apneic. Despite vigorous resuscitative efforts, the infant died. Of note at autopsy was the presence of low-set abnormal ears and bilateral inward-turning ankles. Internally, an abnormality of the tracheobronchial tree was evident, with the right upper lobe bronchus arising from the distal trachea, proximal to the carina. In addition, the right upper lobe was discolored and firm. Microscopically, pneumonia was present. The cause of death was pneumonia due to a right tracheal bronchus. Childhood pneumonia is a known cause of childhood hospitalization, morbidity, and mortality. Identifying the causes of recurrent pneumonia, be it structural, metabolic, or syndromic, aids in preventing recurrent infections and reducing the incidence of childhood mortality. A tracheal bronchus, also known as bronchus suis or "pig bronchus," is an anatomic variant of the tracheobronchial tree in which a bronchus arises proximal to the carina, most commonly on the right and predominantly in males. The incidence is around 0.2%. Although the tracheal

  15. File list: Oth.Lng.20.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

    Full Text Available Oth.Lng.10.AllAg.Tracheal_epithelial_cells hg19 TFs and others Lung Tracheal epithe...lial cells SRX268452,SRX268450,SRX268451 ...

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    Lifescience Database Archive (English)

    Full Text Available DNS.Lng.20.AllAg.Tracheal_epithelial_cells hg19 DNase-seq Lung Tracheal epithelial ...cells SRX1420085,SRX374730,SRX374729 ...

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

    Full Text Available His.Lng.50.AllAg.Tracheal_epithelial_cells hg19 Histone Lung Tracheal epithelial ce...lls ...

  1. File list: Unc.Lng.05.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available Unc.Lng.05.AllAg.Tracheal_epithelial_cells hg19 Unclassified Lung Tracheal cells ...

  2. Tracheal palpation to assess endotracheal tube depth: an exploratory study. (United States)

    McKay, William P; Klonarakis, Jim; Pelivanov, Vladko; O'Brien, Jennifer M; Plewes, Chris


    Correct placement of the endotracheal tube (ETT) occurs when the distal tip is in mid-trachea. This study compares two techniques used to place the ETT at the correct depth during intubation: tracheal palpation vs placement at a fixed depth at the patient's teeth. With approval of the Research Ethics Board, we recruited American Society of Anesthesiologists physical status I-II patients scheduled for elective surgery with tracheal intubation. Clinicians performing the tracheal intubations were asked to "advance the tube slowly once the tip is through the cords". An investigator palpated the patient's trachea with three fingers spread over the trachea from the larynx to the sternal notch. When the ETT tip was felt in the sternal notch, the ETT was immobilized and its position was determined by fibreoptic bronchoscopy. The position of the ETT tip was compared with our hospital standard, which is a depth at the incisors or gums of 23 cm for men and 21 cm for women. The primary outcome was the incidence of correct placement. Correct placement of the ETT was defined as a tip > 2.5 cm from the carina and > 3.5 cm below the vocal cords. Movement of the ETT tip was readily palpable in 77 of 92 patients studied, and bronchoscopy was performed in 85 patients. Placement by tracheal palpation resulted in more correct placements (71 [77%]; 95% confidence interval [CI] 74 to 81) than hospital standard depth at the incisors or gums (57 [61%]; 95% CI 58 to 66) (P = 0.037). The mean (SD) placement of the ETT tip in palpable subjects was 4.1 (1.7) cm above the carina, 1.9 cm (1.5-2.3 cm) below the ideal mid-tracheal position. Tracheal palpation requires no special equipment, takes only a few seconds to perform, and may improve ETT placement at the correct depth. Further studies are warranted.

  3. Trachealess (Trh) regulates all tracheal genes during Drosophila embryogenesis. (United States)

    Chung, SeYeon; Chavez, Cy; Andrew, Deborah J


    The Drosophila trachea is a branched tubular epithelia that transports oxygen and other gases. trachealess (trh), which encodes a bHLH-PAS transcription factor, is among the first genes to be expressed in the cells that will form the trachea. In the absence of trh, tracheal cells fail to invaginate to form tubes and remain on the embryo surface. Expression of many tracheal-specific genes depends on trh, but all of the known targets have relatively minor phenotypes compared to loss of trh, suggesting that there are additional targets. To identify uncharacterized transcriptional targets of Trh and to further understand the role of Trh in embryonic tracheal formation, we performed an in situ hybridization screen using a library of ~100 tracheal-expressed genes identified by the Berkeley Drosophila Genome Project (BDGP). Surprisingly, expression of every tracheal gene we tested was dependent on Trh, suggesting a major role for Trh in activation and maintenance of tracheal gene expression. A re-examination of the interdependence of the known early-expressed transcription factors, including trh, ventral veinless (vvl) and knirps/knirps-related (kni/knrl), suggests a new model for how gene expression is controlled in the trachea, with trh regulating expression of vvl and kni, but not vice versa. A pilot screen for the targets of Vvl and Kni/Knrl revealed that Vvl and Kni have only minor roles compared to Trh. Finally, genome-wide microarray experiments identified additional Trh targets and revealed that a variety of biological processes are affected by the loss of trh. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Congenital tracheal defects: embryonic development and animal models

    Directory of Open Access Journals (Sweden)

    Zenab Arooj Sher


    Full Text Available Tracheal anomalies are potentially catastrophic congenital defects. As a newborn begins to breathe, the trachea needs to maintain an appropriate balance of elasticity and rigidity. If the tracheal cartilages are disorganized or structurally weak, the airways can collapse, obstructing breathing. Cartilage rings that are too small or too rigid can also obstruct breathing. These anomalies are frequently associated with craniofacial syndromes, and, despite the importance, are poorly understood. In this review, we summarize the spectrum of pathological phenotypes of the trachea and correlate them with the molecular events uncovered in mouse models.

  5. Customized Tracheostomy Cannula as a Therapeutic Adjunct in Tracheal Stenosis

    Directory of Open Access Journals (Sweden)

    Doh Young Lee


    Full Text Available Tracheotomy is often successfully used to manage tracheal stenosis, as a temporizing measure prior to definitive treatment or a long-term remedy. In some patients, where a sizeable portion trachea is stenotic, the fixed arm of an ordinary tracheotomy tube may not be of sufficient length to satisfactorily maintain the distal tracheal lumen, and commercially available adjustable tubes may not be at hand in certain clinical settings. Herein, we describe a simple method of constructing a temporary tracheotomy tube with an adjustable distal arm, allowing custom fit at the patient bedside.

  6. Tracheal intubation and sore throat: a mechanical explanation

    National Research Council Canada - National Science Library

    Chandler, M


    .... Use of the model suggests that the tracheal tube and laryngeal mask airway impinge on the pharyngeal wall in different manners and involve different mechanisms for their conformation to the upper airway, but that in a static situation, the forces exerted on the pharyngeal wall are low with both devices. It also suggests that the incidence of sore throat should be lower for softer and smaller tracheal tubes and that the standard ‘Magill’ curve (radius of curvature 140 ± 20 mm) is about optimum for the average airway.

  7. Thompson Test in Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Spencer Albertson


    Full Text Available HPI: A 26-year old male presented to the emergency department after experiencing the acute onset of left ankle pain while playing basketball. Upon jumping, he felt a “pop” in his left posterior ankle, followed by pain and difficulty ambulating. His exam was notable for a defect at the left Achilles tendon on palpation. The practitioner performed a Thompson test, which was positive (abnormal on the left. Significant Findings: The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing the right (unaffected calf, the ankle spontaneously plantar flexed, indicating a negative (normal Thompson test. Upon squeeze of the left (affected calf, the ankle did not plantar flex, signifying a positive (abnormal Thompson test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later. Discussion: The Achilles tendon (also: calcaneal tendon or heel cord is derived from the medial and lateral heads of the gastrocnemius muscle, as well as the soleus muscle. Rupture of the Achilles tendon most commonly occurs in the distal tendon, approximately 2-6 cm from its attachment to the calcaneal tuberosity, in an area of hypovascularity known as the “watershed” or “critical” zone.1-3 The Thompson test (also: Simmonds-Thompson test, described by Simmonds in 1957 and Thompson in 1962, is done while the patient is in the prone position, with feet hanging over the end of a table/gurney, or with the patient kneeling on a stool or chair.4-5 Squeezing the calf of an unaffected limb will cause the ankle to plantar flex, but squeezing the calf of a limb with an Achilles tendon rupture will cause no motion. The sensitivity of the Thompson’s test for the diagnosis of a complete Achilles tendon rupture is 96-100% and the specificity is 93-100%, but data is limited.6-8

  8. Non-operative treatment of ruptured ectopic pregnancy. (United States)

    Dalsgaard Jensen, Trine; Penninga, Luit


    Ruptured ectopic pregnancy often causes abdominal pain, vaginal bleeding and internal haemorrhage; it is a very serious condition and can be life-threatening. Patients with a ruptured ectopic pregnancy are normally treated by surgical intervention. We describe a case of a 20-year-old woman who presented with abdominal pain and vaginal bleeding. Urine human chorionic gonadotropin was positive and on examination she had localised tenderness of the abdomen. Transvaginal ultrasonography revealed a ruptured tubal pregnancy along with blood in the abdomen. The patient was closely monitored and treated conservatively, with a successful outcome. She recovered uneventfully. Our case shows that non-operative treatment of a ruptured ectopic pregnancy may be a possible non-invasive treatment option in highly selected patients. 2016 BMJ Publishing Group Ltd.

  9. Radiologic analysis of the medical collateral ligament rupture

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Chung Che; Lee, Chang Jun; Kim, Kun Sang; Park, Soo Soung [Chung Ang University College of Medicine, Seoul (Korea, Republic of)


    The medical collateral ligament rupture is the most common injury involving the knee joint ligaments. The ruptured medical collateral ligaments of 73 cases with clinical and surgical confirmations were radiologically analyzed. The results were obtained as follows: 1. The most risky age for tearing of the medical collateral ligament was third to fifth decades (50 cases of male and 23 of females). 2. The most common cause of the medical collateral ligament rupture was traffic accident (82.2%). 3. The mean distance of medial knee joint space was 7.9 {+-} 2.0 mm on the normal side and 13.7 {+-} 4.2 mm on the affected side. 4. The mean degree of knee joint space was 10.1 {+-} 2.5 on the normal side and 14.7 {+-} 3.8 on the affected side. 5. The fibula was the bone fractured most frequently in association with the medial collateral ligament rupture (30.6%)

  10. Three cases of spontaneous lumbar artery rupture in hemodialysis patients. (United States)

    Hwang, Na Kyoung; Rhee, Harin; Kim, Il Young; Seong, Eun Young; Lee, Dong Won; Lee, Soo Bong; Kwak, Ihm Soo; Kim, Chang Won; Song, Sang Heon


    We encountered three cases of retroperitoneal hematoma caused by spontaneous lumbar artery rupture, a rare vascular complication. At the time of retroperitoneal hematoma, two patients were on anticoagulant/antiplatelet therapy. One patient was not taking any anticoagulant/antiplatelet agents but was receiving hemodialysis treatment with heparin. Lumbar artery rupture was successfully controlled by transcatheter arterial embolization in all patients, but one patient developed multiple organ failure and died. We suggest that spontaneous lumbar artery rupture may occur in patients being treated with maintenance hemodialysis or anticoagulant/antiplatelet therapy. Therefore, clinicians should suspect lumbar artery rupture in patients with unstable vital signs and rapid onset of anemia because early diagnosis and appropriate intervention are necessary to decrease the risks of morbidity and mortality. © 2016 International Society for Hemodialysis.

  11. Bladder Rupture and Urine Fistula Between-Bladder and Supracondylary Pin Tract After Pelvis Fracture: A Case Report

    Directory of Open Access Journals (Sweden)

    Zekeriya Oztemur


    Full Text Available One of the most important complications of pelvic fractures is bladder rupture. Potential complications of pelvic fractures caused by bladder ruptures are vesicovaginal, vesicorectal, vesicouterine and urethrorectal fistulas. Along with bladder rupture, which is rarely encountered in the literature, the case of urinary fistula from pin tract in femur supracondylar region was represented. The case of the bladder rupture induced by pelvic fracture that associated with urinary fistulisation between bladder and pin tract from femur supracondylar region was reported.

  12. Unexpected traumatic rupture of left atrium mimicking aortic rupture

    Directory of Open Access Journals (Sweden)

    Abdallah K Alameddine


    Full Text Available Left atrial (LA rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.

  13. Determination of legal responsibility in iatrogenic tracheal and laryngeal stenosis. (United States)

    Svider, Peter F; Pashkova, Anna A; Husain, Qasim; Mauro, Andrew C; Eloy, Jean Daniel; Baredes, Soly; Eloy, Jean Anderson


    Laryngotracheal stenosis usually occurs as a result of injury from endotracheal intubation or tracheostomy placement. With an estimated incidence of 1% to 22% after these procedures, chronic sequelae ranging from discomfort to devastating effects on quality of life, and even death, make this complication a potential litigation target. We examined federal and state court records for malpractice regarding laryngotracheal stenosis and examined characteristics influencing determination of liability. Retrospective analysis. The Westlaw Next legal database (Thomson Reuters, New York, NY) was searched for pertinent federal and state malpractice cases and examined for several factors including alleged cause of malpractice, complications, case outcome, and specialty of the defendants. Twenty-three pertinent cases over 35 years were identified. Fourteen (60.9%) cases were decided in the physician's favor, with six plaintiff verdicts awarding an average of $922,129 for malpractice, and three out-of-court settlements averaging $441,600. Hospitals were the most frequently named defendants, and anesthesiologists were most commonly named physician defendants. Endotracheal intubations and tracheostomy history were frequent factors in these cases. Laryngeal lesions were more likely to result in payments, trending higher than those stemming from tracheal lesions. Multiple cases mentioned previous intubation as a potential risk factor that may have led to laryngotracheal stenosis. Location of stenosis and requirement of reparative procedures may also influence outcomes. Cases not decided in the defendant's favor frequently included other extenuating circumstances, including severity of other injuries. Although the majority of cases were defendant decisions, the verdicts decided for the plaintiffs had considerable damages awarded. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Tracheal intubation related complications in the prehospital setting. (United States)

    Caruana, Emmanuel; Duchateau, François-Xavier; Cornaglia, Carole; Devaud, Marie-Laure; Pirracchio, Romain


    Prehospital tracheal intubation (TI) is associated with morbidity and mortality, particularly in cases of difficult intubation. The goal of the present study was to describe factors associated with TI related complications in the prehospital setting. This was a prospective cohort study including all patients intubated on scene in a prehospital emergency medical service over a 4 year period. TI related complications included oxygen desaturation, aspiration, vomiting, bronchospasm and/or laryngospasm, and mechanical complications (mainstem intubation, oesophageal intubation and airway lesion- that is, dental or laryngeal trauma caused by the laryngoscope). Difficult intubation was defined as >2 failed laryngoscopic attempts, or the need for any alternative TI method. A multivariate logistic regression was used to identify the risk factors for TI related complications. 1251 patients were included; 208 complications occurred in 165 patients (13.1%). Among the 208 complications, the most frequent were oesophageal intubation (n=69, 29.7%), desaturation (n=58, 25.0%) and mainstem intubation (n=37, 15.9%). In multivariate analysis, difficult intubation (OR=6.13, 3.93 to 9.54), Cormack and Lehane grades 3 and 4 (OR=2.23, 1.26 to 3.96 for Cormack and Lehane grade 3 and OR=2.61, 1.28 to 5.33 for Cormack and Lehane grade 4 compared with Cormack and Lehane grade 1) and a body mass index >30 kg/m(2) (OR=2.22, 1.38 to 3.56) were significantly associated with TI related complications. Despite specific guidelines, TI related complications are more frequent in the prehospital setting when intubation is deemed difficult, the Cormack and Lehane grade is greater than grade 1 and the patient is overweight. In such situations, particular attention is needed to avoid complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  15. Ruptured thought: rupture as a critical attitude to nursing research. (United States)

    Beedholm, Kirsten; Lomborg, Kirsten; Frederiksen, Kirsten


    In this paper, we introduce the notion of ‘rupture’ from the French philosopher Michel Foucault, whose studies of discourse and governmentality have become prominent within nursing research during the last 25 years. We argue that a rupture perspective can be helpful for identifying and maintaining a critical potential within nursing research. The paper begins by introducing rupture as an inheritance from the French epistemological tradition. It then describes how rupture appears in Foucault's works, as both an overall philosophical approach and as an analytic tool in his historical studies. Two examples of analytical applications of rupture are elaborated. In the first example, rupture has inspired us to make an effort to seek alternatives to mainstream conceptions of the phenomenon under study. In the second example, inspired by Foucault's work on discontinuity, we construct a framework for historical epochs in nursing history. The paper concludes by discussing the potential of the notion of rupture as a response to the methodological concerns regarding the use of Foucault-inspired discourse analysis within nursing research. We agree with the critique of Cheek that the critical potential of discourse analysis is at risk of being undermined by research that tends to convert the approach into a fixed method.

  16. The influence of a heat and moisture exchanger on tracheal climate in a cold environment. (United States)

    Zuur, J Karel; Muller, Sara H; Vincent, Andrew; Sinaasappel, Michiel; de Jongh, Frans H C; Hilgers, Frans J M


    The incidence of pulmonary complaints, severe tracheitis and lung function deterioration is increased during wintertime in laryngectomized individuals. We analyzed how a heat and moisture exchanger (HME) performs in cold and dry ambient circumstances, and how its efficiency in this environmental climate might be improved. Randomized crossover. Intra-tracheal temperature and humidity were measured in 10 laryngectomized patients with and without HME, in a cold (mean, 4.7 degrees C) and dry (mean, 4.5 mgH2O/L) room. Presence of an HME causes the intra-tracheal mean humidity minima and maxima to increase with 4.2 mgH2O/L (95%CI: 3.3-5.0 mgH2O/L; p<0.001) and 2.4 mgH2O/L (95%CI: 1.7-3.1 mgH2O/L; p<0.001), respectively. The intra-tracheal mean temperature minima and maxima increased with 3.9 degrees C (95%CI: 2.7-5.1 degrees C; p<0.001) and 1.2 degrees C (95%CI: 0.8-1.2 degrees C; p<0.001), respectively. In the majority of patients, the calculated relative humidity values appear to reach well above 100% during inspiration. In a cold environment, presence of an HME significantly increases both inspiratory and expiratory temperature and humidity values. Relative humidity calculations suggest the formation of condense droplets during inspiration. To further increase its effectiveness, improvement of the HME's thermal capacity should be aimed for.

  17. Nitric Oxide Synthase Promotes Distension-Induced Tracheal Venular Leukocyte Adherence (United States)

    Moldobaeva, Aigul; Rentsendorj, Otgonchimeg; Jenkins, John; Wagner, Elizabeth M.


    The process of leukocyte recruitment to the airways in real time has not been extensively studied, yet airway inflammation persists as a major contributor to lung pathology. We showed previously in vivo, that neutrophils are recruited acutely to the large airways after periods of airway distension imposed by the application of positive end-expiratory pressure (PEEP). Given extensive literature implicating products of nitric oxide synthase (NOS) in lung injury after ventilatory over-distension, we questioned whether similar mechanisms exist in airway post-capillary venules. Yet, endothelial nitric oxide has been shown to be largely anti-inflammatory in other systemic venules. Using intravital microscopy to visualize post-capillary tracheal venules in anesthetized, ventilated mice, the number of adherent leukocytes was significantly decreased in eNOS-/- mice under baseline conditions (2±1 cell/60 min observation) vs wild type (WT) C57BL/6 mice (7±2 cells). After exposure to PEEP (8 cmH2O for 1 min; 5 times), adherent cells increased significantly (29±5 cells) in WT mice while eNOS-/- mice demonstrated a significantly decreased number of adherent cells (11±4 cells) after PEEP. A similar response was seen when thrombin was used as the pro-inflammatory stimulus. In addition, mouse tracheal venular endothelial cells studied in vitro after exposure to cyclic stretch (18% elongation) or thrombin both demonstrated increased p-selectin expression that was significantly attenuated by NG-nitro-L-arginine methyl ester, N-acetylcysteine amide (NACA) and excess BH4. In vivo treatment with the ROS inhibitor NACA or co-factor BH4 abolished completely the PEEP-induced leukocyte adherence. These results suggest that pro-inflammatory stimuli cause leukocyte recruitment to tracheal endothelium in part due to eNOS uncoupling. PMID:25181540

  18. incomplete uterine rupture following blunt trauma to the

    African Journals Online (AJOL)

    Keywords: Blunt abdominal injury, incomplete uterine rupture, shock and active resuscitation. INTR()I)UC'l'ION ... The major causes of maternal trauma are vehicular .... The management of the condition, irrespective of the cause, is emergency exploratory laparotomy after adequate resuscitation, as was done in this patient3.

  19. [Antenatal prediction of pulmonary hypoplasia and intrauterine treatment by endoscopic fetal tracheal occlusion in severe isolated congenital diaphragmatic hernia]. (United States)

    Gucciardo, Leonardo; Deprest, Jan A; Vaast, Pascal; Favre, Romain; Gallot, Denis; Huissoud, Cyril; Bretelle, Florence; Agenor, Joel; Benachi, Alexandra; Jani, Jacques; Done, Elise; van Mieghem, Tim; Ville, Yves; Devlieger, Roland


    Congenital diaphragmatic hernia (CDH) affects one in 2500 to 5000 births and can be detected in utero by means of ultrasound screening Associated structural problems aggravate the prognosis. The survival rate is 70% or more for cases managed in tertiary care centers. The commonest causes of neonatal death in this setting are pulmonary hypoplasia and pulmonary hypertension. Prenatal imaging findings can now accurately predict postnatal outcome, based mainly on ultrasound determination of the lung-to-head ratio and liver position. This information can be used to counsel patients. In severe cases, prenatal intervention can reverse pulmonary hypoplasia. We review current data on prenatal prediction of neonatal survival. We also discuss experimental and clinical data on the benefits of fetal tracheal occlusion. The TOTAL trial (Tracheal Occlusion To Accelerate Lung growth) is currently ongoing in Europe.

  20. Phosphatidylglycerol in tracheal aspirates for diagnosis of hyaline membrane disease.


    Francoual, J.; Magny, J F; Ropert, J C; DEHAN, M.; Leluc, R


    Lecithin:sphingomyelin ratio and phosphatidylglycerol were determined by a rapid, simple method in tracheal aspirates obtained from 132 newborn infants with respiratory diseases, sixty five of whom developed hyaline membrane disease. Phosphatidylglycerol determination was more sensitive (97%) than lecithin:sphingomyelin ratio, but their specificities were similar (76%).

  1. [Clinical analysis of therapeutic bronchoscopy for tracheal neoplasm]. (United States)

    Ding, Y F; Chen, L; Huang, H D; Dong, Y C; Yao, X P; Huang, Y; Wang, Q; Zhang, W; Li, Q; Bai, C


    Objective: To analyze the clinical features in adults with tracheal neoplasm and to evaluate the efficacy of interventional bronchoscopic treatment. Methods: We retrospectively analyzed the clinical features of 43 adults undergoing therapeutic bronchoscopy for tracheal neoplasm diagnosed in Changhai Hospital affiliated to the Second Military Medical University from January 2004 to July 2014.The degree of stenosis, the grade of dyspnea, and Karnofsky performance status scale were evaluated before and after the last procedure. All cases were followed up for 2 years. Results: The 43 cases took (4.6±3.9) months on average to be diagnosed since initial symptom. The initial misdiagnosis rate was 41.9%(18/43), and 11 cases were mistaken for asthma (11/43). Malignant tumors were more common than benign tumors for tracheal neoplasm in adults. Squamous cell carcinoma and adenoid cystic carcinoma were the top 2 histological types. Central airway obstruction was completely or partially alleviated with significant relief of dyspnea after the procedures, and all 6 cases of tracheal benign tumors got complete alleviation (the overall response rate was 100%). The grade of dyspnea was 3.2±0.7 before and 1.5±0.8 after the procedures(t=6.63, Pneoplasm.

  2. Difficult Tracheal Intubation in Obese Gastric Bypass patients

    DEFF Research Database (Denmark)

    Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.


    undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI...

  3. [Tracheal reconstruction with memory alloy prosthesis coated with collagen]. (United States)

    Lin, Hai-ping; Cao, Zi-ang; Gu, Xu-dong; Pan, Wen-biao; Wu, Xue-jun; Zhang, Gu-lan


    To investigate the feasibility of tracheal reconstruction with a prosthesis made of memory alloy coated with collagen sponge in mongrel dogs. The basic skeleton of the prosthesis was knitted with Ni-Ti memory alloy wires. The tubular mesh was sealed with polyurethane membrane and then inner and external walls of the lumen were coated with collagen sponge. Cervical trachea segmental reconstruction was performed in 8 mongrel dogs with these prostheses. The efficacy of the implanted prostheses were periodically evaluated after operation using x-ray, tracheoscopy and specimen microscope examinations. One dog died of prosthesis dislocation 10 days after operation, another was killed 45 days later because of anastomotic stenosis. 6 dogs survived more than 90 days and the longest one lived for 150 days. Its implanted prosthesis was completely incorporated with the recipient tissue, where re-epithelialization occluded on anastomotic sites. The tracheal lumen was patent. This memory alloy tracheal prosthesis has been proved useful for reconstruction of large, circumferential tracheal defects, although its long-term safety and efficiency need to be confirmed.

  4. Engineered Tissue-Stent Biocomposites as Tracheal Replacements

    NARCIS (Netherlands)

    Zhao, L. (Liping); Sundaram, S. (Sumati); Le, A.V. (Andrew V.); Huang, A.H. (Angela H.); Zhang, J. (Jiasheng); Hatachi, G. (Go); Beloiartsev, A. (Arkadi); Caty, M.G. (Michael G.); Yi, T. (Tai); Leiby, K. (Katherine); Gard, A. (Ashley); Kural, M.H. (Mehmet H.); Gui, L. (Liqiong); Rocco, K.A. (Kevin A.); Sivarapatna, A. (Amogh); Calle, E. (Elizabeth); Greaney, A. (Allison); Urbani, L. (Luca); Maghsoudlou, P. (Panagiotis); A.J. Burns (Alan); DeCoppi, P. (Paolo); Niklason, L.E. (Laura E.)


    textabstractHere we report the creation of a novel tracheal construct in the form of an engineered, acellular tissue-stent biocomposite trachea (TSBT). Allogeneic or xenogeneic smooth muscle cells are cultured on polyglycolic acid polymer-metal stent scaffold leading to the formation of a tissue

  5. Laryngeal Preservation in Managing Advanced Tracheal Adenoid Cystic Carcinoma

    Directory of Open Access Journals (Sweden)

    Thavakumar Subramaniam


    Full Text Available A 37-year-old male athlete was diagnosed with primary tracheal adenoid cystic carcinoma following investigation for dyspnea, wheeze, and eventual stridor. Preoperative bronchoscopy revealed a highly vascular tumor 4 cm distal to the cricoid with no gross disease extending to the carina. Imaging revealed circumferential tracheal irregularity immediately inferior to the cricoid, with no definite cricoid invasion. Locoregional extension of disease was noted invading the thyroid and abutment of the carotid approximately 180°. Intraoperative findings identified tracheal mucosal disease extending distal to the carina and proximally at the cricothyroid joints where bilateral functional recurrent nerves were preserved. A decision made to preserve the larynx given the inability to fully resect distal tracheal disease. A 5 cm sleeve resection of the trachea was made with a cricotracheal anastomosis following suprahyoidal muscle release and laryngeal drop-down. The patient was treated with adjuvant radiotherapy including platinum based chemotherapy in an effort to maximise local control. PET scanning three months after therapy revealed no FDG uptake locally or distally.

  6. Implantation of Induced Pluripotent Stem Cell-Derived Tracheal Epithelial Cells. (United States)

    Ikeda, Masakazu; Imaizumi, Mitsuyoshi; Yoshie, Susumu; Nakamura, Ryosuke; Otsuki, Koshi; Murono, Shigeyuki; Omori, Koichi


    Compared with using autologous tissue, the use of artificial materials in the regeneration of tracheal defects is minimally invasive. However, this technique requires early epithelialization on the inner side of the artificial trachea. After differentiation from induced pluripotent stem cells (iPSCs), tracheal epithelial tissues may be used to produce artificial tracheas. Herein, we aimed to demonstrate that after differentiation from fluorescent protein-labeled iPSCs, tracheal epithelial tissues survived in nude rats with tracheal defects. Red fluorescent tdTomato protein was electroporated into mouse iPSCs to produce tdTomato-labeled iPSCs. Embryoid bodies derived from these iPSCs were then cultured in differentiation medium supplemented with growth factors, followed by culture on air-liquid interfaces for further differentiation into tracheal epithelium. The cells were implanted with artificial tracheas into nude rats with tracheal defects on day 26 of cultivation. On day 7 after implantation, the tracheas were exposed and examined histologically. Tracheal epithelial tissue derived from tdTomato-labeled iPSCs survived in the tracheal defects. Moreover, immunochemical analyses showed that differentiated tissues had epithelial structures similar to those of proximal tracheal tissues. After differentiation from iPSCs, tracheal epithelial tissues survived in rat bodies, warranting the use of iPSCs for epithelial regeneration in tracheal defects.

  7. Fetal membrane healing after spontaneous and iatrogenic membrane rupture: A review of current evidence


    Devlieger, R.; Millar, L. K.; Bryant-Greenwood, G.; Lewi, L.; Deprest, J. A.


    In view of the important protective role of the fetal membranes, wound sealing, tissue regeneration, or wound healing could be life saving in cases of preterm premature rupture of the membranes. Although many investigators are studying the causes of preterm premature rupture of membranes, the emphasis has not been on the wound healing capacity of the fetal membranes. In this review, the relevant literature on the pathophysiologic condition that leads to preterm premature rupture of membranes ...

  8. An ovine tracheal explant culture model for allergic airway inflammation

    Directory of Open Access Journals (Sweden)

    Abeynaike Latasha


    Full Text Available Abstract Background The airway epithelium is thought to play an important role in the pathogenesis of asthmatic disease. However, much of our understanding of airway epithelial cell function in asthma has been derived from in vitro studies that may not accurately reflect the interactive cellular and molecular pathways active between different tissue constituents in vivo. Methods Using a sheep model of allergic asthma, tracheal explants from normal sheep and allergic sheep exposed to house dust mite (HDM allergen were established to investigate airway mucosal responses ex vivo. Explants were cultured for up to 48 h and tissues were stained to identify apoptotic cells, goblet cells, mast cells and eosinophils. The release of cytokines (IL-1α, IL-6 and TNF-α by cultured tracheal explants, was assessed by ELISA. Results The general morphology and epithelial structure of the tracheal explants was well maintained in culture although evidence of advanced apoptosis within the mucosal layer was noted after culture for 48 h. The number of alcian blue/PAS positive mucus-secreting cells within the epithelial layer was reduced in all cultured explants compared with pre-cultured (0 h explants, but the loss of staining was most evident in allergic tissues. Mast cell and eosinophil numbers were elevated in the allergic tracheal tissues compared to naïve controls, and in the allergic tissues there was a significant decline in mast cells after 24 h culture in the presence or absence of HDM allergen. IL-6 was released by allergic tracheal explants in culture but was undetected in cultured control explants. Conclusions Sheep tracheal explants maintain characteristics of the airway mucosa that may not be replicated when studying isolated cell populations in vitro. There were key differences identified in explants from allergic compared to control airways and in their responses in culture for 24 h. Importantly, this study establishes the potential for the

  9. Ectopic Pregnancy With Tubal Rupture: An Analysis Of 80 Cases. (United States)

    Ashfaq, Sana; Sultan, Sadia; Aziz, Safia; Irfan, Marium Mohammed; Hasan, Miray; Siddique, Afshan


    Ectopic pregnancy (EP) is a major problem in obstetrics as there is evidence of increasing incidence throughout the world. It is an important cause of maternal morbidity and mortality. In Pakistan, the care seeking behaviour among female is limited that makes female vulnerable to die due to complication of ectopic pregnancy. The aim of this study is to determine the frequency of tubal rupture in ectopic pregnancy in Pakistani patients. In this crosssectional study data pertaining to age, gestational age, parity and duration of presenting symptoms were collected and analysed. 80 patients were diagnosed to have ectopic pregnancy. The frequency of tubal rupture was 91.25%. It is encountered significantly more often in women with age of 26 years. More tubal rupture is found in patient with low parity, in which the frequency of tubal rupture is up to 100% and decrease up to 78.6% with increasing parity up to four. Furthermore, it is noted that increase in gestational age from 8 weeks to 10 weeks caused an increase in frequency of tubal rupture from 80 to 100% respectively. It is also noted that earlier the patient presents the lesser is the frequency of tubal rupture, as compared to late presentation beyond 3-4 days which make frequency up to 95%. Tubal rupture is still common cause of maternal morbidity and mortality, and is still a major challenge in gynaecological practice. Creating awareness amongst midwives and GPs regarding early diagnosis can contribute to decrease the mortality, morbidity and fertility loss related to EP.

  10. Tracheal dysplasia precedes bronchial dysplasia in mouse model of N-nitroso trischloroethylurea induced squamous cell lung cancer.

    Directory of Open Access Journals (Sweden)

    Moumita Ghosh

    Full Text Available Squamous cell lung cancer (SCC is the second leading cause of lung cancer death in the US and has a 5-year survival rate of only 16%. Histological changes in the bronchial epithelium termed dysplasia are precursors to invasive SCC. However, the cellular mechanisms that cause dysplasia are unknown. To fill this knowledge gap, we used topical application of N-nitroso-tris chloroethylurea (NTCU for 32 weeks to induce squamous dysplasia and SCC in mice. At 32 weeks the predominant cell type in the dysplastic airways was Keratin (K 5 and K14 expressing basal cells. Notably, basal cells are extremely rare in the normal mouse bronchial epithelium but are abundant in the trachea. We therefore evaluated time-dependent changes in tracheal and bronchial histopathology after NTCU exposure (4, 8, 12, 16, 25 and 32 weeks. We show that tracheal dysplasia occurs significantly earlier than that of the bronchial epithelium (12 weeks vs. 25 weeks. This was associated with increased numbers of K5+/K14+ tracheal basal cells and a complete loss of secretory (Club cell secretory protein expressing CCSP+ and ciliated cells. TUNEL staining of NTCU treated tissues confirmed that the loss of CCSP+ and ciliated cells was not due to apoptosis. However, mitotic index (measured by bromodeoxyuridine incorporation showed that NTCU treatment increased proliferation of K5+ basal cells in the trachea, and altered bronchial mitotic population from CCSP+ to K5+ basal cells. Thus, we demonstrate that NTCU-induced lung epithelial dysplasia starts in the tracheal epithelium, and is followed by basal cell metaplasia of the bronchial epithelium. This analysis extends our knowledge of the NTCU-SCC model by defining the early changes in epithelial cell phenotypes in distinct airway locations, and this may assist in identifying new targets for future chemoprevention studies.

  11. Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia. (United States)

    Pan, Yun; Du, Lizhong; Ai, Qing; Song, Sijie; Tang, Xiaoli; Zhu, Danping; Yu, Jialin


    Ventilator-associated pneumonia (VAP) is a common nosocomial infection in neonatal intensive care units with high morbidity and mortality. Bacterial biofilm in the endotracheal tube (ET) provides a notable and persistent source of pathogens that may cause VAP, and thus is important for VAP detection. However, during intubation microbial investigations in ET, samples are unavailable due to the infeasibility of collecting ET samples during intubation of neonates. It is therefore of great importance to find alternative sources of samples that can help identify the ET biofilm flora. In the present study, the microbial signatures of throat swabs and tracheal aspirates were compared with ET biofilm samples from VAP neonates using 16S ribosomal RNA gene polymerase chain reaction, denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Sequences were assigned to phylogenetic species using BLAST. Microbial diversity and richness among the three types of specimens were compared based on their DGGE fingerprints, and taxonomic characteristics based on the BLAST results. The microbial richness and diversity of ET biofilms were similar to tracheal aspirate yet significantly different from throat swab samples (P<0.05). Compared with ET biofilms, the overall constituent ratio of microflora was significantly different in throat swab and tracheal aspirate samples (P<0.05). However tracheal aspirate samples were useful for predicting Staphylococcus sp. in ET biofilms with a sensitivity of 85.7% and a specificity of 83.3%. The sensitivity for the combination of tracheal aspirate and throat swab samples to detect Staphylococcus sp. in ET biofilms was 100%. The detection of Pseudomonas sp. in throat swabs assisted its identification in ET biofilms (sensitivity 33.3% and specificity 100%). The results of the present study suggest that microbial investigations in throat swab and tracheal aspirate samples are beneficial for identifying the ET biofilm flora. There may

  12. Pharmacologic potency and selectivity of a new bronchodilator agent, 2,3-dihydro-7-methyl-9-phenyl-1H-pyrazolo [1,2-a] indazolium bromide (FKK) on canine tracheal preparations "in vivo" and "in vitro". (United States)

    Shiraki, Y; Sakai, K


    In tracheal preparations of dogs anesthetized with pentobarbital, the bronchodilating activity and selectivity of FKK were compared with those of aminophylline and isoproterenol. When administered by either the i.a., i.v. or i.d. route in blood-perfused or nonperfused tracheal preparations, FKK produced a dose-dependent and long-lasting tracheal dilatation through all the administration routes, but unlike aminophylline and isoproterenol it hardly affected systemic blood pressure (SBP), heart rate (HR) and tracheal blood flow (TBF). The ability of i.a. and i.v. FKK to reduce the tracheal intraluminal pressure (ILP) (bronchodilation) by 50% (ED50), was approximately 5.4-6.2 times more potent than aminophylline and 1/3000-1/4500 as potent as isoproterenol. In the isolated canine tracheal preparations contracted with carbachol, the relaxing action produced by FKK was 1/60 and 10 times as potent as those caused by isoproternol and aminophylline, respectively. FKK has neither anti-cholinergic, ganglion blocking, alpha-adrenergic blocking nor beta-adrenergic stimulating properties. Acute lethal toxicity of FKK determined in rats by the oral route was considerably less than that of aminophylline.

  13. Spontaneous tendon ruptures in patients with end-stage renal disease. (United States)

    Basic-Jukic, Nikolina; Juric, Ivana; Racki, Sanjin; Kes, Petar


    Spontaneous tendon ruptures in patients with end-stage renal disease (ESRD) have been occasionally reported. We describe the largest group of patients with spontaneous rupture of major tendons so far reported. Rupture of 16 tendons occurred in 9 patients. The mean patient age was 52.78 years; 77.7% were male. Four patients were treated with hemodialysis, 4 received a renal transplant and 1 was treated with automated peritoneal dialysis. Bilateral rupture was found in 5 patients (3 quadriceps, 1 Achilles and 1 supraspinatus and subscapularis tendon rupture). Distal brachial biceps tendon rupture, Achilles tendon rupture, unilateral quadriceps and rupture of the oblique internal abdominal muscle tendon were developed by 1 patient each. Patients were treated with renal replacement therapy for 3-21 years (mean 12.89). Five patients were treated with steroids and 6 patients received quinolone antibiotic before the tendon rupture. All patients had laboratory and clinical signs of hyperparathyroidism. A patient who was treated with automated peritoneal dialysis for 3 years had primary hyperparathyroidism with nephrolithiasis as the cause of ESRD. Our results demonstrated that patients with hyperparathyroidism are at increased risk for development of spontaneous tendon ruptures, and the risk is further amplified when they receive quinolone antibiotics and/or steroids. Copyright 2009 S. Karger AG, Basel.

  14. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. (United States)

    Valencia, Mauricio; Ferrer, Miquel; Farre, Ramon; Navajas, Daniel; Badia, Joan Ramon; Nicolas, Josep Maria; Torres, Antoni


    The aspiration of subglottic secretions colonized by bacteria pooled around the tracheal tube cuff due to inadvertent deflation (automatic, validated device for the continuous regulation of tracheal tube cuff pressure in preventing ventilator-associated pneumonia. Prospective randomized controlled trial. Respiratory intensive care unit and general medical intensive care unit. One hundred and forty-two mechanically ventilated patients (age, 64 +/- 17 yrs; Acute Physiology and Chronic Health Evaluation II score, 18 +/- 6) without pneumonia or aspiration at admission. Within 24 hrs of intubation, patients were randomly allocated to undergo continuous regulation of the cuff pressure with the automatic device (n = 73) or routine care of the cuff pressure (control group, n = 69). Patients remained in a semirecumbent position in bed. The primary end point variable was the incidence of ventilator-associated pneumonia. Main causes for intubation were decreased consciousness (43, 30%) and exacerbation of chronic respiratory diseases (38, 27%). Cuff pressure control than the automatic group (45.3 vs. 0.7% determinations, p automatic and control groups, respectively. Cuff pressure is better controlled with the automatic device. However, it did not result in additional benefits to the semirecumbent position in preventing ventilator-associated pneumonia.

  15. Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization. (United States)

    Shashoua, Abraham R; Stringer, Nelson H; Pearlman, Julie B; Behmaram, Behnaz; Stringer, Erica A


    The exact frequency and extent of complications after uterine artery embolization (UAE) have yet to be documented in the literature. Ischemic necrosis and rupture of the uterus is a theoretical concern of this procedure. Rupture of the uterus from any cause is a very serious gynecologic complication requiring immediate surgical intervention to prevent death. Ischemic necrosis and rupture of the uterus can occur months after UAE. In our patient they occurred 3 months after UAE for treatment of symptomatic uterine myomas, and required hysterectomy. To our knowledge, this is the first report of ischemic uterine rupture after UAE in the United States.

  16. A case of Sengstaken-Blakemore tube-induced esophageal rupture repaired by endoscopic clipping. (United States)

    Jung, Jin Hwan; Kim, Jin Il; Song, Jun Ho; Kim, Jeong Ho; Lee, Sang Hun; Cheung, Dae Young; Park, Soo Heon; Kim, Jae Kwang


    A 57-year-old man was admitted to another hospital for hematemesis due to heavy drinking. A Sengstaken-Blakemore tube was inserted and the patient was transferred to our hospital. The patient's ensuing movements inadvertently caused an esophageal rupture 2.5 cm in size. Since the patient's condition was stable, treatment via endoscopic repair using metallic clips was chosen over emergency surgery. Two hemoclips were fixed at the ends of the ruptured area; by employing an endoscopic detachable snare, the ruptured area was carefully repaired with 10 metallic clips. As a result, the esophageal rupture could be successfully repaired by endoscopic procedure rather than performing surgery.

  17. The Effects of Passive Smoking on Laryngeal and Tracheal Mucosa in Male Wistar Rats During Growth: An Experimental Study. (United States)

    Zaquia Leão, Henrique; Galleano Zettler, Claudio; Cambruzzi, Eduardo; Lammers, Marcelo; Rigon da Luz Soster, Paula; Bastos de Mello, Fernanda; Reghelin Goulart, Guilherme; de Campos, Deivis; Pereira Jotz, Geraldo


    Cigarettes contain toxic and carcinogenic substances. In this context, cigarette smoking, and similar activities, are associated with numerous pathologies, being considered a risk factor in up to 10% of the total number of deaths in adults. Recent evidence suggests that the exposure of children to smoking in the early days of their development causes many diseases. Using light microscopy, this study aims to analyze the possible histopathological effects of an experimental model of chronic inhalation of cigarette smoke (passive smoking) on the laryngeal and tracheal mucosa of young Wistar rats. A total of 24 young Wistar rats were studied for a period of 120 days. The animals were divided into two groups: passive smoking (n = 16) and control (n = 8). The level of exposure to cigarette smoke was evaluated from the urinary cotinine level. Although no cancerous lesions were identified, histopathological analysis in the laryngeal and tracheal mucosa of all the animals in the experimental group showed that the proportion of moderate and focal inflammation was higher in animals exposed to chronic inhalation of cigarette smoke (P = 0.041). Histopathologic analysis revealed moderate and focal inflammatory lesions in the region of the infraglottic mucosa in exposed animals, although without dysplastic or neoplastic lesions in the laryngeal and tracheal mucosa. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  18. Tracheal resection for laryngotracheal stenosis: A retrospective ...

    African Journals Online (AJOL)


    Aug 3, 2014 ... OTOLARYNGOLOGY. Laryngotracheal stenosis (LTS) is caused by form ation of scar tissue in the trachea and, rarely, in the larynx itself. Symptoms depend on the degree of airway obstruction and can therefore range from asymptomatic to upper airway obstruction severe enough to cause death.[15].

  19. Saved from a fatal flight: A ruptured splenic artery aneurysm in a pregnant woman

    Directory of Open Access Journals (Sweden)

    Anke C. Heitkamp


    Conclusion: In case of pregnant women with acute abdomen and hypovolemia, emergency physicians, surgeons, anesthesiologists, and gynecologists should be aware of the possibility of a ruptured SAA, apart from more common causes like placental abruption, placenta percreta, or uterine rupture. Early recognition and prompt multidisciplinary treatment might save the life of mother and child.

  20. Aortic plaque rupture in the setting of acute lower limb ischemia.

    LENUS (Irish Health Repository)

    O'Donnell, David H


    Acute aortic plaque rupture is an uncommon cause of acute lower limb ischemia. The authors report sequence computed tomographic imaging of a distal aortic plaque rupture in a young man with bilateral lower limb complications. Clinical awareness, prompt recognition and imaging, and appropriate treatment of this uncommon condition are necessary to improve patient outcomes.

  1. Spontaneous rupture of pyometra

    National Research Council Canada - National Science Library

    Mallah, Fatemeh; Eftekhar, Tahere; Naghavi-Behzad, Mohammad


    Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen...

  2. Blunt tracheal transection repair requiring open abdominal management. (United States)

    Nakagiri, Tomoyuki; Inoue, Masayoshi; Nakagawa, Junichiro; Okumura, Meinoshin


    A 19-year-old man sustained multiple injuries during a motorcycle accident. A computed tomographic scan revealed that the trachea was completely transected, and the endotracheal tube did not reach the distal stump. Extracorporeal membrane oxygenation was used to maintain oxygenation and avoid mediastinal emphysema. Tracheal anastomosis through a right thoracotomy was planned initially, but prior to the operation, extracorporeal membrane oxygenation flow and respiratory condition deteriorated, with evidence of oxygen desaturation. An abdominal compartment syndrome was diagnosed, and open abdominal management was performed. Therefore, the patient had to undergo tracheal anastomosis through a median sternotomy in the supine position. The laparotomy was closed, and the patient was discharged without respiratory complications. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Drosophila syndecan regulates tracheal cell migration by stabilizing Robo levels (United States)

    Schulz, Joachim G; Ceulemans, Helga; Caussinus, Emmanuel; Baietti, Maria F; Affolter, Markus; Hassan, Bassem A; David, Guido


    Here we identify a new role for Syndecan (Sdc), the only transmembrane heparan sulphate proteoglycan in Drosophila, in tracheal development. Sdc is required cell autonomously for efficient directed migration and fusion of dorsal branch cells, but not for dorsal branch formation per se. The cytoplasmic domain of Sdc is dispensable, indicating that Sdc does not transduce a signal by itself. Although the branch-specific phenotype of sdc mutants resembles those seen in the absence of Slit/Robo2 signalling, genetic interaction experiments indicate that Sdc also helps to suppress Slit/Robo2 signalling. We conclude that Sdc cell autonomously regulates Slit/Robo2 signalling in tracheal cells to guarantee ordered directional migration and branch fusion. PMID:21836636

  4. [Adherence of Acinetobacter baumannii to rat tracheal tissue]. (United States)

    Ruiz, M; Bello, H; Sepúlveda, M; Domínguez, M; Martínez, M A; Pinto, M E; González, G; Mella, S; Zemelman, R


    Acinetobacter baumannii is an important nosocomial pathogen whose virulence factors have not been fully elucidated. To study the adherence and hemagglutinating capacity of several biotypes of Acinetobacter baumannii. Thirty nine strains of Acinetobacter baumannii isolated from hospitalized patients were studied. The adherence of these strains to small pieces of rat tracheal tissue was studied. Additionally, their ability to hemagglutinate human erythrocytes and the effect of D-mannose and D-galactose on the adherence and hemagglutinating capacity was assessed. Transmission electron microscopy of strains was performed looking for the presence of fimbriae. All strains exhibited adherence to tissues. All strains had also D-mannose and D-galactose resistant hemagglutinating ability. Fimbriae were found in Acinetobacter baumannii and E coil cells. Adherence of Acinetobacter baumannii to rat tracheal tissue, apparently not related to the presence of fimbriae, may be a virulence mechanism of this bacterium.

  5. Ruptured Cesarean Scar Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Sujatha BS


    Full Text Available A pregnancy with implantation on the scar of a past cesarean section is uncommon. However such pregnancies are on the rise due to the increasing number of lower segment cesarean section. One of the complications of such a pregnancy is uterine rupture in early pregnancy which can be life threatening to the patient. The following is a report of a patient who presented at 10 weeks of gestational age with features of hypovolemic shock and lower position of the gestational sac in relation to the uterus with normal fetal heart rate. The diagnosis of ruptured cesarean scar pregnancy was made only after laparotomy.

  6. Post-tracheal extubation negative pressure pulmonary edema


    Pinhal, F; Rebelo, L.; Mondim, V; Botelho, M.


    Pulmonary edema negative pressure (NPPE) also described in the literature as acute pulmonary edema or post-obstructing after extubation, corresponds to an unusual event, with an incidence of approximately 0.1% in anesthetized patients. ¹ The authors describe the case of NPPE occurred after tracheal extubation in a patient undergoing laparoscopic orchidectomy under general anesthesia. They report the pathophysiology, radiological and bronchoscopic pattern and therapeutic measures instituted.

  7. Gene expression profiling of Drosophila tracheal fusion cells. (United States)

    Chandran, Rachana R; Iordanou, Ekaterini; Ajja, Crystal; Wille, Michael; Jiang, Lan


    The Drosophila trachea is a premier genetic system to investigate the fundamental mechanisms of tubular organ formation. Tracheal fusion cells lead the branch fusion process to form an interconnected tubular network. Therefore, fusion cells in the Drosophila trachea will be an excellent model to study branch fusion in mammalian tubular organs, such as kidneys and blood vessels. The fusion process is a dynamic cellular process involving cell migration, adhesion, vesicle trafficking, cytoskeleton rearrangement, and membrane fusion. To understand how these cellular events are coordinated, we initiated the critical step to assemble a gene expression profile of fusion cells. For this study, we analyzed the expression of 234 potential tracheal-expressed genes in fusion cells during fusion cell development. 143 Tracheal genes were found to encode transcription factors, signal proteins, cytoskeleton and matrix proteins, transporters, and proteins with unknown function. These genes were divided into four subgroups based on their levels of expression in fusion cells compared to neighboring non-fusion cells revealed by in situ hybridization: (1) genes that have relative high abundance in fusion cells, (2) genes that are dynamically expressed in fusion cells, (3) genes that have relative low abundance in fusion cells, and (4) genes that are expressed at similar levels in fusion cells and non-fusion tracheal cells. This study identifies the expression profile of fusion cells and hypothetically suggests genes which are necessary for the fusion process and which play roles in distinct stages of fusion, as indicated by the location and timing of expression. These data will provide the basis for a comprehensive understanding of the molecular and cellular mechanisms of branch fusion. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Rupture of Achilles Tendon : Usefulness of Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nam Hyeon; Ki, Won Woo; Yoon, Kwon Ha; Kim, Song Mun; Shin, Myeong Jin [Ulsan Medical College, Ulsan (Korea, Republic of); Kwon, Soon Tae [Chungnam University College of Medicine, Daejeon (Korea, Republic of)


    To differentiate a complete rupture of Achilles tendon from an incomplete one which is important because its treatment is quite different. And it is necessary to know the exact site of the rupture preoperatively. Fifteen cases of fourteen patients which were diagnosed as Achilles tendon rupture by ultrasonography and surgery were reviewed. We compared sonographic rupture site with surgical findings. Ultrasonographic criteria for differentiation of complete and incomplete rupture was defined as follows : the discreteness, which means the proximal intervening hypoechogenicity to the interface echogenicity of distal margin of ruptured tendon : the slant sign, which represents the interface of ruptured distal margin which was seen over the 3/4 of the thickness of the tendon without intervening low echogeneicity : the invagination sign, which means the echogenic invagination from Kager triangle into posterior aspect of Achilles tendon over the half thickness of the tendon. The sites of complete tendon rupture were exactly corresponded to surgical finding in four cases of ten complete ruptures. And the discrepancy between sonographic and surgical findings in the site of complete rupture was 1.2 {+-} 0.4 cm in six cases. Three of ten complete ruptures showed the discreteness sign, all of ten showed the slant sign and two of ten showed the invagination sign. It is helpful to differentiate a complete from incomplete rupture of the Achilles tendon and to localize the site of the complete rupture with the ultrasonographic evaluation

  9. Multimodal non-surgical treatment of a feline tracheal adenocarcinoma. (United States)

    Azevedo, Carolina; Brawner, William; Schleis Lindley, Stephanie; Smith, Annette


    A 10-year-old, castrated male domestic shorthair cat presented with a 2-3 month history of weight loss, lethargy and coughing. Thoracic radiographs revealed a soft tissue opacity overlying the dorsal trachea from the first rib to second rib and the ventral aspect of the trachea extending from the second rib to approximately the fourth rib. CT confirmed a mass involving the dorsal, right lateral and ventral aspects of the trachea narrowing the lumen and extending from vertebra C7 through T4. Bronchoscopy revealed a partially circumferential irregular and multilobulated tracheal mass, which was biopsied. The histopathological diagnosis was tracheal adenocarcinoma. The cat was treated with a definitive course of external beam radiation therapy (RT; 3 Gy × 18), cytotoxic chemotherapy, a tyrosine kinase inhibitor and palliative RT. The cat remained asymptomatic for 2 months and the mass remained stable radiographically for 11 months after RT. With multimodal treatment the cat had a survival time of 755 days. Initial treatment included definitive RT, carboplatin and piroxicam, followed by toceranib phosphate and palliative RT when the mass recurred. This case report describes the first documented use of non-surgical treatment and long-term outcome of tracheal adenocarcinoma in a cat. This case report is an indication that prolonged survival can be achieved with multimodal therapy.

  10. Multimodal non-surgical treatment of a feline tracheal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Carolina Azevedo


    Full Text Available Case summary A 10-year-old, castrated male domestic shorthair cat presented with a 2–3 month history of weight loss, lethargy and coughing. Thoracic radiographs revealed a soft tissue opacity overlying the dorsal trachea from the first rib to second rib and the ventral aspect of the trachea extending from the second rib to approximately the fourth rib. CT confirmed a mass involving the dorsal, right lateral and ventral aspects of the trachea narrowing the lumen and extending from vertebra C7 through T4. Bronchoscopy revealed a partially circumferential irregular and multilobulated tracheal mass, which was biopsied. The histopathological diagnosis was tracheal adenocarcinoma. The cat was treated with a definitive course of external beam radiation therapy (RT; 3 Gy × 18, cytotoxic chemotherapy, a tyrosine kinase inhibitor and palliative RT. The cat remained asymptomatic for 2 months and the mass remained stable radiographically for 11 months after RT. Relevance and novel information With multimodal treatment the cat had a survival time of 755 days. Initial treatment included definitive RT, carboplatin and piroxicam, followed by toceranib phosphate and palliative RT when the mass recurred. This case report describes the first documented use of non-surgical treatment and long-term outcome of tracheal adenocarcinoma in a cat. This case report is an indication that prolonged survival can be achieved with multimodal therapy.

  11. An Overview of Tracheal Stenosis Research Trends and Hot Topics. (United States)

    Farzanegan, Roya; Feizabadi, Mansoureh; Ghorbani, Fariba; Movassaghi, Masoud; Vaziri, Esmaeil; Zangi, Mahdi; Lajevardi, Seyedamirmohammad; Shadmehr, Mohammad Behgam


    Tracheal stenosis remains a challenge in the thoracic surgery field. Recognizing the hot topics and major concepts in this area would help the health policy makers to determine their own priorities and design the effective research plans. The present study analyzed and mapped the topics and trends of tracheal stenosis studies over time as well as authors' and countries' contributions. Search results were obtained employing Bibexcel. To determine cold and hot topics, co-occurrence analysis was applied using three international databases 'Web of Science', 'PubMed' and 'Scopus'. Appropriately, different categories in the articles such as keywords, authors, and countries were explored via VOSviewer and NetDraw. Afterward, the trends of research topics were depicted in four time-intervals from 1945 to 2015 by ten co-occurrence terms. The majority of articles were limited to case series and retrospective studies. The studies had been conducted less frequently on prevention, risk factors and incidence determination but extensively on treatment and procedures. Based on the articles indexed in WOS, 45 countries and 8,260 authors have contributed to scientific progress in this field. The highest degree of cooperation occurred between the USA and England with 15 common papers. Most of the published literature in tracheal stenosis research field was about surgical and non-surgical treatments. Conducting the screening and prevention studies would diminish the burden of this disease on the health system as well as the patients and their families' well-being.

  12. Tracheal stent prediction using statistical deformable models of tubular shapes (United States)

    Pinho, R.; Huysmans, T.; Vos, W.; Sijbers, J.


    Tracheal stenosis is a narrowing of the trachea that impedes normal breathing. Tracheotomy is one solution, but subjects patients to intubation. An alternative technique employs tracheal stents, which are tubular structures that push the walls of the stenotic areas to their original location. They are implanted with endoscopes, therefore reducing the surgical risk to the patient. Stents can also be used in tracheal reconstruction to aid the recovery of reconstructed areas. Correct preoperative stent length and diameter specification is crucial to successful treatment, otherwise stents might not cover the stenotic area nor push the walls as required. The level of stenosis is usually measured from inside the trachea, either with endoscopes or with image processing techniques that, eg compute the distance from the centre line to the walls of the trachea. These methods are not suited for the prediction of stent sizes because they can not trivially estimate the healthy calibre of the trachea at the stenotic region. We propose an automatic method that enables the estimation of stent dimensions with statistical shape models of the trachea. An average trachea obtained from a training set of CT scans of healthy tracheas is placed in a CT image of a diseased person. The shape deforms according to the statistical model to match the walls of the trachea, except at stenotic areas. Since the deformed shape gives an estimation of the healthy trachea, it is possible to predict the size and diameter of the stent to be implanted in that specific subject.

  13. [Vascular tracheal compression presenting as bronchiolitis in infants]. (United States)

    Flurin, V; Deschildre, A; Fourier, C; Martinot, A; Hue, V; Ramon, P; Petyt, L; Vaksmann, G; Leclerc, F


    Anomalies of the aortic arch and pulmonary arteries may produce compression of the trachea with chronic stridor or wheezing aggravated by crying, feeding and flexion of the neck. Three infants, 3, 5 and 2 months-old, respectively, were admitted suffering from acute bronchiolitis. The first patient had intermittent wheezing for one month; lateral chest X-rays showed an opaque area inserted between the trachea and oesophagus and computed tomography showed pulmonary artery sling with tracheal stenosis which was successfully operated. The second patient displayed pulmonary atelectasia which required bronchoscopy; this technique showed tracheal stenosis which was due to pulmonary artery sling. The third patient had a history of congenital stridor: he required endotracheal intubation; a bronchoscopy performed because persistent pulmonary atelectasia showed tracheal stenosis which was secondary to a double aortic arch. The condition was improved after surgical correction. A history of stridor and/or wheezing in patients admitted for bronchiolitis must lead to consider the possibility of vascular compression of the trachea and to perform specific investigations.

  14. 60 Review Article PRETERM RUPTURE OF MEMBRANES: THE ...

    African Journals Online (AJOL)

    Preterm prelabour rupture of membranes (PPROM) is one of the major factors that have been found to correlate with adverse pregnancy outcome1-8. It remains a critically important clinical and public health problem. PPROM is a leading cause of preterm delivery with a third of all preterm births resulting from preterm.

  15. Uterine rupture an obstetrics catastrophy; incidence, risk factors ...

    African Journals Online (AJOL)

    Context: Ruptured uterus is still an important obstetrics complication because it contributes significantly to both maternal and foetal morbidity and mortality in our setting. Therefore there is a need to further evaluate its causes and the outcome of its management. Objective: To determine the incidence, risk factors, ...

  16. Subarachnoid hemorrhage: risks of aneurysm rupture and delayed cerebral ischemia

    NARCIS (Netherlands)

    de Rooij, N.K.


    Three percent of the population harbors an intracranial aneurysm. A minority of these aneurysms will rupture and cause a subarachnoid hemorrhage (SAH). SAH is a devastating disease with high case fatality and morbidity. A major contributor to the poor outcome after SAH is delayed cerebral ischemia

  17. Bowel prolapse following spontaneous rupture of a femoral hernia. (United States)

    Sein, Tin Aung; Damodaran, Ashok


    This case presents a rare complication of the spontaneous rupture of a femoral hernia in an elderly woman without causing much systemic effect despite the herniated bowel being necrosed and perforated, giving rise to an enterocutaneous fistula. The small bowel had also prolapsed through the fistula opening, making it a very rare and alarming presentation.

  18. The effects of equine rhinovirus, influenza virus and herpesvirus infection on tracheal clearance rate in horses.


    Willoughby, R; Ecker, G.; McKee, S; Riddolls, L; Vernaillen, C; Dubovi, E; Lein, D; Mahony, J B; Chernesky, M; Nagy, E.


    The response of horses exposed to three common respiratory viruses was studied by measuring tracheal mucociliary clearance rates in the trachea. Tracheal clearance rates (TCR) were determined before, during illness and following recovery in horses exposed to equine rhinovirus (ERhV-2), equine influenza virus (EIV) and equine herpesvirus (EHV-4) by means of lateral scintigraphs made following an injection of technetium-99m sulphide colloid into the tracheal lumen. In six horses exposed to ERhV...

  19. [Bilateral rupture of the Achilles tendons after treatment with ciprofloxacin]. (United States)

    Attarzadeh, Amir Pasha; Ryge, Camilla


    We report a case of spontaneous non-traumatic bilateral rupture of the Achilles tendons following ciprofloxacin treatment. A 54-year-old man presented with spontaneous Achilles tendon rupture on the left side, tendinitis and partial tear on the right side following few days of treatment with ciprofloxacin 500 mg twice daily and long-term treatment with prednisolon 10 mg once daily. This rare side effect caused by concurrent treatment with steroids and ciprofloxacin should be kept in mind. Any signs of tendinitis following this treatment should arouse the physicians' suspicion towards ciprofloxacin.

  20. Spontaneous rupture of thymic neuroendocrine carcinoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Yeong; Lee, In Jae; Min, Soo Kee [Hallym University College of Medicine, Chuncheon (Korea, Republic of)


    Thymic neuroendocrine carcinoma (NEC) is a rare neoplasm with tendencies of local invasion and metastasis. Usually, it is detected incidentally or by its symptoms caused by mass effect. Rupture of the tumor is extremely rare. In this study, we report a case of a ruptured thymic NEC that was combined with a potentially fatal hemorrhage. This lesion was manifested as a progressive bulging of the right cardiac border on serial chest radiographs, and on CT as a large anterior mediastinal mass with heterogeneous enhancement, internal necrosis, and hematoma.

  1. Deflate-gate: Conservative Management of a Large Ruptured Hydrocele

    Directory of Open Access Journals (Sweden)

    Viktor X. Flores


    Full Text Available A hydrocele is a common cause of intrascrotal swelling that results when fluid accumulates between the parietal and visceral layers of the tunica vaginalis. Over time, fluid may collect to form a massive hydrocele and result in significant discomfort for the patient. In this case report, we present a rare event of a 28-year-old gentleman with a documented massive hydrocele measuring 14.1 × 8.9 cm who ruptured his hydrocele during sexual intercourse. We expectantly managed the patient's ruptured hydrocele and encountered no complications throughout the course of his recovery.

  2. Size-Dependent Rupture Strain of Elastically Stretchable Metal Conductors (United States)

    Graudejus, O.; Jia, Z.; Li, T.; Wagner, S.


    Experiments show that the rupture strain of gold conductors on elastomers decreases as the conductors are made long and narrow. Rupture is caused by the irreversible coalescence of microcracks into one long crack. A mechanics model identifies a critical crack length ℓcr, above which the long crack propagates across the entire conductor width. ℓcr depends on the fracture toughness of the gold film and the width of the conductor. The model provides guidance for the design of highly stretchable conductors. PMID:22773917

  3. A pregnant woman with spontaneous rupture of the uterine artery

    DEFF Research Database (Denmark)

    Jònsdòttir, Fjòla; Pinborg, Anja; Wilken-Jensen, Charlotte


    Pregnant women with acute abdominal pain are a clinical challenge. We present a rare but potential life-threatening condition of a pregnant woman with acute abdominal pain. The woman was in gestational week 37 with severe abdominal pain and was admitted to the labour ward. She became haemo......-dynamic instable 24 hours after vaginal delivery, and emergency laparotomi revealed a spontaneous rupture of the right uterine artery. Spontaneous rupture of the uterine artery is rare but should be considered as a possible cause of acute abdominal pain in pregnant women....

  4. Rupture of spleen post colonoscopy. (United States)

    Younes, Nidal A; Al-Ardah, Mahmoud I; Daradkeh, Salam S


    We review an interesting case of elective colonoscopy for rectal bleeding in a 68-year-old woman complicated by splenic rupture. She was managed by aggressive fluid and blood resuscitation followed by splenectomy. She had a smooth recovery and was discharged home 4 days after admission. The extreme rarity and interesting clinical course of the patient are discussed.

  5. Sonographic Findings of Ruptured Endometrioma

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Sung Il; Ko, Su Yeon; Kim, Young Jun; Park, Hee Seun; Jeon, Hae Jeong [Konkuk University School of Medicine, Seoul (Korea, Republic of); Jeong, Kyung Ah [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)


    To evaluate the characteristic sonographic findings of ruptured endometrioma in comparison with unruptured endometrioma. Fifty nine cases of pathologically proven endometrioma were categorized as the ruptured endometrioma group and the unruptured endometrioma group on the basis of the operation records. The sonographic findings such as locularity, the internal echotexture, the size and the wall thickness of the cyst and the presence of a fluid-fluid level, fibrin strands, a retracting clot and fluid in the pelvic cavity were retrospectively evaluated using logistic regression analysis. On univariate analysis, the sonographic finding of a thin wall (odds ratio, 4.1: 95% confidence interval: 1.2-13.8) and a fluid-fluid level (odds ratio, 9.0: 95% confidence interval: 2.4-33.6) were significantly different between the ruptured endometrioma group and the unruptured endometrioma group. Logistic regression analysis showed that a thin wall (odds ratio, 7.5: 95% confidence interval: 1.6-34.4) and a fluid-fluid level (odds ratio, 14.7: 95% confidence interval: 3.1-70.2) were both independent variables significantly associated with unruptured endometrioma. The characteristic sonographic findings of ruptured endometrioma are a thin cystic wall and a fluid-fluid level in the cyst, as compared with those of unruptured endometrioma

  6. Blunt rupture of the diaphragm. A retrospective analysis of 41 patients. (United States)

    Sarna, S; Kivioja, A


    Forty-one patients with multiple injuries together with diaphragmatic rupture due to blunt trauma were reviewed. The rupture was caused by a motor vehicle accident in 29 (71%) and falling from a height in four (10%) patients. A chest X-ray on admission suggested the diagnosis in 70% of the cases. Small bowel herniation did not occur in ruptures smaller than 15 centimetres. All patients had associated injuries and 84% suffered intra-abdominal trauma, most commonly splenic rupture (42% of all patients). 15 out of 18 patients with a concomitant rupture of the spleen were injured in automobile accidents. The occurrence of splenic rupture in patients injured in automobile vs other accidents differed significantly (P = 0.027). The mortality rate was 12%. Mortality and most of the complications were related to associated injuries. We conclude that 1) there is a high occurrence of intra-abdominal injuries, especially splenic ruptures, in patients with rupture of the diaphragm, 2) the occurrence of splenic rupture is higher in patients injured in automobile accidents than in patients injured by some other mechanism, and 3) a chest radiograph on admission is the best diagnostic aid.

  7. [Tricuspidal valve rupture after blunt chest trauma]. (United States)

    Dąbrowski, Wojciech; Nestorowicz, Andrzej; Wośko, Jarosław; Zadora, Przemysław; Tomaszewski, Adrzej; Jurko, Cezary


    Blunt chest trauma is frequently associated with cardiac contusion and structural damage, most cases only being recognized after death. We report a case of multiple organ trauma, where cardiac failure, caused by tricuspid valve rupture, was markedly delayed. A 21 yr old man was admitted to hospital after a car accident. He was suffering from cerebral contusion and oedema, pulmonary contusion, and a left pneumothorax. He also had multiple fractures of the facial bones, orbit, L4 vertebra and left tibia. He was tracheotomised, and a subdural sensor was inserted for continuous monitoring of intracranial pressure. He was sedated and ventilated for two weeks. On the 12th day, his jaw was reconstructed, and immediately after surgery, mild signs of cardiac failure were observed, which were attributed to cardiac contusion. Two weeks after admission, the patient was weaned from the ventilator, and three days later, his facial bones were reconstructed. Four days later, the signs of cardiac failure reappeared. Transoesophageal echocardiography revealed rupture of a head of papillary muscle, with 4th degree tricuspid insufficiency and enlargement of the right ventricle. The ruptured muscle was reconstructed under extracorporeal circulation, and the patient made a satisfactory recovery. Acute tricuspid valve insufficiency, albeit rare, may occur in patients with blunt chest trauma. Sedation and lack of physical activity may delay the definite diagnosis, especially when only transthoracic echocardiography is used. Cardiac arrhythmias, diastolic murmur, or signs of congestive cardiac failure in a chest trauma patient may all suggest some structural damage; therefore, transoesophageal echocardiography should be performed as early as possible in such situations.

  8. Huge Tracheal Diverticulum in a Patient with Mounier-Kuhn Syndrome

    Directory of Open Access Journals (Sweden)

    Michele Mondoni


    Full Text Available Tracheal diverticulum is a rare benign entity. Tracheobronchomegaly (TBM, also known as Mounier-Kuhn syndrome, is a rare disorder characterized by marked dilation of the trachea and main bronchi, associated with thinning or atrophy of the elastic tissue. Because of the weakened trachea and increased intraluminal pressure related to chronic cough, some patients may develop mucosal herniation leading to tracheal diverticulosis. We report the case of a patient with TBM with a huge tracheal diverticulum, diagnosed by bronchoscopy and computed tomography with three-dimensional reconstruction. To our knowledge this is the largest tracheal diameter described in a patient affected by this syndrome.

  9. Vortex dynamics in ruptured and unruptured intracranial aneurysms (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  10. Direct visualization of microalgae rupture by ultrasound-driven bubbles (United States)

    Pommella, Angelo; Harun, Irina; Pouliopoulos, Antonis; Choi, James J.; Hellgardt, Klaus; Garbin, Valeria


    Cell rupture induced by ultrasound is central to applications in biotechnology. For instance, cell disruption is required in the production of biofuels from microalgae (unicellular species of algae). Ultrasound-induced cavitation, bubble collapse and jetting are exploited to induce sufficiently large viscous stresses to cause rupture of the cell membranes. It has recently been shown that seeding the flow with bubbles that act as cavitation nuclei significantly reduces the energy cost for cell processing. However, a fundamental understanding of the conditions for rupture of microalgae in the complex flow fields generated by ultrasound-driven bubbles is currently lacking. We perform high-speed video microscopy to visualize the miscroscale details of the interaction of Chlamydomonas reinhardtii , microalgae of about 10 μm in size, with ultrasound-driven microbubbles of 2-200 μm in diameter. We investigate the efficiency of cell rupture depending on ultrasound frequency and pressure amplitude (from 10 kPa up to 1 MPa), and the resulting bubble dynamics regimes. In particular we compare the efficiency of membrane rupture in the acoustic microstreaming flow induced by linear oscillations, with the case of violent bubble collapse and jetting. V.G. acknowledges partial support from the European Commission (FP7-PEOPLE-2013-CIG), Grant No. 618333.

  11. Four cases of spontaneous rupture of the urinary bladder

    Energy Technology Data Exchange (ETDEWEB)

    Amano, Toshiyasu; Miwa, Sotaro; Takashima, Hiroshi; Takemae, Katsuro [Nagoya Red Cross Hospital (Japan)


    Between November 1997 and March 2001, 4 female patients from 44 to 65 years of age with a spontaneous rupture of the urinary bladder were analyzed. They complained of abdominal pain and had undergone an intra-pelvic gynecological operation (3 for uterine cancer, 1 for an ovarian cyst) several years before. The three with uterine cancer had also received radiation therapy. For their present condition, spontaneous urinary bladder rupture, their treatment was indwelling a urethral catheter. Two of them have had no recurrence of urinary bladder rupture after one month since having the urethral catheter indwelt. One, however, had to have the catheter re-indwelt due to unsuccessful suturing of the urinary bladder wall. The fourth patient had bilateral nephrostomy tubes due to severe radiation cystitis. Thus, one can infer that intra-pelvic gynecological operations and radiation therapy are major factors causing spontaneous urinary bladder rupture. While indwelling a urethral catheter may be effective for some patients with a spontaneous rupture of the urinary bladder, it may be very difficult to treat more complicated cases. (author)

  12. Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope (United States)


    Background Tracheal intubation with Macintosh laryngoscope is taught to medical students as it is a lifesaving procedure. However, it is a difficult technique to learn and the consequences of intubation failure are potentially serious. The Airtraq optical laryngoscope is a relatively novel intubation device, which allows visualization of the glottic plane without alignment of the oral, pharyngeal, and tracheal axes, possessing advantages over Macintosh for novice personnel. We introduced a teaching mode featured with a progressive evaluation scheme for preparation and performance of tracheal intubation with medical students in this prospective randomized crossover trial who had no prior airway management experience to find the superior one. Methods Twenty-six medical students of the 8-year programme in the 6th year participated in this trial, when they did their one-week rotation in the department of anaesthesiology. Each of the students intubated 6 patients, who were scheduled for surgeries under general anaesthesia, each laryngoscope for 3 patients respectively. One hundred and forty-nine consecutive patients scheduled for surgical procedures requiring tracheal intubation were enrolled. Patients were randomly allocated to undergo tracheal intubation using Macintosh (n = 75) or Airtraq (n =74) laryngoscope. The progressive evaluation scheme was applied to each intubation attempt. Results Intubation success rate was significantly higher in Airtraq group than Macintosh group (87.8% vs. 66.7%, P Cormack and Lehane glottic view was obtained in 94.6% of patients in the Airtraq group versus 32% of patients in the Macintosh group (P <0.001). Duration of intubation in Airtraq group was significantly shorter (68 ± 21 s vs. 96 ± 22 s, P < 0.05) compared to Macintosh group. Conclusions Airtraq laryngoscope is easier to master for novice personnel with a higher intubation success rate and shorter intubation duration compared with the Macintosh

  13. Complicações da intubação traqueal em pediatria Complications of tracheal intubation in pediatrics

    Directory of Open Access Journals (Sweden)

    Nélio de Souza


    Full Text Available OBJETIVO: Descrever a frequência e os tipos de complicações da intubação traqueal e suas principais causas. MÉTODOS: Estudo transversal de pacientes internados na UTI Pediátrica da Santa Casa de Misericórdia de São Paulo, entre maio/98 e dezembro/99 e que foram submetidos a intubação traqueal por mais de 24 horas. Os critérios de exclusão incluíam intubações anteriores, cirurgias ou traumas em região cervical ou orofaringe. RESULTADOS: Foram estudados 147 casos com idade variando de um mês até 15 anos e três meses. Em 31,3% foram usados tubos traqueais de tamanho inadequado e 14,3% necessitaram cinco ou mais tentativas para serem intubados. Houve maior dificuldade de intubação por parte dos médicos residentes. O maior número de tentativas de intubação traqueal foi relacionado com aumento de traumas, hipóxia, bradicardia e piora no escore de Downes após a extubação. Foram observados 21,8% de extubação acidental, que se relacionou com piora no escore de Downes e necessidade de reintubação. Os médicos residentes também causaram maior número de traumas e de bradicardia. CONCLUSÃO: A maioria das complicações pode ser atribuída à falta de experiência e treinamento do médico que realizou a intubação traqueal, devendo-se para minimizá-las implementar programas de treinamento e aumentar a supervisão durante a intubação traqueal.OBJECTIVE: To describe the frequency and types of tracheal intubation complications and their main causes. METHODS: Cross sectional study of patients who were submitted to tracheal intubation for more than 24 hours at the Pediatric ICU of Santa Casa de Misericórdia de São Paulo, between May 1998 and December 1999. Exclusion criteria were previous intubations, surgeries or traumas in the cervical region or oropharynx. RESULTS: A study of 147 patients with ages varying from 1 month to 15 years and 3 months was carried out. An inadequate tracheal tube had been used in 31.3% of

  14. In vitro reactivity (“organ chamber”) of guinea pig tracheal rings—methodology considerations (United States)

    Albuquerque, Agnes Afrodite Sumarelli; Carvalho, Marco Túlio Menezes; Evora, Patricia Martinez; de Nadai, Tales Rubens; Celotto, Andrea Carla


    The present text was motivated by the difficulties faced by our postgraduate students when using airways studies protocols and will take into consideration the three mechanisms of relaxation: (I) guanosine 3,5-cyclic monophosphate (cGMP)/NO-dependent; (II) adenosine 3,5-cyclic monophosphate (cAMP)/PGI2-dependent, and (III) hyperpolarization-dependent. Tracheal rings are studied in an organ bath containing a gassed physiological salt solution, usually at a temperature of 37 °C. An agent or procedure that causes contraction [acetylcholine (Ach) or metacholine] of the smooth muscle is needed before study airway dilator drugs. The presented airways studies protocols are useful to study the bronchial epithelial-dependent reactivity. PMID:27386490

  15. Spontaneous splenic rupture in an active duty Marine upon return from Iraq: a case report. (United States)

    Rice, Jason P; Sutter, Christian M


    Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq. A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause. Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient's case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication.

  16. Spontaneous splenic rupture in an active duty Marine upon return from Iraq: a case report

    Directory of Open Access Journals (Sweden)

    Sutter Christian M


    Full Text Available Abstract Introduction Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq. Case presentation A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause. Conclusion Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient's case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication.

  17. Spontaneous Rupture of Bladder in Puerperium without Uterine Rupture

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    Subrat Panda


    Full Text Available Objective: we report a case of intraperitoneal urinary bladder rupture I week following normal delivery ina primigravida, who presented with huge urinary ascites, anuria and renal failure. Abdominalparacentesis and exploratory laparotomy was done and a diagnosis of intraperitoneal bladder rupturewas made. The rent was repaired in layers. This may be preventable if adequate precaution in the formof evacuating the bladder before the patient goes into second stage of labor is undertaken.

  18. The impact of topically applied preservation solutions on the respiratory epithelium of tracheal grafts submitted to cold ischemia: functional and morphological analysis

    Directory of Open Access Journals (Sweden)

    Artur Eugênio de Azevedo-Pereira


    Full Text Available OBJECTIVE: Advances in graft reepithelialization and revascularization have renewed interest in airway transplantation. This study aims to determine whether topically applied preservation solutions can ameliorate ischemic injury to tracheal grafts. We analyzed 1 the effects of cold ischemia on the mucociliary clearance of tracheal grafts and 2 the impact of topically applied preservation solutions on the effects of cold ischemia on mucociliary clearance. METHOD: Tracheal segments (n=217 from 109 male Wistar rats were harvested, submerged in low-potassium-dextran-glucose, histidine-tryptophan-ketoglutarate, or saline solution (saline group, and stored at 4°C for 6, 10, 16, or 24 hours. A control group (not submerged was analyzed immediately after harvesting. In situ mucociliary transport and ciliary beating frequency were measured using a stroboscope. Epithelial integrity, cellular infiltration, and mucus storage were quantified by light microscopy and image analysis software, along with transmission electron microscopy. RESULTS: 1 The effects of cold ischemia: in situ mucociliary transport and ciliary beating frequency were greater in the control group than after cold ischemia. Microscopic analysis results were similar between groups. 2 The effects of preservation solutions: there was no difference between the low-potassium-dextran-glucose, histidine-tryptophan-ketoglutarate, and saline groups in functional or light microscopy analysis. The saline group presented stronger signs of ischemic injury with transmission electron microscopy. CONCLUSIONS: Cold ischemia diminished the mucociliary clearance of the tracheal respiratory epithelium. Topically applied preservation solutions did not ameliorate the injury caused by cold ischemia to the tracheal respiratory epithelium.

  19. 3D printed polyurethane prosthesis for partial tracheal reconstruction: a pilot animal study. (United States)

    Jung, Soo Yeon; Lee, Sang Jin; Kim, Ha Yeong; Park, Hae Sang; Wang, Zhan; Kim, Hyun Jun; Yoo, James J; Chung, Sung Min; Kim, Han Su


    A ready-made, acellular patch-type prosthesis is desirable in repairing partial tracheal defects in the clinical setting. However, many of these prostheses may not show proper biological integration and biomechanical function when they are transplanted. In this study, we developed a novel 3D printed polyurethane (PU) tracheal scaffold with micro-scale architecture to allow host tissue infiltration and adequate biomechanical properties to withstand physiological tracheal condition. A half-pipe shaped PU scaffold (1.8 cm of height, 0.18 cm thickness, and 2 cm of diameter) was fabricated by 3D printing of PU 200 μm PU beam. The 3D printed tracheal scaffolds consisted of a porous inner microstructure with 200 × 200 × 200 μm3 sized pores and a non-porous outer layer. The mechanical properties of the scaffolds were 3.21 ± 1.02 MPa of ultimate tensile strength, 2.81 ± 0.58 MPa of Young's modulus, and 725% ± 41% of elongation at break. To examine the function of the 3D printed tracheal scaffolds in vivo, the scaffolds were implanted into 1.0 × 0.7 cm2 sized anterior tracheal defect of rabbits. After implantation, bronchoscopic examinations revealed that the implanted tracheal scaffolds were patent for a 16 week-period. Histologic findings showed that re-epithelialization after 4 weeks of implantation and ciliated respiratory epithelium with ciliary beating after 8 weeks of implantation were observed at the lumen of the implanted tracheal scaffolds. The ingrowth of the connective tissue into the scaffolds was observed at 4 weeks after implantation. The biomechanical properties of the implanted tracheal scaffolds were continually maintained for 16 week-period. The results demonstrated that 3D printed tracheal scaffold could provide an alternative solution as a therapeutic treatment for partial tracheal defects.

  20. The diagnosis of breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse; Conrad, Carsten


    STUDY OBJECTIVE: The aim of this study was to evaluate the accuracy of Magnetic Resonance Imaging (MRI) as performed according to a strict study protocol in diagnosing rupture of silicone breast implants. MATERIAL AND METHODS: The study population consisted of 64 women with 118 implants, who had...... participated in either one or two study MRI examinations, aiming at determining the prevalence and incidence of silent implant rupture, respectively, and who subsequently underwent explantation. Implant rupture status was determined by four independent readers and a consensus diagnosis of either rupture...... (intracapsular or extracapsular), possible rupture or intact implant was then obtained. Strict predetermined rupture criteria were applied as described in this report and findings at surgery were abstracted in a standardised manner and results compared. RESULTS: At MRI, 66 implants were diagnosed as ruptured...

  1. [Ruptured cerebral artery blister aneurysm]. (United States)

    Vega Valdés, Pedro; Murias Quintana, Eduardo; Meilán Martínez, Angela; Gutiérrez Morales, Julio; Lopez Garcia, Antonio


    We report the case of a young patient with subarachnoid haemorrhage secondary to a ruptured blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of rupture, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment. Copyright © 2010 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  2. Spontaneous rupture of the ureter (United States)

    Eken, Alper; Akbas, Tugana; Arpaci, Taner


    Spontaneous rupture of the ureter is a very rare condition and usually results from ureteral obstruction by a calculus. Only theoretical mecha­nisms have been proposed and no possible explanation has yet been reported in the literature. Intravenous contrast-enhanced computed tomography is the most informative study with high sensitivity. Treatment should be individualised, and depends on the state of the patient. Minimally invasive endourological procedures with double-J catheter placement and percutaneous drainage offer excellent results. Conservative management with analgesics and antibiotic coverage may be an alternative to surgery. Herein, we present a case of spontaneous rupture of the proximal ureter with no evidence of an underlying pathological condition. PMID:25715862

  3. Spontaneous rupture of renal pelvis secondary to ureteral obstruction by urothelial tumor

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Daniel Alvarenga; Palma, Ana Laura Gatti; Kido, Ricardo Yoshio Zanetti; Barros, Ricardo Hoelz de Oliveira; Martins, Daniel Lahan; Penachim, Thiago Jose; Caserta, Nelson Marcio Gomes, E-mail:, E-mail: [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Medicina. Dept. de Radiologia


    Partial spontaneous rupture of the upper urinary tract is rare and usually associated with nephrolithiasis. Other reported causes, apart from instrumentation and trauma, involve obstructive ureteral tumor in the pelvic cavity, retroperitoneal fibrosis, fluid overload, and pregnancy. We report a case of spontaneous rupture of renal pelvis secondary to ureteral obstruction caused by urothelial tumor, clinically suspected and evaluated by CT scans and MRIs, discussing the relevant findings for diagnosis.(author)

  4. Achilles tendon rupture in badminton. (United States)

    Kaalund, S; Lass, P; Høgsaa, B; Nøhr, M


    The typical badminton player with an Achilles tendon rupture is 36 years old and, despite limbering up, is injured at the rear line in a sudden forward movement. He resumes work within three months and has a slight lack of dorsiflexion in the ankle as the main complication. Most patients resume badminton within one year, but some finish their sports career, mainly due to fear of a new injury. The investigation discusses predisposing factors and prophylactic measures. PMID:2605439

  5. Recurrent respiratory distress and cardiopulmonary arrest caused by megaoesophagus secondary to achalasia

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    Nigel Tapiwa Mabvuure


    CONCLUSION: Oesophagectomy should be considered for patients with end-stage achalasia and mega-oesophagus causing respiratory compromise to avoid potential fatal complications such as tracheal compression and subsequent respiratory arrest.

  6. Factors influencing mortality in traumatic ruptures of diaphragm. (United States)

    Düzgün, Arife Polat; Ozmen, Mehmet Mahir; Saylam, Bariş; Coşkun, Faruk


    Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality. The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality. The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury. The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.

  7. Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study

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    Angélica de Fátima de Assunção Braga

    Full Text Available Abstract Background and objectives: The temporary fetal tracheal occlusion performed by fetoscopy accelerates lung development and reduces neonatal mortality. The aim of this paper is to present an anesthetic experience in pregnant women, whose fetuses have diaphragmatic hernia, undergoing fetoscopic tracheal occlusion (FETO. Method: Retrospective, descriptive study, approved by the Institutional Ethics Committee. Data were obtained from medical and anesthetic records. Results: FETO was performed in 28 pregnant women. Demographic characteristics: age 29.8 ± 6.5; weight 68.64 ± 12.26; ASA I and II. Obstetric: IG 26.1 ± 1.10 weeks (in FETO; 32.86 ± 1.58 (reversal of occlusion; 34.96 ± 2.78 (delivery. Delivery: cesarean section, vaginal delivery. Fetal data: Weight (g in the occlusion and delivery times, respectively (1045.82 ± 222.2 and 2294 ± 553; RPC in FETO and reversal of occlusion: 0.7 ± 0.15 and 1.32 ± 0.34, respectively. Preoperative maternal anesthesia included ranitidine and metoclopramide, nifedipine (VO and indomethacin (rectal. Preanesthetic medication with midazolam IV. Anesthetic techniques: combination of 0.5% hyperbaric bupivacaine (5-10 mg and sufentanil; continuous epidural predominantly with 0.5% bupivacaine associated with sufentanil, fentanyl, or morphine; general. In 8 cases, there was need to complement via catheter, with 5 submitted to PC and 3 to BC. Thirteen patients required intraoperative sedation; ephedrine was used in 15 patients. Fetal anesthesia: fentanyl 10-20 and pancuronium 0.1-0.2 (IM. Neonatal survival rate was 60.7%. Conclusion: FETO is a minimally invasive technique for severe congenital diaphragmatic hernia repair. Combined blockade associated with sedation and fetal anesthesia proved safe and effective for tracheal occlusion.

  8. Bilateral Achilles tendon rupture: a report on two cases. (United States)

    Orava, S; Hurme, M; Leppilahti, J


    Two cases of traumatic bilateral Achilles tendon rupture are reported. One of the patients was a healthy middle-aged man, who had been an active national-level gymnast 20 years earlier. He had not suffered any complaints of Achilles tendons before. The ruptures occurred when, after a sauna, he showed his guests a vault forwards, which he had been able to perform easily. This time the landing took place on the toes, causing a high peak stretch to the calf muscles and Achilles tendons. The total rupture of both Achilles tendons was treated surgically, with an excellent result 2 days after the trauma. End-to-end suturation and a fascial flap plasty were made on both sides. No macroscopic degeneration could be detected on the rupture sites. He was allowed to walk freely 6 weeks after the surgery. The second case was a 54-year-old woman, who had suffered from Achilles tendinitis and peritendinitis for 2 years. Both tendons had been surgically treated, and severe adhesions and local degenerative changes had been found. The tendon rupture occurred when she injured her left ankle while getting out of the car. Two days later she fell at home, because of the weakness of the left side, and consequently the right Achilles tendon was injured. She was treated conservatively for 10 days, before the surgery was performed. Both tendons were ruptured and an extensive degeneration of the area was observed. The right side suffered from a rerupture, which was again treated surgically. After surgery the recovery was slow, but the final result 3 years later was moderate. Neither of the patients had any systemic diseases.

  9. In vitro pharmacokinetics of sirolimus-coated stent for tracheal stenosis

    African Journals Online (AJOL)

    In vitro pharmacokinetics of sirolimus-coated stent for tracheal stenosis. Shanzuan Wang, Zhengxian Chen, Qunying Lin, Qingyu Lin, Yumei Geng, Suwang Wang. Abstract. Purpose: To investigate the in vitro pharmacokinetics of sirolimus-coated stent for tracheal stenosis. Methods: Naked nickel titanium alloy stent was ...

  10. Slow-Release Drug Deliver System with Polylactic Acid Hydrogels in Prevention of Tracheal Wall Fibroplasia

    Directory of Open Access Journals (Sweden)

    Jinrang Li


    Conclusions: Both MMC/PLA and DSP/PLA hydrogels can inhibit fibroplasia of the tracheal wall and it can be coated in a Poly L-lactide-co and ndash;glycolide (PLGA scaffold for treating laryngeal-tracheal stenosis in future. [Arch Clin Exp Surg 2012; 1(1.000: 1-7

  11. The diagnostic difficulties in tracheal neoplasms; Trudnosci diagnostyczne w nowotworach tchawicy

    Energy Technology Data Exchange (ETDEWEB)

    Bartnik, W.; Szewczyk, M.; Lomikowska, E.; Meler, M.; Rosolowska, J. [Wojewodzki Szpital Zespolony, Kalisz (Poland)


    Since 1990-1992 in the Dept. of ENT Kalisz 5 patients with tracheal neoplasms were treated. On the base of this cases the diagnostic difficulties has been presented. A rare case of tracheal carcinoma adenoides treated by telecobaltotherapy was described. 6 years survival rate was observed. (author)

  12. Segmental tracheal reconstruction by 3D-printed scaffold: Pivotal role of asymmetrically porous membrane. (United States)

    Lee, Doh Young; Park, Su A; Lee, Sang Jin; Kim, Tae Ho; Oh, Se Heang; Lee, Jin Ho; Kwon, Seong Keun


    Three-dimensional (3D) printed scaffold for tracheal reconstruction can substitute the conventional treatment of tracheal stenosis. This study investigated the survival outcomes of segmental tracheal reconstruction using 3D printed polycaprolactone (PCL) scaffold with or without asymmetrically porous membrane in rabbit animal model. Animal study. Six mature New Zealand white rabbits were categorized into two groups (three animals for each) according to the procedures they received: tracheal reconstruction using 3D printed PCL scaffold without asymmetrically porous membrane (group 1) versus with asymmetrically porous membrane (group 2). We compared the endoscopic findings of tracheal lumen, radiologic assessment using microcomputed tomography (CT) scanner and histologic findings. Overall survival duration after procedure was compared in both groups. The survival of group 2 was longer than group 1 (21, 37, 46 days vs. 4, 10, 12 days, respectively). Although mucosal regeneration in tracheal lumen was not full enough in both groups, the patency was well maintained in group 2. Micro-CT and histologic analysis showed that there were tracheal narrowing in the whole length in group 1, whereas only the anastomosis site was stenotic in group 2. Asymmetrically porous membrane reinforced by 3D printed mesh is promising as a 360-degree tracheal substitute with comparable survival and luminal patency. Further study is necessary to minimize the narrowing of the anastomosis site and improve the mucosal regeneration for longer survival. NA. Laryngoscope, 126:E304-E309, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Tracheal hypoplasia with a discrete subaortic septal ridge in a Rottweiler puppy. (United States)

    Reed, Scott D; Evans, Dawn E


    Concurrent tracheal hypoplasia and discrete subaortic stenosis are described in a 12-week-old Rottweiler puppy that presumably died of pulmonary edema. A brief literature review and comparison to previously published cases of tracheal hypoplasia in other breeds is presented along with a description of a subaortic septal ridge and comparison to the analogous condition in humans.

  14. Incidence and treatment of tracheal cancer: a nationwide study in the Netherlands.

    NARCIS (Netherlands)

    Honings, J.; Dijck, J.A.A.M. van; Verhagen, A.F.T.M.; Heijden, H.F.M. van der; Marres, H.A.M.


    BACKGROUND: The aim of this study was to assess the incidence, characteristics, treatment, and survival of patients with tracheal malignancies in the Netherlands. METHODS: All cases of tracheal cancer entered into the database of the Netherlands Cancer Registry in the period 1989-2002 were selected.

  15. Tracheal rupture after intubation and placement of an endotracheal balloon catheter (A-view(R)) in cardiac surgery

    NARCIS (Netherlands)

    Timman, S.T.; Mourisse, J.M.J.; Heide, S.M. van der; Verhagen, A.F.T.M.


    The endotracheal balloon catheter (A-view(R)) is a device developed to locate atherosclerotic plaques of the ascending aorta (AA) in cardiac surgery to prevent stroke. The saline-filled balloon is located in the trachea and combines the advantages of transoesophageal echocardiography (e.g. used

  16. Medical image of the week: severe atelectasis with tracheal shift

    Directory of Open Access Journals (Sweden)

    Poojary I


    Full Text Available A 59-year-old woman with severe oxygen dependent COPD presented with acute respiratory distress requiring intubation and was found to have left lower lobe collapse with tracheal shift. Her past medical history consists of severe malnutrition, alcohol abuse, and emphysema with recurrent pneumonias associated with acute respiratory failure often requiring intubation. She has greater than a 50-pack year history of tobacco use. She has undergone bronchoscopy and multiple CT Chest imaging without evidence of an endobronchial lesion or malignancy. Postural drainage and percussion along with antibiotics and inhaled bronchodilators resulted in marked improvement in the left lower lobe.

  17. File list: InP.Lng.05.AllAg.Tracheal_epithelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

    Full Text Available NoD.Lng.05.AllAg.Tracheal_epithelial_cells hg19 No description Lung Tracheal epithe...lial cells ...

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    Lifescience Database Archive (English)

    Full Text Available InP.Lng.20.AllAg.Tracheal_epithelial_cells hg19 Input control Lung Tracheal epithel...ial cells SRX268454,SRX268453,SRX268455 ...

  1. Tracheal restoration in dogs with umbilical cord membrane of bovine preserved in glicerin

    Directory of Open Access Journals (Sweden)

    Alexandre Mazzanty


    Full Text Available The viability of the use the bovine umbilical membrane preserved in 98% glycerin implanted in the cervical trachea was studied. Seven adult mongrel dogs, three males and four females weighting 6 to 14 kg, were used. After the usual anesthesia protocol and asseptic technique, three tracheal rings were partially removed for implantation of a segment of the umbilical membrane. The animals were observed during 30 days and then reoperated for macroscopic observations and for fragment collection for histological evaluation. It occurred a repair of the tracheal lesion, with formation of granulation tissue rich in collagen fibers linking the extremities of the tracheal cartilages. Epithelial migration over the tracheal surface was also seen. It is concluded that the segment of the bovine umbilical cord preserved in 98% glycerin can be used in the repair of tracheal defects. It offers a temporary support for granulation tissue formation and epithelization in the implanted area.

  2. Management of blunt tracheal trauma in children: a case series and review of the literature. (United States)

    Duval, Elisabeth L; Geraerts, Saskia D; Brackel, Hein J


    Blunt tracheal trauma seldom develops in children because of their anatomy and the mobility of the cartilage. It has the potential to be overlooked, either because of the severity of concomitant injuries or because of the unfamiliarity of paediatricians with this type of injury. However, tracheal injury might be lethal due to airway compromise. Early bronchoscopy may be necessary to anticipate complications and prevent permanent dysfunction. We present a retrospective, double-institution case series over a 5-year period, describing five children, aged 3 to 14 years, with tracheal injury after blunt cervical trauma. All patients showed emphysema with pneumomediastinum. After explorative bronchoscopy, all patients were successfully treated with antibiotics and/or supportive ventilation. In summary, minimal lesions due to blunt tracheal trauma could be treated conservatively in children. Since the external signs of tracheal injury are not indicative of the extent of the trauma, a high index of suspicion is warranted in these patients.

  3. [Fiberoptic intubation using two tracheal tubes for a child with Goldenhar syndrome]. (United States)

    Kaji, Junko; Higashi, Midoriko; Sakaguchi, Yoshiro; Maki, Jun; Kai, Tetsuya; Yamaura, Ken; Hoka, Sumio


    Goldenhar syndrome is associated with difficult airway due to the characteristic craniofacial anomalies such as hypoplasia of the mandible and molar bones. We present our method of fiberoptic intubation using two tracheal tubes for a girl with Goldenhar syndrome undergoing cochlear implant surgery. She had received general anesthesia for dental treatment one year before, but the treatment had been cancelled because of the failure of tracheal intubation. We induced anesthesia for her with inhalation of sevoflurane and nitrous oxide. After obtaining a stable anesthetic level, we inserted two tracheal tubes from the right and left nostrils, one for a tracheal tube and the other for a nasopharyngeal airway. During the procedure, the fiberscope was advanced through the tracheal tube with a slit connector, and her ventilation was assisted through the nasopharyngeal airway with her mouth closed by a tape to avoid a leak of ventilating gas. Using this two-tube method, we successfully intubated the trachea of a patient Goldenhar syndrome.

  4. Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy

    Directory of Open Access Journals (Sweden)

    Lilibeth Fermin


    Full Text Available Extracorporeal Membrane Oxygenation (ECMO for repair of tracheal injury during transhiatal esophagectomy Tracheal injury is a rare but potentially fatal complication of esophagectomies requiring prompt recognition and treatment. We describe a case of tracheal injury recognized in the operative period of an open transhiatal esophagectomy for squamous cell carcinoma of the mid to distal esophagus. When injury was discovered, attempts to improve oxygenation and ventilation by conventional methods were unsuccessful. Therefore, peripheral ECMO was used to support oxygenation during the tracheal defect repair. The use of ECMO for the repair of a tracheal injury during esophagectomy is very uncommon but, in our case, provided adequate oxygenation and ventilation while the surgeon repaired the injury and the patient was able to be promptly weaned from ECMO support and extubated not long after.

  5. A comparison of midline and tracheal gene regulation during Drosophila development.

    Directory of Open Access Journals (Sweden)

    Sarah K R Long

    Full Text Available Within the Drosophila embryo, two related bHLH-PAS proteins, Single-minded and Trachealess, control development of the central nervous system midline and the trachea, respectively. These two proteins are bHLH-PAS transcription factors and independently form heterodimers with another bHLH-PAS protein, Tango. During early embryogenesis, expression of Single-minded is restricted to the midline and Trachealess to the trachea and salivary glands, whereas Tango is ubiquitously expressed. Both Single-minded/Tango and Trachealess/Tango heterodimers bind to the same DNA sequence, called the CNS midline element (CME within cis-regulatory sequences of downstream target genes. While Single-minded/Tango and Trachealess/Tango activate some of the same genes in their respective tissues during embryogenesis, they also activate a number of different genes restricted to only certain tissues. The goal of this research is to understand how these two related heterodimers bind different enhancers to activate different genes, thereby regulating the development of functionally diverse tissues. Existing data indicates that Single-minded and Trachealess may bind to different co-factors restricted to various tissues, causing them to interact with the CME only within certain sequence contexts. This would lead to the activation of different target genes in different cell types. To understand how the context surrounding the CME is recognized by different bHLH-PAS heterodimers and their co-factors, we identified and analyzed novel enhancers that drive midline and/or tracheal expression and compared them to previously characterized enhancers. In addition, we tested expression of synthetic reporter genes containing the CME flanked by different sequences. Taken together, these experiments identify elements overrepresented within midline and tracheal enhancers and suggest that sequences immediately surrounding a CME help dictate whether a gene is expressed in the midline or


    Zallocchi, Marisa; Sisson, Joseph H.; Cosgrove, Dominic


    Usher syndrome is the major cause of deaf/blindness in the world. It is a genetic heterogeneous disorder, with nine genes already identified as causative for the disease. We noted expression of all known Usher proteins in bovine tracheal epithelial cells, and exploited this system for large-scale biochemical analysis of Usher protein complexes. The dissected epithelia were homogenized in non-detergent buffer, and sedimented on sucrose gradients. At least two complexes were evident after the first gradient: one formed by specific isoforms of CDH23, PCDH15 and VLGR-1, and a different one at the top of the gradient that included all the Usher proteins and rab5, a transport vesicle marker. TEM analysis of these top fractions found them enriched in 100–200 nm vesicles, confirming a vesicular association of the Usher complex(es). Immunoisolation of these vesicles confirmed some of the associations already predicted and identified novel interactions. When the vesicles are lysed in the presence of phenylbutyrate, most of the Usher proteins co-sediment into the gradient at a sedimentation coefficient of approximately 50S, correlating with a predicted molecular mass of 2 × 106 Daltons. Although it is still unclear whether there is only one complex or several independent complexes that are trafficked within distinct vesicular pools, this work shows for the first time that native Usher proteins complexes occur in vivo. This complex(es) is present primarily in transport vesicles at the apical pole of tracheal epithelial cells, predicting that Usher proteins may be directionally transported as complexes in hair cells and photoreceptors. PMID:20058854

  7. Ruptured ectopic pregnancy associated with tubal schistosomiasis

    Directory of Open Access Journals (Sweden)

    L Sahu


    Full Text Available Endemic in major parts of Africa and Middle East, Schistosoma haematobium is a common cause of recurrent urogenital infections and obstetric complications such as spontaneous abortions, ectopic pregnancies, and low birth weight babies. The involvement of fallopian tubes is not rare in endemic areas and may predispose to ectopic pregnancy and infertility. Indian subcontinent is a very lowrisk region for schistosoma infection. Tubal schistosomiasis is not exceptional in endemic zones, but is rarely found in India. The species most often isolated is S. haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. We report a case of tubal schistosomiasis presenting as ruptured ectopic pregnancy discovered on a surgical specimen after salpingectomy.

  8. Imaging of diaphragmatic rupture after trauma

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    Eren, S. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey)]. E-mail:; Kantarci, M. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey); Okur, A. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey)


    Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented.

  9. Rupture rate following primary flexor tendon repair of the hand with potential contributing risk factors. (United States)

    Ibrahim, Mazin Saad; Khan, Muhammad Asim; Rostom, Mai; Platt, Alastair


    This study aimed to investigate rupture rates following primary flexor tendon repair and to identify potential risk factors of rupture. Fifty-one patients with 100 flexor tendon injuries who underwent primary repair over a one-year period were reviewed. We collected demographic and surgical data. Causes of rupture were examined. Ruptured primary tendon repairs were compared with those that did not rupture. Univariate and multivariate analysis were undertaken to identify significant risk factors. Eleven percent of repaired tendons ruptured with a higher rupture rate noted in the non-dominant hand (p value = 0.009), in Zone II (0.001), and when more than 72 hours surgical delay occurred (0.01). Multivariate regression analysis identified repair in Zone II injuries to be the most significant predictor. Our rate of rupture of 11% was associated with delay in surgery, repair on non-dominant hand, and Zone II repairs. Careful consideration of these factors is crucial to reduce this rate.

  10. Differential diagnosis between traumatic and nontraumatic rupture of the intracranial vertebral artery in medicolegal autopsy. (United States)

    Ro, Ayako; Kageyama, Norimasa; Takatsu, Akihiro; Fukunaga, Tatsushige


    We attempted to establish histopathological identification between traumatic rupture and nontraumatic arterial dissection of the intracranial vertebral artery (IVA) resulting in subarachnoid hemorrhage (SAH). Step-serial observations of ruptured IVAs among four traumatic and 44 nontraumatic SAH patients were investigated. We found that the most specific characteristic for differentiation was the shape of the ruptured adventitia. Extension of the adventitia was clearly observed in nontraumatic cases. In contrast, traumatic cases showed transmural ruptures. Other specific characteristics were also detected. For traumatic cases, small incomplete tears of intima and media were frequently found; they formed oblique tears without adventitial extension. Fragmentized internal elastic lamina was also observed in traumatic cases. In contrast, previous arterial dissections were frequently confirmed in nontraumatic cases. Medial degenerations or defects were detected in all nontraumatic cases. In these cases, the peripheral lesion of the rupture was appeared as intimal tears at recessed vascular wall caused by medial defects. This suggested a relationship between medial lesions and pathogenesis of arterial dissections. These additional features were found in both ruptured and non-ruptured intracranial arteries. We concluded that histopathological investigation is a reliable method for differential diagnosis between traumatic and nontraumatic rupture of the IVA resulting in fatal SAH. These morphological differentiations could be valuable for medicolegal diagnosis.

  11. Management of tracheal chondrosarcoma almost completely obstructing the airway: a case report. (United States)

    Andolfi, Marco; Vaccarili, Maurizio; Crisci, Roberto; Puma, Francesco


    Primary malignant tracheal tumors account for only 0.2 % of all malignancies of the respiratory tract. Tracheal chondrosarcoma is a rare condition and only 17 cases have been described in the literature from 1965 to date. Herein we report the very unusual case of a patient with a tracheal chondrosarcoma, electively treated by curative surgery despite the virtually complete obstruction of the airway. We present the case of a 79-year old Caucasian man with long-lasting wheezing misdiagnosed as asthma and affected by a tracheal chondrosarcoma almost completely obstructing the airway. Videobronchoscopy and imaging investigations revealed a well-circumscribed mass arising from the cartilaginous rings of the cervical trachea with a posterior residual respiratory space of about 1 mm. Because of the mobility and flaccidity of the uninvolved pars membranacea, the tiny respiratory space slightly expanded during inspiration and expiration allowing the patient to be treated without an essential emergency procedure. Standard tracheal intubation was impossible. Rigid bronchoscopy enabled placement of a small tracheal tube distally to the tumor. Successful cervical tracheal resection and reconstruction was then performed, achieving complete tumor excision. Histologically, the mass was characterized as a low-grade tracheal chondrosarcoma. Videobronchoscopy performed 9 months after surgery showed a wide, well healed tracheal anastomosis. Ten months after surgery, the patient is alive and disease free. Complete surgical resection is the treatment of choice for tracheal chondrosarcoma. Rigid bronchoscopy is an essential tool for diagnostic and therapeutic purposes. It allows the palliative maneuvers for obstruction relief but also, in resectable patients, the intraoperative safe and straightforward management of the obstructed airway.

  12. A new retrograde transillumination technique for videolaryngoscopic tracheal intubation. (United States)

    Biro, P; Fried, E; Schlaepfer, M; Kristensen, M S


    This single-centre, prospective trial was designed to assess the efficacy of a new retrograde transillumination device called the 'Infrared Red Intubation System' (IRRIS) to aid videolaryngoscopic tracheal intubation. We included 40 adult patients, who were undergoing elective urological surgery under general anaesthesia. We assessed the ability to differentiate the transilluminated glottis from other structures and found a median (IQR [range]) larynx recognition time of 8 (5-14 [3-28]) s. The difference in laryngeal visibility on the screen between the deactivated vs. activated device expressed on a visual analogue scale was significant (6 (4-7 [2-10]) vs. 10 (8-10 [4-10]); p < 0.001). The number of laryngoscope insertions was 1 (1-2 [1-3]) and the device showed high values on a visual analogue scale ranging from 0 (lowest score) to 10 (highest score) for helpfulness (6 (5-7 [2-10])), credibility (10 (8-10 [5-10])) and ease of use (10 (9-10 [8-10])). Tracheal intubation with the system lasted 26 (16-32 [6-89]) s. No alternative technique of securing the airway was necessary. The lowest SpO2 during intubation was 98 (97-99 [91-100])%. We conclude that this method of retrograde transillumination can assist videolaryngoscopy. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

  13. Tracheobronchomegaly following intrauterine tracheal occlusion for congenital diaphragmatic hernia. (United States)

    Enriquez, Goya; Cadavid, Lina; Garcés-Iñigo, Enrique; Castellote, Amparo; Piqueras, Joaquim; Peiró, Jose Luis; Carreras, Elena


    Fetuses with severe congenital diaphragmatic hernia (CDH) and pulmonary hypoplasia may benefit from fetal endoluminal tracheal occlusion (FETO). Enlargement of the main bronchi and trachea appears to be a common complication of FETO. To retrospectively evaluate the trachea and main bronchi of infants who underwent FETO for CDH and compare diameters with age-matched references. Postnatal and follow-up chest radiographs were performed in seven children with unilateral CDH treated by FETO. Additional CT was performed in six of these (one neonate died before CT could be performed). Images were acquired from 3 days to 23 months of age. For each child, radiographs and CT images with optimal visualisation of the airways were selected for retrospective analysis. Tracheal and bronchial morphology was assessed by two experienced paediatric radiologists, and the diameters of these structures measured and compared with age-matched references. Mean diameters of the trachea and main bronchi were above the age-matched normal range in all patients, regardless of the side of the hernia or the degree of lung hypoplasia. Enlargement of the trachea and main bronchi appears following FETO and persists at least to the age of 5 years.

  14. Distal projection of insufflated gas during tracheal gas insufflation. (United States)

    Carter, Christopher S; Hotchkiss, John R; Adams, Alexander B; Stone, Mary K; Marini, John J


    Tracheal gas insufflation (TGI) flushes expired gas from the ventilator circuitry and central airways, augmenting CO2 clearance. Whereas a significant portion of this washout effect may occur distal to the injection orifice, the penetration and mixing behavior of TGI gas has not been studied experimentally. We examined the behavior of 100% oxygen TGI injected at set flow rates of 1-20 l/min into a simulated trachea consisting of a smooth-walled, 14-mm-diameter tube. Models incorporating a separate coaxial TGI injector, a rough-walled trachea, and a bifurcated trachea were also studied. One-hundred percent nitrogen, representing expiratory flow, passed in the direction opposite to TGI at set flow rates of 1-25 l/min. Oxygen concentration within the "trachea" was mapped as a function of axial and radial position. Three consistent findings were observed: 1) mixing of expiratory and TGI gases occurred close to the TGI orifice; 2) the oxygenated domain extended several centimeters beyond the endotracheal tube, even at high-expiratory flows, but had a defined distal limit; and 3) more distally from the site of gas injection, the TGI gas tended to propagate along the tracheal wall, rather than as a central projection. We conclude that forward-directed TGI penetrates a substantial distance into the central airways, extending the compartment susceptible to CO2 washout.

  15. Association of tracheal mucus or blood and airway neutrophilia with racing performance in Thoroughbred horses in an Australian racing yard. (United States)

    Salz, R O; Ahern, B J; Boston, R; Begg, L M


    To determine the variation of tracheal mucus scores, tracheal blood scores and transendoscopic tracheal wash (TW) cytology in a population of Thoroughbred (TB) racehorses and assess their association with racing performance. A total of 220 endoscopic examinations were performed and TWs obtained from 155 TB racehorses. Samples were collected 60-120 min following gallop work. Tracheal mucus score, tracheal blood score and TW cytology were analysed and their association with racing performance assessed. Of the total examinations and samples, 194 from 135 horses fitted the criteria for inclusion. The overall prevalence of visible tracheal mucus was 2.5% (5/194) and of increased tracheal mucus was 0%. The prevalence of visible tracheal blood was 8.8% (17/194) and of increased tracheal blood was 4.6% (9/194). A total of 36% (70/194) of TWs contained elevated percentages of neutrophils and of these, 96% (67/70) occurred in the absence of any visible tracheal mucus. There was no significant association between tracheal mucus score or TW cytology and subsequent racing performance. There was a statistically significant association (P = 0.004) between increased tracheal blood scores and poor racing performance. Visible tracheal blood seen after strenuous exercise in clinically normal TB racehorses was a risk factor for poor racing performance, but the presence of airway neutrophilia was not. No horses in this study were found to have increased tracheal mucus, so the association of increased tracheal mucus with racing performance could not be assessed. © 2016 Australian Veterinary Association.

  16. Insights into earthquake rupture and recovery from paleoseismic faults (United States)

    Rowe, C. D.; Griffith, W. A.; Ross, C.; Melosh, B. L.; Young, E.


    There are two key factors distinguishing earthquake slip from creep that have the potential to be preserved in rocks from ancient fault zones. First, slip velocity is sufficiently high that the frictional heat production on the slip surface outpaces conductive heat dissipation, resulting in a net temperature rise. If the slip is sufficiently localized and the normal stress is high enough, this temperature rise can dissociate hydrous minerals, cause rapid maturation of organic compounds, and melt fault rock. These reactions are recorded in fault rock mineralogy and composition and can be used to estimate coseismic temperatures from 250 C to greater than 1400 C. Second, seismic slip is *dynamic*, that is, that the slipping area expands in size at rates comparable to the shear wave velocity in the rocks ( 3 km/s), which results in extreme stress gradients in the wall rock at the rupture tip. The stressing rate exceeds the speed at which fractures can propagate through the wall rock, resulting in distinctive patterns of very tightly spaced and branching fractures, and sometimes pulverization. These fractures can be the dominant form of off-fault damage and may cause permeability spikes through the fresh fracture networks. Using both types of fossil earthquake signatures, we can identify ancient seismic rupture planes and use these to map out the geometry of earthquake rupture networks at the outcrop scale (10^-3 - 10^3 meters), which is below the resolution and location uncertainty of earthquake seismology in most active faults. Using examples from the Pofadder and Norumbega Shear Zones, I will show that earthquakes can rupture multiple parallel and non-parallel surfaces simultaneously, and that healing during afterslip can affect damage zones as well as the rupture surface. Outcrop studies may be able to elucidate the consequences for slip distribution and help explain spatial variations in fracture energy and stress drop that are barely resolvable in seismic data.

  17. Rupture of intracranial aneurysm and full moon


    Ottomann, Christian


    ABSTRACT OBJECTIVE: To test the hypothesis that the incidence of intracranial aneurysm rupture increases at the time of a full moon period. DESIGN: Retrospective analysis SETTING: Time of rupture and neurosurgical treatment at a university hospital in the capital city of Germany. SETTING: 486 consecutive patients, irrespective of age and sex. MAIN OUTCOME MEASURES: Number of patients who attended an rupture of an intracranial aneurysm and surgical treatment during 1990 to 1998. Th...

  18. Rupture of Al matrix in U-Mo/Al dispersion fuel by fission induced creep

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    Jeong, Gwan Yoon; Sohn, Dong Seong [UNIST, Daejeon (Korea, Republic of); Kim, Yeon Soo [Argonne National Laboratory, Argonnge (United States); Lee, Kyu Hong [KAERI, Daejeon (Korea, Republic of)


    This phenomenon was found specifically in the dispersion fuel plate with Si addition in the Al matrix to suppress interaction layer (IL) formation between UMo and Al. It is known that the stresses induced by fission induced swelling in U-Mo fuel particles are relieved by creep deformation of the IL, surrounding the fuel particles, that has a much higher creep rate than the Al matrix. Thus, when IL growth is suppressed, the stress is instead exerted on the Al matrix. The observed rupture in the Al matrix is believed to be caused when the stress exceeded the rupture strength of the Al matrix. In this study, the possibility of creep rupture of the Al matrix between the neighboring U-Mo fuel particles was examined using the ABAQUS finite element analysis (FEA) tool. The predicted rupture time for a plate was much shorter than its irradiation life indicating a rupture during the irradiation. The higher stress leads Al matrix to early creep rupture in this plate for which the Al matrix with lower creep strain rate does not effectively relieve the stress caused by the swelling of the U-Mo fuel particles. For the other plate, no rupture was predicted for the given irradiation condition. The effect of creeping of the continuous phase on the state of stress is significant.

  19. A Reliable Way to Track Rupture Process of Earthquakes (United States)

    Liu, Z.; Ge, Z.


    Compressive sensing (CS) is an algorithm which could find the solution to a sparse linear problem, which is physically consist with inversion problem of rupture process. Because relative to the whole fault plane, the seismic power radiation area is sparse in a specific moment during a great earthquake. CS method is used to invert the rupture process from teleseismic P wave data recorded by multiple seismic arrays with different azimuths and epicentral distances. Synthetic tests illustrate that, our method can suppress the artifacts caused by interference phases ( eg. PcP ) thus we can obtain a more reliable result than using the data from a single array. Moreover, the "swimming effect" in traditional back-projection method can be reduced due to the better azimuth coverage. Then the rupture process of the Mw7.9 earthquake in the Aleutian Islands, occurred at June 23, 2014 20:53 UTC is inverted. The results show that the rupture is along the subduction zone, which can be used to locate the primary fault plane combined with central moment tensor. In addition, where the released power concentrates in the earthquake is also given, which could help us determine which area is effected by the earthquake most heavily, thus the rescue operation can be effective. In conclusion, different from traditional beamforming method, CS can offer a high-resolution solution.

  20. Ruptured Cesarean Scar Ectopic Pregnancy


    Sujatha BS; Sunanda Bharatnur; Samarth Virmani; Shripad Hebbar; Arijit Bishnu


    A pregnancy with implantation on the scar of a past cesarean section is uncommon. However such pregnancies are on the rise due to the increasing number of lower segment cesarean section. One of the complications of such a pregnancy is uterine rupture in early pregnancy which can be life threatening to the patient. The following is a report of a patient who presented at 10 weeks of gestational age with features of hypovolemic shock and lower position of the gestational sac in relation to the u...

  1. Kernohan's phenomenon associated with left ruptured occipital arteriovenous malformation. (United States)

    Fujimoto, A; Sato, H; Katayama, W; Nakai, K; Tsunoda, T; Kobayashi, E; Nose, T


    A 23-year-old woman presented with ipsilateral hemiparesia due to rupture of a left occipital arteriovenous malformation (AVM). Emergency decompression (the onset-operation interval was 46 minutes,) was carried out and the patient could leave the hospital upon recovery without neurological deficits. In general, Kernohan's phenomenon is caused by the gradual displacement of the cerebral peduncle against the tentorial edge caused by compression by the contralateral mass. This phenomenon is very rare among the cases with spontaneous intracranial hemorrhage and only three cases including the present one have been reported in the literature. In all cases the onset-operation intervals of were very short. Kernohan's phenomenon associated with a ruptured AVM is a rare condition and emergency decompression is required.

  2. Renal pelvis rupture during pregnancy: diagnosing a confusing source of despair. (United States)

    Boekhorst, Ferry; Bogers, Hein; Martens, Jolise


    We present an impressive case of a pregnant woman presenting with severe right flank pains. A rare rupture of the right renal pelvis turned out to be the cause of her problems. Renal pelvis rupture in pregnancy is difficult to diagnose. It is easily confused with other more prevalent diagnoses, like hydronephrosis, ureteral distension, renal calculus and pyelonephritis. Ultrasonography is not always conclusive. Pyelography seems to be a good diagnostic tool, this case shows that MRI is another option. Renal pelvis rupture can be effectively treated with the insertion of a JJ-stent. 2015 BMJ Publishing Group Ltd.

  3. Impairment of tracheal mucociliary clearance but not ciliary beat frequency by a combination of low level ozone and sulfur dioxide in sheep

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    Abraham, W.M.; Sielczak, M.W.; Delehunt, J.C.; Marchette, B.; Wanner, A.


    We used conscious sheep to determine the effect of a combined exposure to ozone (O/sub 3/) and sulfur dioxide (SO/sub 2/) on tracheal mucus velocity (TMV) and ciliary beat frequency (CBF). TMV was measured in vivo by tracking the movement of radiopaque particles which had been deposited on the tracheal mucosa. CBF of tracheal epithelial cells, obtained by brushing, was measured in vitro with phase contrast microscopy. On two separate occasions, six sheep were exposed by mask to either a combination of 0.3 ppm O/sub 3/ and 3 ppm SO/sub 2/ or air (control) for 5 h on each of three consecutive days. TMV and CBF were measured prior to the first exposure, and immediately and 24 h after the last exposure. The combination of O/sub 3/ and SO/sub 2/ depressed mean TMV by 40% immediately after and by 25%, 24 h after exposure. Both values were different from the corresponding values after air exposure (p less than 0.05). However, this depression in TMV was not associated with an impairment in CBF. We conclude that in conscious sheep, exposure to a combination of low level O/sub 3/ and SO/sub 2/ causes a depression in TMV, and changes in CBF are probably not a primary cause of this mucociliary dysfunction.

  4. Pump out the volume--The effect of tracheal and subelytral pressure pulses on convective gas exchange in a dung beetle, Circellium bacchus (Fabricus). (United States)

    Duncan, Frances D; Förster, Thomas D; Hetz, Stefan K


    Many flightless beetles like the large apterous dung beetle Circellium bacchus, possess a subelytral cavity (SEC) providing an extra air space below the elytra which connects to the tracheal system (TS) via metathoracic and abdominal spiracles. By measuring subelytral and intratracheal pressure as well as body movements and gas exchange simultaneously in a flow-through setup, we investigated the contribution of convection on Circellium respiratory gas exchange. No constriction phase was observed. TS and SEC pressures were always around atmospheric values. During interburst phase open abdominal spiracles and a leaky SEC led to small CO(2)-peaks on a continuous CO(2) baseline, driven by intermittent positive tracheal pressure peaks in anti-phase with small negative subelytral pressure peaks caused by dorso-ventral tergite action. Spiracle opening was accompanied by two types of body movements. Higher frequency telescoping body movements at the beginning of opening resulted in high amplitude SEC and TS pressure peaks. High frequency tergite movements caused subelytral pressure peaks and led to a saw tooth like CO(2) release pattern in a burst. We propose that during the burst open mesothoracic spiracles increase the compliance of the subelytral cavity allowing big volumes of tracheal air being pulled out by convection. Copyright 2009 Elsevier Ltd. All rights reserved.

  5. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

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    Payal Kajekar


    Full Text Available Background and Aims: Pentax airway scope (AWS has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade, total dose of local anaesthetic used, anaesthetists rating and patient′s tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%. The mean (standard deviation intubation time and total time to complete the tracheal intubation was 5.4 (2.4 and 13.9 (3.7 min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS. Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.

  6. Tracheal CT morphology: correlation with distribution and extent of thoracic adipose tissue

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    Ap Dafydd, Derfel [Imperial College Healthcare NHS Trust, Department of Radiology, Charing Cross Hospital, London (United Kingdom); Desai, Sujal R. [King' s College Hospital NHS Foundation Trust, King' s College London, King' s Health Partners, London (United Kingdom); Gordon, Fabiana; Copley, Susan J. [Imperial College, London (United Kingdom)


    To evaluate the relationship between adipose tissue measurements and anterior bowing of the posterior tracheal wall in a large nonselected group of patients undergoing CT pulmonary angiography (CTPA). Consecutive patients undergoing CTPA over a 4-month period were analyzed retrospectively. Using an adapted scoring system (posterior bowing, flattening, mild/moderate or severe anterior bowing of the posterior tracheal membrane), the axial morphology and cross-sectional area of the trachea at the narrowest point and 1 cm above the aortic arch were evaluated. Measurements of adipose tissue were taken (anterior mediastinal fat width, sagittal upper abdominal diameter and subcutaneous fat thickness at the level of the costophrenic angle). Relationships between tracheal morphology and measurements of adipose tissue were analyzed. 296 patients were included (120 males, 176 females, mean age 59 years, range 19-90). Severe anterior bowing of the posterior tracheal wall correlated with increasing sagittal upper abdominal diameter (p = 0.002). Mild/moderate and severe anterior bowing of the posterior tracheal wall correlated with increasing mediastinal fat width (p = 0.000 and p = 0.031, respectively). Tracheal cross-sectional area was inversely correlated with increasing subcutaneous fat thickness (p = 0.022). The findings demonstrate a statistically significant relationship between CT tracheal morphology and adipose tissue measurements in a large nonselected population. (orig.)

  7. Cell autonomy of HIF effects in Drosophila: tracheal cells sense hypoxia and induce terminal branch sprouting. (United States)

    Centanin, Lázaro; Dekanty, Andrés; Romero, Nuria; Irisarri, Maximiliano; Gorr, Thomas A; Wappner, Pablo


    Drosophila tracheal terminal branches are plastic and have the capacity to sprout out projections toward oxygen-starved areas, in a process analogous to mammalian angiogenesis. This response involves the upregulation of FGF/Branchless in hypoxic tissues, which binds its receptor Breathless on tracheal cells. Here, we show that extra sprouting depends on the Hypoxia-Inducible Factor (HIF)-alpha homolog Sima and on the HIF-prolyl hydroxylase Fatiga that operates as an oxygen sensor. In mild hypoxia, Sima accumulates in tracheal cells, where it induces breathless, and this induction is sufficient to provoke tracheal extra sprouting. In nontracheal cells, Sima contributes to branchless induction, whereas overexpression of Sima fails to attract terminal branch outgrowth, suggesting that HIF-independent components are also required for full induction of the ligand. We propose that the autonomous response to hypoxia that occurs in tracheal cells enhances tracheal sensitivity to increasing Branchless levels, and that this mechanism is a cardinal step in hypoxia-dependent tracheal sprouting.

  8. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K


    It is unknown whether the bone bruise that occurs in connection with acute anterior cruciate ligament (ACL) rupture is causing pain and dysfunction. We followed prospectively 17 patients [10 men, seven women, mean age 28 years (range 23-34)] with acute ACL rupture for 2 months. A magnetic resonance...

  9. Non-bleeding Spontaneous Rupture of Hepatocellular Carcinoma ...

    African Journals Online (AJOL)

    Rupture of hepatocellular carcinoma (HCC) is not uncommon and most ruptured HCC present with hemoperitoneum and hemorrhagic shock. Management of ruptured HCC is different than non.ruptured one. Short. and long.term mortality increases following rupture of HCC with increasing chances of tumor dissemination.

  10. Preterm premature rupture of the fetal membranes: current concepts. (United States)

    Srinivas, S K; Macones, G A


    Preterm birth and preterm premature rupture of membranes (PPROM) are common causes of perinatal morbidity and mortality. Fetal membrane integrity is regulated partially by collagenases and inhibitors. A number of genetic polymorphisms with genes related to infection, inflammation and collagen degradation have been identified and studies as risk factors for PPROM. This manuscript reviews the state of the science on the pathophysiology of PPROM and possible genetic influences.

  11. Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran (United States)

    Farzanegan, Roya; Farzanegan, Behrooz; Zangi, Mahdi; Golestani Eraghi, Majid; Noorbakhsh, Shahram; Doozandeh Tabarestani, Neda; Shadmehr, Mohammad Behgam


    Background Tracheal stenosis is one of the worst complications associated with endotracheal intubation and it is the most common reason for reconstructive airway surgeries. Due to various local risk factors, the incidence rate of tracheal stenosis may vary in different countries. In order to estimate the incidence rate of post-intubation tracheal stenosis (PITS) in patients admitted to an intensive care unit (ICU), a follow-up study was planned. As there was no similar methodological model in the literature, a feasibility step was also designed to examine the whole project and to enhance the follow-up rate. Objectives To estimate the PITS incidence rate in patients admitted to ICUs, as well as to evaluate the feasibility of the study. Methods This prospective cohort study was conducted in five hospitals in two provinces (Tehran and Arak) of Iran from November 2011 to March 2013. All patients admitted to ICUs who underwent more than 24 hours of endotracheal intubation were included. Upon their discharge from the ICUs, the patients received oral and written educational materials intended to ensure a more successful follow-up. The patients were asked to come back for follow-up three months after their extubation, or sooner in case of any symptoms developing. Those with dyspnea or stridor underwent a bronchoscopy. The asymptomatic patients were given a spirometry and then they underwent a bronchoscopy if the flow-volume loop suggested airway stenosis. Results Some seventy-three patients (70% men) were included in the study. Multiple trauma secondary to motor vehicle accidents (52%) was the most common cause of intubation. Follow-ups were completed in only 14 (19.2%, CI = 0.109 - 0.300) patients. One patient (7%, CI = 0.007 - 0.288) developed symptomatic tracheal stenosis that was confirmed by bronchoscopy. The barriers to a successful follow-up were assessed on three levels: ineffective oral education upon discharge, improper usage of educational materials, and

  12. Anesthetic management of a large mediastinal mass for tracheal stent placement

    Directory of Open Access Journals (Sweden)

    Suman Rajagopalan


    Full Text Available ABSTRACT The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

  13. Differentiation of hemopericardium due to ruptured myocardial infarction or aortic dissection on unenhanced postmortem computed tomography. (United States)

    Ampanozi, Garyfalia; Flach, Patricia M; Ruder, Thomas D; Filograna, Laura; Schweitzer, Wolf; Thali, Michael J; Ebert, Lars C


    The aim of the study was to evaluate unenhanced postmortem computed tomography (PMCT) in cases of non-traumatic hemopericardium by establishing the sensitivity, specificity and accuracy of diagnostic criteria for the differentiation between aortic dissection and myocardial wall rupture due to infarction. Twenty six cases were identified as suitable for evaluation, of which ruptured aortic dissection could be identified as the underlying cause of hemopericardium in 50% of the cases, and myocardial wall rupture also in 50% of the cases. All cases underwent a PMCT and 24 of the cases also underwent one or more additional examinations: a subsequent autopsy, or a postmortem magnetic resonance (PMMR), or a PMCT angiography (PMCTA), or combinations of the above. Two radiologists evaluated the PMCT images and classified each case as "aortic dissection", "myocardial wall rupture" or "undetermined". Quantification of the pericardial blood was carried out using segmentation techniques. 17 of 26 cases were correctly identified, either as aortic dissections or myocardial ruptures, by both readers. 7 of 13 myocardial wall ruptures were identified by both readers, whereas both readers identified correctly 10 of 13 aortic dissection cases. Taking into account the responses of both readers, specificity was 100% for both causes of hemopericardium and sensitivity as well as accuracy was higher for aortic dissections than myocardial wall ruptures (72.7% and 87.5% vs 53.8% and 75% respectively). Pericardial blood volumes were constantly higher in the aortic dissection group, but a statistical significance of these differences could not be proven, since the small count of cases did not allow for statistical tests. This study showed that diagnostic criteria for the differentiation between ruptured aortic dissection and myocardial wall rupture due to infarction are highly specific and accurate.

  14. Diagnostic value of ultrasound, computed tomography, and angiography in ruptured aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Landtman, M.; Kivisaari, L.; Bondestam, S.; Taavitsainen, M.; Standertskjoeld-Nordenstam, C.G.; Somer, K.


    Some ruptural aneurysms cause nonspecific symptoms and the patients are referred for radiological examination because of the problems of differential diagnosis from conditions such as renal colic, diverticulitis, herniated disc, aortic dissection etc. Seven such patients have been examined either with ultrasonography, computed tomography or angiography. The diagnostic methods are compared. The more recent US and CT imaging methods are sufficiently rapid and reliable for diagnostic purposes, which should improve the prognosis for patients requiring immediate surgery for ruptured aortic aneurysms.

  15. Evaluation of vertical forces in the pads of Pitbulls with cranial cruciate ligament rupture


    Souza, Alexandre Navarro Alves; Tatarunas, Angelica Cecilia; Matera, Julia Maria


    Abstract Background Cranial cruciate ligament rupture (CCLR) is one of the most important stifle injuries and a common cause of lameness in dogs. Our objective was to measure the vertical forces in the pads of Pitbulls with cranial cruciate ligament rupture (CCLR) using a pressure sensitive walkway. A pressure sensitive walkway was used to collect vertical force data from the pads of 10 Pitbulls affected with unilateral CCLR. Ten healthy...

  16. Whip restraint for a steam pipe rupture event on a nuclear power plant / Alfred Cornelius Pieters


    Pieters, Alfred Cornelius


    One of the requirements of a safe nuclear power plant design is the postulation of the dynamic effects of a steam pipe rupture. The dynamic effects are the discharging fluid and pipe whip on structures, systems or components. A pipe rupture can be caused in the steam pipe system where a defect such as a crack exists. Multiple factors contribute to the initiation of pipe cracks during the plant’s life. Cracks may start microscopically small and over time, with the assistance...

  17. The SCEC/USGS dynamic earthquake rupture code verification exercise (United States)

    Harris, R.A.; Barall, M.; Archuleta, R.; Dunham, E.; Aagaard, Brad T.; Ampuero, J.-P.; Bhat, H.; Cruz-Atienza, Victor M.; Dalguer, L.; Dawson, P.; Day, S.; Duan, B.; Ely, G.; Kaneko, Y.; Kase, Y.; Lapusta, N.; Liu, Yajing; Ma, S.; Oglesby, D.; Olsen, K.; Pitarka, A.; Song, S.; Templeton, E.


    Numerical simulations of earthquake rupture dynamics are now common, yet it has been difficult to test the validity of these simulations because there have been few field observations and no analytic solutions with which to compare the results. This paper describes the Southern California Earthquake Center/U.S. Geological Survey (SCEC/USGS) Dynamic Earthquake Rupture Code Verification Exercise, where codes that simulate spontaneous rupture dynamics in three dimensions are evaluated and the results produced by these codes are compared using Web-based tools. This is the first time that a broad and rigorous examination of numerous spontaneous rupture codes has been performed—a significant advance in this science. The automated process developed to attain this achievement provides for a future where testing of codes is easily accomplished.Scientists who use computer simulations to understand earthquakes utilize a range of techniques. Most of these assume that earthquakes are caused by slip at depth on faults in the Earth, but hereafter the strategies vary. Among the methods used in earthquake mechanics studies are kinematic approaches and dynamic approaches.The kinematic approach uses a computer code that prescribes the spatial and temporal evolution of slip on the causative fault (or faults). These types of simulations are very helpful, especially since they can be used in seismic data inversions to relate the ground motions recorded in the field to slip on the fault(s) at depth. However, these kinematic solutions generally provide no insight into the physics driving the fault slip or information about why the involved fault(s) slipped that much (or that little). In other words, these kinematic solutions may lack information about the physical dynamics of earthquake rupture that will be most helpful in forecasting future events.To help address this issue, some researchers use computer codes to numerically simulate earthquakes and construct dynamic, spontaneous

  18. Treatment alternative for irreparable rotator cuff ruptures ...

    African Journals Online (AJOL)

    Background: The treatment of massive irreparable rotator cuff rupture has still no consensus among shoulder surgeons. It is assumed that symptomatic rotator cuff tendon rupture is accepted as irreparable if retraction amount of tendon is Patte stage 3 on MRI; degree of fatty atrophy is Goutallier stage 3 or 4; narrowing of ...

  19. Ruptured intracranial dermoids: magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Patkar D


    Full Text Available Rupture of intracranial dermoids tumour is rare and carries with it the risk of significant morbidity as well as fatality. Three cases that presented with varying symptoms ranging from headache to chiasmatic compression and suspected to have rupture of dermoid tumour are described. The importance of MR imaging in their diagnosis is discussed.

  20. Urinary bladder rupture during voiding cystourethrography

    Directory of Open Access Journals (Sweden)

    Kyong Ok Lee


    Full Text Available Voiding cystourethrography (VCUG is a commonly performed diagnostic procedure for the evaluation of vesicoureteral reflux with urinary tract infection or congenital renal diseases in children. The procedure is relatively simple and cost-effective, and complications are very rare. The iatrogenic complication of VCUG range from discomfort, urinary tract infection to bacteremia, as well as bladder rupture. Bladder rupture is a rare complication of VCUG, and only a few cases were reported. Bladder rupture among healthy children during VCUG is an especially uncommon event. Bladder rupture associated with VCUG is usually more common in chronically unused bladders like chronic renal failure. Presented is a case of bladder rupture that occurred during a VCUG in a healthy 9-monthold infant, due to instilled action of dye by high pressure. This injury completely healed after 7 days of operation, and it was confirmed with a postoperative cystography. The patient’s bladder volume, underlying disease, velocity of the contrast media instilled, catheter size, and styles of instillation are important factors to prevent bladder rupture during VCUG. Management of bladder rupture should be individualized, but the majority of infants are treated with the operation. In conclusion, bladder rupture is a rare complication, however, delicate attention is needed in order to prevent more dire situations.

  1. Spontaneous Achilles tendon rupture in alkaptonuria | Mohammed ...

    African Journals Online (AJOL)

    Spontaneous Achilles tendon ruptures are uncommon. We present a 46-year-old man with spontaneous Achilles tendon rupture due to ochronosis. To our knowledge, this has not been previously reported in Sudan literature. The tendon of the reported patient healed well after debridement and primary repairs.

  2. Ruptured Retina Artery Macroaneurysm Presenting with Recurrent ...

    African Journals Online (AJOL)

    A 74-year-old hypertensive presented with recurrent vitreous haemorrhage. Examination showed a ruptured retinal arterial macroaneurysm. Control of systemic hypertension was associated with resolution. Risk factors and management are discussed. Ruptured retinal arterial macroaneurysm should be considered in ...

  3. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    Objective: To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery (PICA) aneurysms. Methods: 11 consecutive patients (7 women, 4 men, mean age of 49.2 years) with ruptured distal PICA aneurysms were studied retrospectively. All had onset of acute ...

  4. Spontaneous rupture of choledochal cyst: case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ho Seob; Nam, Kyung Jin; Lee, Jin Hwa; Kim, Chan Sung; Choi, Jong Cheol; Oh, Jong Young [Dong-a University College of Medicine, Pusan (Korea, Republic of)


    Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.

  5. Unusual case of pancreatic inflammatory myofibroblastic tumor associated with spontaneous splenic rupture

    Directory of Open Access Journals (Sweden)

    Hassan Fadi K


    Full Text Available Abstract Background Spontaneous splenic rupture considered a relatively rare but life threatening. The three commonest causes of spontaneous splenic rupture are malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. We describe a unique and unusual case of inflammatory myofibroblastic tumor of the tail of pancreas presented with massively enlarged spleen and spontaneous splenic rupture. Case presentation A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue. Massively enlarged spleen was detected. Hypotension and rapid reduction of hemoglobin level necessitated urgent laparatomy. About 1.75 liters of blood were found in abdominal cavity. A large tumor arising from the tail of pancreas and local rupture of an enlarged spleen adjacent to the tumor were detected. Distal pancreatectomy and splenectomy were performed. To our knowledge, we report the first case of massively enlarged spleen that was complicated with spontaneous splenic rupture as a result of splenic congestion due to mechanical obstruction caused by an inflammatory myofibroblastic tumor of the tail of pancreas. A review of the literature is also presented. Conclusion Inflammatory myofibroblastic tumor of the tail of pancreas should be included in the differential diagnosis of the etiological causes of massively enlarged spleen and spontaneous splenic rupture.

  6. Creep strength and rupture ductility of creep strength enhanced ferritic steels

    Energy Technology Data Exchange (ETDEWEB)

    Kushima, Hideaki; Sawada, Kota; Kimura, Kazuhiro [National Inst. for Materials Science, Tsukuba, Ibaraki (Japan)


    Creep strength and rupture ductility of Creep Strength Enhanced Ferritic (CSEF) steels were investigated from a viewpoint of stress dependence in comparison with conventional low alloy ferritic creep resistant steels. Inflection of stress vs. time to rupture curve was observed at 50% of 0.2% offset yield stress for both CSEF and conventional ferritic steels. Creep rupture ductility tends to decrease with increase in creep exposure time, however, those of conventional low alloy steels indicate increase in the long-term. Creep rupture ductility of the ASME Grades 92 and 122 steels indicates drastic decrease with decrease in stress at 50% of 0.2% offset yield stress. Stress dependence of creep rupture ductility of the ASME Grades 92 and 122 steels is well described by stress ratio to 0.2% offset yield stress, regardless of temperature. Drop of creep rupture ductility is caused by inhomogeneous recovery at the vicinity of prior austenite grain boundary, and remarkable drop of creep rupture ductility of CSEF steels should be derived from those stabilized microstructure. (orig.)

  7. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    LU Hua-ding


    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  8. Triple Achilles Tendon Rupture: Case Report. (United States)

    Saxena, Amol; Hofer, Deann


    We present a case report with 1-year follow-up data of a 57-year-old male soccer referee who had sustained an acute triple Achilles tendon rupture injury during a game. His triple Achilles tendon rupture consisted of a rupture of the proximal watershed region, a rupture of the main body (mid-watershed area), and an avulsion-type rupture of insertional calcific tendinosis. The patient was treated surgically with primary repair of the tendon, including tenodesis with anchors. Postoperative treatment included non-weightbearing for 4 weeks and protected weightbearing until 10 weeks postoperative, followed by formal physical therapy, which incorporated an "antigravity" treadmill. The patient was able to return to full activity after 26 weeks, including running and refereeing, without limitations. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. The changing specter of uterine rupture. (United States)

    Porreco, Richard P; Clark, Steven L; Belfort, Michael A; Dildy, Gary A; Meyers, Janet A


    The objective of the study was to review all patient records discharged with codes for uterine rupture in 2006 in Hospital Corporation of America hospitals. All patient charts were distributed to a committee of perinatologists and general obstetricians. Case report forms were analyzed for variables of interest to determine validity of coding and quality of care. Of 69 cases identified, only 41 were true ruptures. Twenty patients had previous cesareans, and in 9 of these patients, concurrent use of oxytocics was documented. Among the 21 patients without previous cesareans, 7 had previous uterine surgery, and oxytocics were documented in 12 of the remaining 14 patients. Standard of care violations were identified in 10 of 41 true rupture cases. Epidemiological data on uterine rupture based on hospital discharge codes without concurrent chart review may be invalid. Patients with previous cesareans represent only half of true uterine ruptures in contemporary practice.

  10. Modelling earthquake ruptures with dynamic off-fault damage (United States)

    Okubo, Kurama; Bhat, Harsha S.; Klinger, Yann; Rougier, Esteban


    modelling earthquake ruptures. We then modelled earthquake ruptures allowing for coseismic off-fault damage with appropriate fracture nucleation and growth criteria. We studied the effect of different conditions such as rupture speed (sub-Rayleigh or supershear), the orientation of the initial maximum principal stress with respect to the fault and the magnitude of the initial stress (to mimic depth). The comparison between the sub-Rayleigh and supershear case shows that the coseismic off-fault damage is enhanced in the supershear case when compared with the sub-Rayleigh case. The orientation of the maximum principal stress also has significant difference such that the dynamic off-fault cracking is more likely to occur on the extensional side of the fault for high principal stress orientation. It is found that the coseismic off-fault damage reduces the rupture speed due to the dissipation of the energy by dynamic off-fault cracking generated in the vicinity of the rupture front. In terms of the ground motion amplitude spectra it is shown that the high-frequency radiation is enhanced by the coseismic off-fault damage though it is quickly attenuated. This is caused by the intricate superposition of the radiation generated by the off-fault damage and the perturbation of the rupture speed on the main fault.

  11. Source of the fluid component of secretions from tracheal submucosal glands in cats. (United States)

    Corrales, R J; Nadel, J A; Widdicombe, J H


    The idea that the fluid component of cat tracheal submucosal gland secretions is produced by Na-linked secretion of Cl was tested. Gland secretion was stimulated with phenylephrine; gland fluid flow, net salt movement, and output of 35SO4-labeled macromolecules were measured. With CI, I, NO3, or Br as the major anion, phenylephrine caused equal increases in gland flow and output of 35S-labeled macromolecules while increasing net transepithelial 22Na movement from 0 to about 10 mu eq X cm-2 X h-1. With the impermeant gluconate as a major anion, phenylephrine caused the same increase in output of 35S label, a smaller increase in gland flow, and had no effect on net 22Na movement. Short circuiting in the presence of Cl, or high concentrations of the loop diuretics, furosemide or bumetanide, did not alter the actions of phenylephrine. Ouabain or replacement of Na by choline or Li abolished all secretory effects of phenylephrine. We conclude that active Cl secretion is not responsible for the transepithelial flows of salt and water induced by phenylephrine. Instead, these flows may be secondary to the release of osmotically active components of the secretory granules.

  12. Computed tomographic findings in a Bluetick Coonhound with a longitudinal thoracic tracheal tear. (United States)

    Dancer, Sumari C; Van Der Zee, Johannes; Kirberger, Robert M


    A 9-year-old intact male Bluetick Coonhound presented for progressive subcutaneous emphysema of 5 days' duration due to a suspected tracheal tear. Cervical computed tomography (CT) and thoracic CT were performed after failure to identify the tracheal tear with tracheoscopy. A longitudinal tracheal tear was identified starting 4.3 cm cranial to the tracheal bifurcation and extending caudally over a distance of 3.6 cm. Severe pneumomediastinum, subcutaneous emphysema, and retroperitoneal gas were also present. A follow-up CT 7 days postoperatively confirmed the successful repair of the tear with partial resolution of the presurgical secondary pathology and the patient recovered uneventfully. © 2018 American College of Veterinary Radiology.

  13. A grossly abnormal trachea- severe tracheal diverticulosis and Mounier-Kuhn syndrome. (United States)

    Lyons, O D; Gilmartin, J J


    A 53-year-old smoker presented with a history of recurrent lower respiratory tract infections. A diagnosis of Tracheal Diverticulosis due to Tracheobronchomegaly (Mounier-Kuhn Syndrome) was made. The clinical history, diagnosis and treatment options are discussed.

  14. Morphologic features of biocompatibility and neoangiogenesis onto a biodegradable tracheal prosthesis in an animal model

    National Research Council Canada - National Science Library

    Brizzola, Stefano; de Eguileor, Magda; Brevini, Tiziana; Grimaldi, Annalisa; Congiu, Terenzio; Neuenschwander, Peter; Acocella, Fabio


    ... (Degrapol ® ) tracheal prosthesis in an in-vivo angiogenesis-inducing animal model focusing on the specific tissue reaction, the neo-angiogenesis and also the eventual cathepsin B role during the polymer degradation...

  15. Paclitaxel Drug-eluting Tracheal Stent Could Reduce Granulation Tissue Formation in a Canine Model

    Directory of Open Access Journals (Sweden)

    Ting Wang


    Conclusions: The paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo, suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.

  16. Nebulized Lidocaine to Attenuate the Cardiovascular Response to Direct Laryngoscopy and Tracheal Intubation

    National Research Council Canada - National Science Library

    Bock, Judith


    This study described the use of 120 mg nebulized lidocaine to attenuate the cardiovascular response to direct laryngoscopy and tracheal intubation in ASA I and ASA II patients undergoing various surgical procedures...


    NARCIS (Netherlands)


    The interaction of quaternary anticholinergics with muscarinic receptors in bovine tracheal smooth muscle strips was investigated because some of these compounds have shown anomalous (biphasic) behaviour in radioligand displacement studies, in contrast to their tertiary analogues. It was found that

  18. Infected tracheal diverticulum: a rare association with alpha-1 antitrypsin deficiency

    Directory of Open Access Journals (Sweden)

    Cecília Beatriz Alves Amaral


    Full Text Available Tracheal diverticulum, defined as a benign outpouching of the tracheal wall, is rarely diagnosed in clinical practice. It can be congenital or acquired in origin, and most cases are asymptomatic, typically being diagnosed postmortem. We report a case of a 69-year-old woman who was hospitalized after presenting with fever, fatigue, pleuritic chest pain, and a right neck mass complicated by dysphagia. Her medical history was significant: pulmonary emphysema (alpha-1 antitrypsin deficiency; bronchiectasis; and thyroidectomy. On physical examination, she presented diminished breath sounds and muffled heart sounds, with a systolic murmur. Laboratory tests revealed elevated inflammatory markers, a CT scan showed an air-filled, multilocular mass in the right tracheal wall, and magnetic resonance imaging confirmed the CT findings. Fiberoptic bronchoscopy failed to reveal any abnormalities. Nevertheless, the patient was diagnosed with tracheal diverticulum. The treatment approach was conservative, consisting mainly of antibiotics. After showing clinical improvement, the patient was discharged.

  19. Natural history of Morquio A patient with tracheal obstruction from birth to death

    Directory of Open Access Journals (Sweden)

    Caitlin Doherty


    This autopsied case with MPS IVA addresses the importance of tracheal obstruction for morbidity and mortality of the disease, and the pathological findings contribute to a further understanding of the pathogenesis of MPS IVA and the development of novel therapies.

  20. The rupture in the physics teacher’s pedagogical sequence

    Directory of Open Access Journals (Sweden)

    Anne Louise Scarinci


    Full Text Available This is the result of an observational research, carried out with a group of high school physics teachers in professional development. We departed from the recognition of the incipient learning in courses, as identified from the few changes resultant in teachers’ practices. While studying their attempts to take into classroom the proposals learned in the courses, we’ve observed that such attempts frequently originated a rupture in the pedagogical sequence. This caused a great distress and a tendency to return to the “old” practice. Of what does this rupture consist? Which obstacles may be causing them? This question lead us to study the characteristics of teachers’ practices and their evolution/oscillation, motivated by the professional development course. We’ve related the ruptures in their pedagogical sequence with the incoherence in teachers' strategies and attitudes when applying the teaching theory being learned, whereas still maintaining aspects of their practice founded into the old theory. We’ve concluded that the learning of a new teaching theory requires a ground attitudinal change, more fundamental than possible changes in the teaching strategies, these ones capable of planning.

  1. Spontaneous calyceal rupture caused by a ureteral calculus

    African Journals Online (AJOL)

    A. Chaabouni

    Ureteroscopy revealed a little calculus in distal ureter. The patient successfully underwent endoscopic treatment. The clinical manifestation of spontaneous urinary extravasation is diverse, ranging from mild flank discomfort to unremitting abdom- inal pain such as acute abdomen. Gastrointestinal symptoms like nausea and ...

  2. An Unusual Cause of Uterine Rupture - A Case Report | Uzoigwe ...

    African Journals Online (AJOL)

    The baby was still alive at the time of delivery due to cushion-effect of the amniotic fluid but had early neonate death because of severe asphyxia and complications of prematurity. Other workers have found that fetal demise is more common when maternal injuries include trauma to the uterus 8-10. CONCLUSION: Pregnant ...

  3. Nursing for the complete VATS lobectomy performed with non-tracheal intubation


    Wang, Li; Wang, Yidong; Lin, Suihong; Yin, Pengying; XU, YANWEN


    Video-assisted thoracoscopic surgery (VATS) has without doubt been the most important advance in thoracic surgery. The general anesthesia before the tracheal intubation for VATS was often accompanied with tracheal mucosa and lung injuries, which were typically manifested as painful throat, nausea, vomiting, and other symptoms. However, the non-intubated anesthesia VATS can avoid these shortcomings due to its shorter anesthesia time, simpler steps, and quicker post-operative recovery. A total ...

  4. Rupture of vesicourethral anastomosis following radical retropubic prostatectomy

    Directory of Open Access Journals (Sweden)

    Marcos Dall'oglio


    Full Text Available OBJECTIVE: Rupture of vesicourethral anastomosis following radical retropubic prostatectomy is a complication that requires immediate management. We evaluated the morbidity of this rare complication. MATERIALS AND METHODS: We analyzed retrospectively 5 cases of disruption of vesicourethral anastomosis during post-operative period in a consecutive series of 1,600 radical retropubic prostatectomies, performed by a single surgeon. RESULTS: It occurred in a ratio of 1:320 prostatectomies (0,3%. Management was conservative in all the cases with an average catheter permanence time of 28 days, being its removal preceded by cystography. Two cases were secondary to bleeding, 1 followed the change of vesical catheter and 2 by unknown causes after removing the Foley catheter. Only one patient evolved with urethral stenosis, in the period ranging from 6 to 120 months. CONCLUSION: Rupture of vesicourethral anastomosis is not related to the surgeon's experience, and conservative treatment has shown to be effective.

  5. Spontaneous haemorrhage and rupture of third ventricular colloid cyst.

    LENUS (Irish Health Repository)

    Ogbodo, Elisha


    Acute bleeding within a colloid cyst of the third ventricle represents a rare event causing sudden increase in the cyst volume that may lead to acute hydrocephalus and rapid neurological deterioration. We report a case of spontaneous rupture of haemorrhagic third ventricular colloid cyst and its management. A 77-year-old ex-smoker presented with unsteady gait, incontinence and gradually worsening confusion over a 3-week period. Brain CT scan findings were highly suggestive of a third ventricular colloid cyst with intraventricular rupture. He underwent cyst excision and histopathology, which confirmed the radiological diagnosis with evidence of haemorrhage within the cyst. A ventriculo peritoneal shunt was performed for delayed hydrocephalus. Surgical management of these patients must include emergency ventriculostomy followed by prompt surgical removal of the haemorrhagic cyst.

  6. Outcomes of preterm premature rupture of membranes in twin pregnancies. (United States)

    Trentacoste, Stephanie V; Jean-Pierre, Claudel; Baergen, Rebecca; Chasen, Stephen T


    To describe outcomes in twin pregnancies with preterm premature rupture of membranes (PPROM). Dichorionic twin pregnancies complicated by PPROM at premature rupture of membranes (PROM), latency from PROM to delivery, and infection were examined. In 49 twin pregnancies, the median gestational age at PROM was 31 weeks with a median latency between PROM and delivery of 0 days (interquartile range 0-6). Latency intervals of >or=2 and >or=7 days were achieved by 40.8% and 22.4%, respectively. PPROM at or= 2 days (70.6% vs. 25.0%) and >or=7 days (47.1% vs. 9.4%). There was a significant relationship between latency and clinical and histologic signs of infection. After 30 weeks, most twin pregnancies with PPROM delivered within 2 days. Infection appears to be a consequence rather than a cause of PPROM in most cases.

  7. Spontaneous splenic rupture and Anisakis appendicitis presenting as abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Valle Joaquín


    Full Text Available Abstract Introduction Anisakidosis, human infection with nematodes of the family Anisakidae, is caused most commonly by Anisakis simplex. Acquired by the consumption of raw or undercooked marine fish or squid, anisakidosis occurs where such dietary customs are practiced, including Japan, the coastal regions of Europe and the United States. Rupture of the spleen is a relatively common complication of trauma and many systemic disorders affecting the reticuloendothelial system, including infections and neoplasias. A rare subtype of rupture occurring spontaneously and arising from a normal spleen has been recognized as a distinct clinicopathologic entity. Herein we discuss the case of a woman who presented to our institution with appendicitis secondary to Anisakis and spontaneous spleen rupture. Case presentation We report the case of a 53-year-old Caucasian woman who presented with hemorrhagic shock and abdominal pain and was subsequently found to have spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. She underwent open surgical resection of the splenic rupture and the appendicitis without any significant postoperative complications. Histopathologic examination revealed appendicitis secondary to Anisakis simplex and splenic rupture of undetermined etiology. Conclusions To the best of our knowledge, this report is the first of a woman with the diagnosis of spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. Digestive anisakiasis may present as an acute abdomen. Emergency physicians should know and consider this diagnosis in patients with ileitis or colitis, especially if an antecedent of raw or undercooked fish ingestion is present. Spontaneous rupture of the spleen is an extremely rare event. Increased awareness of this condition will enhance early diagnosis and effective treatment. Further research is required to identify the possible risk factors associated with spontaneous rupture of the spleen.

  8. Study on tracheal collapsibility, compliance, and stress by considering nonlinear mechanical property of cartilage. (United States)

    Teng, Zhongzhao; Ochoa, Ignacio; Li, Zhiyong; Liao, Zijie; Lin, Yihan; Doblare, Manuel


    Tracheal cartilage has been widely regarded as a linear elastic material either in experimental studies or in analytic and numerical models. However, it has been recently demonstrated that, like other fiber-oriented biological tissues, tracheal cartilage is a nonlinear material, which displays higher strength in compression than in extension. Considering the nonlinearity requires a more complex theoretical frame work and costs more to simulate. This study aims to quantify the deviation due to the simplified treatment of the tracheal cartilage as a linear material. It also evaluates the improved accuracy gained by considering the nonlinearity. Pig tracheal rings were used to exam the mechanical properties of cartilage and muscular membrane. By taking into account the asymmetric shape of tracheal cartilage, the collapse behavior of complete rings was simulated, and the compliance of airway and stress in the muscular membrane were discussed. The results obtained were compared with those assuming linear mechanical properties. The following results were found: (1) Models based on both types of material properties give a small difference in representing collapse behavior; (2) regarding compliance, the relative difference is big, ranging from 10 to 40% under negative pressure conditions; and (3) the difference in determining stress in the muscular membrane is small too: transmural pressure is lower than -0.5 kPa. The results obtained in this study may be useful in both understanding the collapse behavior of trachea and in evaluating the error induced by the simplification of treating the tracheal cartilage as a linear elastic material.

  9. Corpus Luteum Cyst Rupture - US Findings and Clinical Features

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    Shin, Shang Hun; Lee, Jong Hwa; Kang, Byeong Seong; Yang, Myeon Jun; Jeong, Yoong Ki [Ulsan University Hospital, Ulsan (Korea, Republic of); Kim, Yong Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Lee, Jae Hung [Dong Kang General Hospital, Ulsan (Korea, Republic of)


    To describe the US findings of corpus luteum cyst rupture in order to elucidate the associated clinical features. Twenty patients with proven corpus luteum cyst rupture were included in this study. The US findings of these patients were retrospectively analyzed in terms of the presence of designable cyst, size of the cyst, thickness and blood flow of the cyst wall, extension and echogenicity of peritoneal fluid, and involved site (right or left ovary). We also surveyed the clinical features such as the onset period according to the menstrual cycle, and the presence of suspectable cause. Fourteen of the 20 patients revealed designable cysts (mean diameter of 2.6 cm) with thick walled cysts (mean thickness, 4.6 mm, 2.4-6.8 mm) and increased blood flow. Six patients didn't reveal any cyst but only hematoma in adnexa. All patients had hemoperitoneum in the pelvic cavity, and the hemoperitoneum was extended to Morrison's pouch in 8 patients and to the subphrenic space in 6. The cysts occurred in the right adnexa in 15 patients and in the left in 5. Mean interval from the last menstrual period (LMP) was 26 days (13-44 days) and 6 of the 8 patients for whom it had been possible to obtain detailed history taking had had coitus just before the occurrence of symptom. When women who are hospitalized for acute abdomen and who are in luteal phase reveal US findings of hematoma or thick-walled cyst in adnexa and hemoperitoneum, a corpus luteum cyst rupture is highly suspected. In our case study the corpus luteum cyst rupture predominantly occurred in the right side, and the most suspectable cause was trauma such as coitus in the luteal phase

  10. [Spontaneous achilles tendon rupture in granulomatous vasculitis]. (United States)

    Benthien, Jan Philipp; Delling, G; Rüther, W


    A 66-year old patient sustained a non-traumatic rupture of her left achilles tendon. She suffered from Sjögren's syndrome which occurred in conjunction with a systemic vasculitis, and recurrent episcleritis. The combination of Sjögren's syndrome and systemic vasculitis is well known. Subsequently, she was treated with high-dose systemic steroids over a period of 2 years. In order to reduce the amount of steroids due to preexisting severe osteoporosis and thoracic vertebral fractures, her medication was changed to cyclophosphamide shortly before her injury. Intraoperatively, a granuloma was discovered at the site of the rupture. This granuloma had infiltrated most of the achilles tendon at this site and virtually replaced viable tendon tissue. Originally, the rupture was supposedly due to the high dose steroids. This theory had to be revised according to the intraoperative findings. Following excision of the granuloma and operative treatment of the achilles tendon rupture, the continuity of the tendon could be completely restored. A MRI scan 3 months after the procedure demonstrated a completely healed Achilles tendon. Spontaneous achilles tendon rupture due to a granuloma in patients with vasculitis seems to be a rare event. However, tendon ruptures in combination with systemic lupus erythematodes have been described. Mostly, these events are attributed to long term application of steroids. Spontaneous rupture in combination with high dose treatment of steroids seems to be an underestimated problem.

  11. The role of proximal pulleys in preventing tendon bowstringing: pulley rupture and tendon bowstringing. (United States)

    Leeflang, S; Coert, J H


    The aim of this study was to investigate factors that contribute to tendon bowstringing at the proximal phalanx. We hypothesised that: (1) a partial rupture of the A2 pulley leads to significant bowstringing, (2) the location of the A2 rupture, starting proximally or distally, influences bowstringing, (3) an additional A3 pulley rupture causes a significant increase in bowstringing following a complete A2 pulley rupture and (4) the skin and tendon sheath may prevent bowstringing in A2 and A3 pulley ruptures. Index, middle and ring fingers of eight freshly frozen cadaver arms were used. A loading device pulled with 100 N force was attached to the flexor digitorum profundus (FDP). The flexor digitorum superficialis (FDS) was preloaded with 5 N. Bowstringing was measured and quantified by the size of the area between the FDP tendon and the proximal phalanx over a distance of 5 mm with ultrasonography (US). US images showed that already a 30% excision of the A2 pulley resulted in significant bowstringing. In addition, a partial distal incision of the A2 pulley showed significantly more bowstringing compared to a partial proximal incision. Additional A3 pulley incision and excision of the proximal tendon sheath did not increase bowstringing. Subsequently, removing the skin did increase the bowstringing significantly. A partial A2 pulley rupture causes a significant bowstringing. A partial rupture of the A2 pulley at the distal rim of the A2 pulley resulted in more bowstringing than a partial rupture at the proximal rim. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Management of suprastomal tracheal fibroma: introduction of a new technique and comparison with other techniques. (United States)

    Shires, Courtney B; Shete, Mona M; Thompson, Jerome W


    Suprastomal tracheal granuloma/fibroma (SSTGF) is a common cause of failure to decannulate following pediatric tracheostomy. Because larger lesions obstruct the trachea, it is necessary to remove them prior to decannulation. Various methods have been described for the management of these obstructing tracheal lesions, including the KTP laser, Nd-YAG laser, sphenoid punch, optical forceps, microsuspension laryngoscopy with an articulated arm (MSLAA), and external excision. A hollow core guide fiber for the CO(2) laser has been developed that can be advanced to better approximate targeted tissues and minimize thermal spread using a near-contact method. A retrospective chart review was performed of 30 children under the age of 7 years (21M, 9F) with SSTGF who underwent treatment by either external excision (n=10), MSLAA (n=10), or CO(2) laser vaporization by fiberoptic laser carrier (n=10). The medical charts were reviewed for excision techniques and outcomes. Mean operative time for external excision was 34.9min (SD=10.2min), for MSLAA was 16.3min (SD=4.8min), and for fiberoptic CO(2) laser carrier was 19.3min (SD=7.1min). Mean hospital time postoperatively for external excision was 24h (SD=510min), for MSLAA was 3.3h (SD=37.7min), and for fiberoptic CO(2) laser carrier was 3.9h (SD=46.3min). Need for additional procedures was seen in 60% of external excision procedures, 70% of MSLAA procedures, and in 30% of fiberoptic CO(2) laser carrier procedures. Immediate postoperative decannulation was possible in 10% of the external excision group, 20% of the MSLAA group, and 40% of the fiberoptic CO(2) laser carrier group. The new technique of using a fiberoptic carrier for the CO(2) laser to treat children with SSTGF's is comparable to more traditional techniques of SSTGF removal when considering the need for additional procedures, postoperative hospital stay, and percentage of immediate postoperative decannulation and provides another useful tool in the armamentarium of the

  13. Endovascular treatment of a ruptured internal mammary artery pseudoaneurysm presenting as massive hemothorax in a patient with type I neurofibromatosis

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    Yeh, Dae Wook; Kim, Soo Jin; Kim, Chang Won; Kim, Suk; Lee, Tae Hong; Moon, Tae Yong; Chung, Sung Woon [Pusan National University Hospital, Pusan (Korea, Republic of)


    We report a case of an acute hemothorax caused by a rupture of a left internal mammary artery pseudoaneurysm in a 45-year-old woman with a type I neurofibromatosis, which was successfully treated using endovascular coil embolization.

  14. Traumatic tracheal diverticulum corrected with resection and anastomosis during one-lung ventilation and total intravenous anesthesia in a cat. (United States)

    Sayre, Rebecca S; Lepiz, Mauricio; Wall, Corey; Thieman-Mankin, Kelley; Dobbin, Jennifer


    This report describes the clinical findings and diagnostic images of a traumatic intrathoracic tracheal avulsion with a tracheal diverticulum in a cat. Furthermore, a complete description of the tracheal resection and anastomosis using one-lung ventilation (OLV) with total and partial intravenous anesthesia is made. A 3-year-old neutered male domestic shorthair cat weighing 6.8 kg was presented to the University Teaching Hospital for evaluation of increased respiratory noise 3 months following unknown trauma. Approximately 12 weeks prior to presentation, the cat had been seen by the primary care veterinarian for respiratory distress. At that time, the cat had undergone a tracheal ballooning procedure for a distal tracheal stricture diagnosed by tracheoscopy. The tracheal ballooning had provided only temporary relief. At presentation to our institution, the cat had increased respiratory effort with harsh upper airway noise auscultated during thoracic examination. The remainder of the physical examination was normal. Diagnostics included a tracheoscopy and a thoracic computed tomographic examination. The cat was diagnosed with tracheal avulsion, pseudotrachea with a tracheal diverticulum, and stenosis of the avulsed tracheal ends. Surgical correction of the tracheal stricture via a thoracotomy was performed using OLV with total and partial intravenous anesthesia. The cat recovered uneventfully and at last follow-up was active and doing well. This case report describes OLV using standard anesthesia equipment that is available at most private practices. Furthermore, this case describes the computed tomographic images of the intrathoracic tracheal avulsion and offers a positive outcome for tracheal resection and anastomosis. © Veterinary Emergency and Critical Care Society 2015.


    Kaye, Benjamin M; Boroffka, Susanne A E B; Haagsman, Annika N; Ter Haar, Gert


    Tracheal hypoplasia is commonly seen in English Bulldogs affected with brachycephalic airway syndrome. Previously published diagnostic criteria for tracheal hypoplasia in this breed have been a radiographic tracheal diameter:tracheal inlet ratio (TD:TI) tracheal diameter:third rib diameter ratio (TD:3R) tracheal dimensions in English Bulldogs. Objectives of this prospective cross-sectional study were to describe radiographic and CT tracheal dimensions in a sample of clinically normal English Bulldogs and compare these values with tracheoscopy scores. Computed tomography (n = 40), radiography (n = 38), and tracheoscopy (n = 40) studies were performed during a single general anesthesia session for each included dog. Tracheal measurements were recorded at three locations: cervical, thoracic inlet, and thorax. Tracheal diameters were narrowest at the thoracic inlet with all techniques. Computed tomographic measurements averaged 19% greater than radiographic measurements. All included dogs had radiographic tracheal measurements greater than the previously published criteria for tracheal hypoplasia. Mean CT TD:TI was 0.26 (± 0.03, 0.20-0.33), and mean CT TT:3R was 2.27 (± 0.24, 1.71-2.74). Radiographic TD:TI and CT TD:TI were significantly correlated (P = 0.00); however radiographic TT:3R and CT TT:3R were not significantly correlated (P = 0.25). Tracheoscopy identified hypoplastic changes in all dogs and tracheoscopy scores were not correlated with CT or radiography diameter measurements. In conclusion, findings indicated that some CT and radiographic tracheal diameter measurements were comparable in English Bulldogs however diameters for both imaging techniques were not comparable with tracheoscopy scores. © 2015 American College of Veterinary Radiology.

  16. A large ruptured mediastinal cystic teratoma. (United States)

    Machuca, Jenny S; Tejwani, Dimple; Niazi, Masooma; Diaz-Fuentes, Gilda


    A 51-year-old woman presented with a 2-month history of intermittent cough and precordial chest pain associated with shortness of breath. Initial chest-x-ray revealed a large well-circumscribed mass in the left perihilar region and consolidation of left lower lobe. Computed tomography scan of the chest revealed a large irregular fluid-filled mass occupying the left hemithorax, causing a mediastinal shift to the right, and a left pleural effusion. A pigtail was inserted; pleural fluid was exudative without evidence of malignant cells. Left thoracotomy revealed an anterior mediastinal mass of 20 cm in diameter adherent to the pericardium, pleura, and lung. Pathologic examination showed a variety of cell lines consisting of respiratory mucosa, mucous glands, cartilage, smooth muscle, adipose tissue, and pancreatic tissue, results consistent with a mature teratoma. Mature cystic teratomas are usually benign in nature and represent 60% to 70% of mediastinal germ cell tumors; they are found most commonly in young adults. The anterior mediastinum is the most common site for these types of tumors. Rupture of a mediastinal cystic teratoma is a rare event and can be a life-threatening condition. The treatment is mainly surgical, with an excellent prognosis such as in our patient.

  17. Ambroxol inhibits rhinovirus infection in primary cultures of human tracheal epithelial cells. (United States)

    Yamaya, Mutsuo; Nishimura, Hidekazu; Nadine, Lusamba Kalonji; Ota, Chiharu; Kubo, Hiroshi; Nagatomi, Ryoichi


    The mucolytic drug ambroxol hydrochloride reduces the production of pro-inflammatory cytokines and the frequency of exacerbation in patients with chronic obstructive pulmonary disease (COPD). However, the inhibitory effects of ambroxol on rhinovirus infection, the major cause of COPD exacerbations, have not been studied. We examined the effects of ambroxol on type 14 rhinovirus (RV14) infection, a major RV group, in primary cultures of human tracheal epithelial cells. RV14 infection increased virus titers and cytokine content in the supernatants and RV14 RNA in the cells. Ambroxol (100 nM) reduced RV14 titers and cytokine concentrations of interleukin (IL)-1β, IL-6 and IL-8 in the supernatants and RV14 RNA in the cells after RV14 infection, in addition to reducing susceptibility to RV14 infection. Ambroxol also reduced the expression of intercellular adhesion molecule-1 (ICAM-1), the receptor for RV14, and the number of acidic endosomes from which RV14 RNA enters the cytoplasm. In addition, ambroxol reduced the activation of the transcription factor nuclear factor kappa B (NF-κB) in the nucleus. These results suggest that ambroxol inhibits RV14 infection partly by reducing ICAM-1 and acidic endosomes via the inhibition of NF-κB activation. Ambroxol may modulate airway inflammation by reducing the production of cytokines in rhinovirus infection.

  18. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture


    Wei Yee Leong; Daniel Gheorghiu; Janardhan Rao


    Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR) in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body bui...

  19. Spontaneous rupture of ovarian cystadenocarcinoma: pre- and post-rupture computed tomography evaluation

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    Salvadori, Priscila Silveira; Atzingen, Augusto Castelli von; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Bomfim, Lucas Novais [Universidade Tiradentes (UNIT), Maceio, AL, (Brazil)


    Epithelial ovarian tumors are the most common malignant ovarian neoplasms and, in most cases, eventual rupture of such tumors is associated with a surgical procedure. The authors report the case of a 54-year-old woman who presented with spontaneous rupture of ovarian cystadenocarcinoma documented by computed tomography, both before and after the event. In such cases, a post-rupture staging tends to be less favorable, compromising the prognosis. (author)

  20. A Patient with Splenic Artery Aneurysm Rupture and the Importance of Rapid Sonography in the ED

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    Masayuki Iyanaga


    Full Text Available We report a case of a splenic artery aneurysm rupture presenting with shock which required timely embolization therapy. This case demonstrates how the rapid use of bedside ultrasound by emergency department (ED physicians can help identify the cause of shock and, therefore, initiate appropriate treatment quickly even if the cause is rare, as in this case.

  1. Tracheal ulcer due to Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly. (United States)

    Ito, Takeo; Fujisaki, Hideaki; Nishio, Suehiro; Hiroshige, Shigeo; Miyazaki, Eishi; Kadota, Jun-ichi


    A 74-year-old man was referred to our hospital because of a tracheal stenosis circumscribed with soft tissue density and a left pulmonary nodule. Open biopsy of a right submandibular lymph node revealed diffuse large B-cell lymphoma, and the malignant cells were positive for Epstein-Barr virus gene products. Bronchofiberscopy revealed a tracheal necrotizing ulcer. After chemotherapy, the tracheal ulcer resolved. To our knowledge, this is the first report of a case of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly with a tracheal ulcer. © 2013 Published by The Japanese Respiratory Society on behalf of The Japanese Respiratory Society.

  2. Right Diaphragm Spontaneous Rupture: A Surgical Approach

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    Duilio Divisi


    Full Text Available We present a case of spontaneous rupture of the diaphragm, characterized by nonspecific symptoms. The rapid diagnosis and appropriate surgical approach led to a positive resolution of the pathology.

  3. Cognitive frames in psychology: demarcations and ruptures. (United States)

    Yurevich, Andrey V


    As there seems to be a recurrent feeling of crisis in psychology, its present state is analyzed in this article. The author believes that in addition to the traditional manifestations that have dogged psychology since it emerged as an independent science some new features of the crisis have emerged. Three fundamental "ruptures" are identified: the "horizontal" rupture between various schools and trends, the "vertical" rupture between natural science and humanitarian psychology, and the "diagonal" rupture between academic research and applied practice of psychology. These manifestations of the crisis of psychology have recently been compounded by the crisis of its rationalistic foundations. This situation is described in terms of the cognitive systems in psychology which include meta-theories, paradigms, sociodigms and metadigms.

  4. [Bilateral rupture of the Achilles tendon--an unusual occurrence]. (United States)

    Schikora, N; Delank, K-S; Gärtner, J; Eysel, P


    We present the clinical case of a sixty-four-year-old man with bilateral spontaneous rupture of the Achilles tendon having a multiple disseminated oesophagus carcinoma. After immobilisation due to metastases of the 2nd lumbar vertebra, there was a spontaneous, painless rupture of the Achilles tendon while the patient was mobilised wearing a Hohmann spine brace. Afterwards we carried out a thorough case history with the help of clinical examination, sonographic and magnetic resonance imaging. The bilateral rupture has been treated conservatively with the Adipromed Shoe. With regard to the 2nd lumbar vertebra fracture and metastases, a Hohmann spine brace was given to the patient. Because of the described circumstances, no surgery had been carried out. Furthermore, the patient experienced much more independence and an improved quality of life in his last couple of months. Surgery would have not been recommended and could have caused the complete immobilisation and loss of patient's quality of life. With this case report we would like to point out the consequences of an unwise therapeutic decision to a patient who only has a few more months to live. This case report is discussed with regard to the possible aetiopathology and the current literature.

  5. Describing Soils: Calibration Tool for Teaching Soil Rupture Resistance (United States)

    Seybold, C. A.; Harms, D. S.; Grossman, R. B.


    Rupture resistance is a measure of the strength of a soil to withstand an applied stress or resist deformation. In soil survey, during routine soil descriptions, rupture resistance is described for each horizon or layer in the soil profile. The lower portion of the rupture resistance classes are assigned based on rupture between thumb and…

  6. Blunt cardiac rupture in a toddler

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    Peep Talving


    Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

  7. [Negative pressure pulmonary edema after tracheal extubation: case report]. (United States)

    Barbosa, Fabiano Timbó; Barbosa, Luciano Timbó; Almeida, Jadielson Higino de; Silva, Kleyner Leão Gomes da; Brandão, Roberta Ribeiro Marques; Santos, Leyna Leite


    Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, thought infrequently diagnosed and reported. This report aimed at presenting a case of postextubation negative pressure pulmonary edema refractory to use of diuretics and with successful therapeutic after using positive pressure noninvasive mechanic ventilation. A 22-year-old-woman underwent an operation to opened colecistectomy. The preoperative exams were abnormality us. Immediately after the extubation the patient presented with dyspnea and lungs stertors. The treatment for the acute pulmonary edema started with oxygen therapy under Venturi mask, lifting up chest and diuretic. The patient was transferred to Intensive Care Unit due to the lack of success with the treatment. A noninvasive ventilation (NIV) was started with support pressure of 15 cmH2O and PEEP of 5 cmH2O with resolution of symptoms. The patient was maintained under observation for 24 hours after the event with good conditions and received discharge to room without symptoms. Negative pressure pulmonary edema (NPPE) is a difficult diagnosed event and it must be always considered when patient develop with symptoms and signals of respiratory insufficiency postextubation. In our case was possible to treat with positive pressure non-invasive mechanical ventilation, but in case of the NIV failure the tracheal intubation and the invasive mechanical ventilatory support be initiated to improve the oxygen levels of the patient.

  8. Tracheal intubation in the ICU: Life saving or life threatening?

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    Jigeeshu V Divatia


    Full Text Available Tracheal intubation (TI is a routine procedure in the intensive care unit (ICU, and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR, the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  9. Ex vivo tracheomalacia model with 3D-printed external tracheal splint. (United States)

    Kaye, Rachel; Goldstein, Todd; Aronowitz, Danielle; Grande, Daniel A; Zeltsman, David; Smith, Lee P


    To design and evaluate an ex vivo model of tracheomalacia with and without a three-dimensional (3D)-printed external tracheal splint. Prospective, ex vivo animal trial. Three groups of ex vivo porcine tracheas were used: 1) control (unmanipulated trachea), 2) tracheomalacia (tracheal rings partially incised and crushed), and 3) splinted tracheomalacia (external custom tracheal splint fitted onto group 2 trachea). Each end of an ex vivo trachea was sealed with a custom-designed and 3D-printed cap; a transducer was placed through one end to measure the pressure inside the trachea. Although the negative pressure was applied to the tracheal lumen, the tracheal wall collapse was measured externally and internally using a bronchoscope. Each group had at least three recorded trials. Tracheal diameter was evaluated using ImageJ software (National Institutes of Health, Bethesda, MD) and was averaged between two raters. Average tracheal occlusion percentage was compared using Student t test. The average occlusion was 31% for group 1, 87.4% for group 2, and 20% for group 3. Significant differences were found between the control and tracheomalacia groups (P splinted tracheomalacia groups (P splinted tracheomalacia groups (P = 0.13). Applied pressure was plotted against occlusion and regression line slope differed between the tracheomalacia (0.91) and control (0.12) or splinted tracheomalacia (0.39) groups. We demonstrate the potential for an ex vivo tracheomalacia model to reproduce airway collapse and show that this collapse can be treated successfully with a 3D-printed external splint. These results are promising and justify further studies. N/A. Laryngoscope, 127:950-955, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Maternal and perinatal outcomes in premature rupture of membranes

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    Maissa Marçola Scandiuzzi


    Full Text Available Introducion: pregnancies complicated by premature rupture of membranes (PROM are associated with bad outcomes and controvertial management. Although underlain mechanism is unknown, strong evidences point infection as the main cause underneath preterm premature rupture of membranes and preterm labour. Objective: to determine maternal and neonatal outcomes in pregnancies complicated by premature rupture of membranes. Method: retrospective analysis of maternal and neonatal outcomes of pregnancies complicated by PROM at University Hospital of Faculdade de Medicina Jundiaí, from march 2007 to june 2009. Results: the results showed a higher prevalence: age between 20 and 30 years (54.5%, caucasian (58.6%, unmarried (46%, non-smokers (72.82%, gestation LMP term (63.3% and USG (64.5%, number of prenatal consultations more than six (59.8%, multiparous (66.6%, obstetric history with normal vaginal delivery (PVN (56.3%, cervical dilatation at admission between 2 cm - 3 cm, evanescence 50%, ruptured membranes between 1 and 4 hours, conduct the spontaneous delivery (82.5%, type of delivery PVN (55,6%, newborn weighing 2,500 kg and 3,500 kg (61.6%, Apgar score greater than seven at 1 and 5 minutes (89.2% and 99.2% respectively, need for resuscitation (81,5%, Neo ICU (2.6% and length of the binomial two days. Conclusion: based on our results and in comparison with the literature review, we found a similar prevalence in our service and other services of those studies. The exception was the high prevalence of cesarean section over the other and the high number of pregnant women had not received prenatal care (22.9%.

  11. Yield Stress Effects on Mucus Plug Rupture (United States)

    Hu, Yingying; Bian, Shiyao; Grotberg, John C.; Takayama, Shuichi; Grotberg, James B.


    Mucus plugs can obstruct airways, resulting in lost gas exchange and inflammation. Yield stress, one of the significant rheological properties of mucus, plays a significant role in plug rupture. We use carbopol 940 gels as mucus simulants to study dynamics of mucus plug rupture in experiments. Yield stress increases with gel concentration increasing (0.1% ~0.3%). The yield stress of the 0.2% gel is about 530 dyn/cm2, which can simulate normal mucus. A 2D PDMS channel is used to simulate a collapsed airway of the 12th generation in a human lung. Plug rupture is driven by a pressure drop of 1.6 ×104 ~ 2.0 ×104 dyn/cm2. Initial plug length varies from half to two times the half channel width. A micro-PIV technique is used to acquire velocity fields during rupture, from which wall shear stress is derived. Plug shortening velocity increases with the pressure drop, but decreases with yield stress or the initial plug length. Wall shear stress increases with yield stress, which indicates more potential damage may occur to epithelial cells when pathologic mucus has a high yield stress. Near the rupture moment, a wall shear stress peak appears at the front of the film deposited by the plug during rupture. This work is supported by NIH: HL84370 and HL85156.

  12. Better Visual Outcome by Intraocular Lens Ejection in Geriatric Patients with Ruptured Ocular Injuries (United States)

    Sugita, Tadasu; Tsunekawa, Taichi; Matsuura, Toshiyuki; Takayama, Kei; Yamamoto, Kentaro; Kachi, Shu; Ito, Yasuki; Ueno, Shinji; Nonobe, Norie; Kataoka, Keiko; Suzumura, Ayana; Iwase, Takeshi; Terasaki, Hiroko


    Ocular trauma is one of the leading causes of visual impairment worldwide. Because of the popularity of cataract surgeries, aged individuals with ocular trauma commonly have a surgical wound in their eyes. The purpose of this study was to evaluate the visual outcome of cases that were coincident with intraocular lens (IOL) ejection in the eyes with ruptured open-globe ocular injuries. Consecutive patients with open-globe ocular injuries were first reviewed. Patients’ characteristics, corrected distance visual acuities (CDVAs) over 3 years after the trauma, causes of injuries, traumatic wound patterns, and coexistence of retinal detachment were examined. The relationships between poor CDVA and the other factors, including the complications of crystalline lens and IOL ejection, were examined. A total of 105 eyes/patients [43 eyes with rupture, 33 with penetrating, 28 with intraocular foreign body (IOFB), and 1 with perforating injuries] were included. Rupture injuries were common in aged patients and were mostly caused by falls, whereas penetrating and IOFB injuries were common in young male patients. CDVAs of the eyes with rupture injuries were significantly worse than those of the eyes with penetrating or IOFB injuries. CDVA from more than 50% of the ruptured eyes resulted in no light perception or light perception to 20/500. CDVA of the ruptured eyes complicated by crystalline lens ejection was significantly worse than that of those complicated by IOL ejection. The wounds of the ruptured eyes complicated by IOL ejection were mainly located at the superior corneoscleral limbus, whereas those of the eyes complicated by crystalline lens ejection were located at the posterior sclera. There were significant correlations between poor CDVA and retinal detachment and crystalline lens ejection. These results proposed a new trend in the ocular injuries that commonly occur in aged patients; history of cataract surgery might affect the final visual outcome after open

  13. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

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    Aubrey-Bassler F


    Full Text Available Abstract Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143, haematologic (n = 84 and non-haematologic neoplasms (n = 48. Amyloidosis (n = 24, internal trauma such as cough or vomiting (n = 17 and rheumatologic diseases (n = 10 are less frequently reported. Colonoscopy (n = 87 was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6, infarction (n = 6 and hamartomata (n = 5. Medications associated with rupture include anticoagulants (n = 21, thrombolytics (n = 13 and recombinant G-CSF (n = 10. Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm

  14. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. (United States)

    Aubrey-Bassler, F Kris; Sowers, Nicholas


    Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma

  15. Rupture Following Biceps-to-Triceps Tendon Transfer in Adolescents and Young Adults With Spinal Cord Injury: (United States)

    Merenda, Lisa A.; Rutter, Laure; Curran, Kimberly; Kozin, Scott H.


    Background: Tendon transfer surgery can restore elbow extension in approximately 70% of persons with tetraplegia and often results in antigravity elbow extension strength. However, we have noted an almost 15% rupture/attenuation rate. Objective: This investigation was conducted to analyze potential causes in adolescents/young adults with spinal cord injury (SCI) who experienced tendon rupture or attenuation after biceps-to-triceps transfer. Methods: Medical charts of young adults with SCI who underwent biceps-to-triceps transfer and experienced tendon rupture or attenuation were reviewed. Data collected by retrospective chart review included general demographics, surgical procedure(s), use and duration of antibiotic treatment, time from tendon transfer surgery to rupture/attenuation, and method of diagnosis. Results: Twelve subjects with tetraplegia (mean age, 19 years) who underwent biceps-to-triceps reconstruction with subsequent tendon rupture or attenuation were evaluated. Mean age at time of tendon transfer was 18 years (range, 14-21 years). A fluoroquinolone was prescribed for 42% (n=5) of subjects. Tendon rupture was noted in 67% (n=8), and attenuation was noted in 33% (n=4). Average length of time from surgery to tendon rupture/attenuation was 5.7 months (range, 3-10 months). Conclusion: Potential contributing causes of tendon rupture/attenuation after transfer include surgical technique, rehabilitation, co-contraction of the transfer, poor patient compliance, and medications. In this cohort, 5 subjects were prescribed fluoroquinolones that have a US Food and Drug Administration black box concerning tendon ruptures. Currently, all candidates for upper extremity tendon transfer reconstruction are counseled on the effects of fluoroquinolones and the potential risk for tendon rupture. PMID:23459326

  16. Blunt Traumatic Cardiac Rupture: Single-Institution Experiences over 14 Years

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    Jeong Hee Yun


    Full Text Available Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24% died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%. The right atrium was the most common location of injury (43%. Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase–myocardial band (CK-MB levels (p=0.042 and platelet counts (p= 0.004 between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007, worse Trauma and Injury Severity Scores (p=0.007, and higher Injury Severity Scores (p=0.004 than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient’s life.

  17. Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients. (United States)

    Li, Zhuo-Dong; Liu, Yang; Zhu, Jiang; Wang, Jun; Lu, Fang-Lin; Han, Lin; Xu, Zhi-Yun


    Aortic rupture is one of the main causes of early death in acute and subacute Stanford type A aortic dissection (ATAAD) patients. This study aimed to analyze potential risk factors for pre-operational aortic rupture in ATAAD patients. We retrospectively reviewed aortic dissection cases treated between May 2013 and May 2016 in Changhai Hospital, Shanghai. A total of 329 patients with ATAAD were included in the final analysis, and 31 patients died of aortic rupture before surgery. Clinical data on basic characteristics, clinical presentation, and biochemical measurements for all 329 patients were analyzed. The in-hospital aortic rupture rate was 9.4% (31/329), and the rupture accounted for 47% (31/66) of all in-hospital deaths of ATAAD patients. Patients who experienced rupture were significantly older (P0.7 ng/mL (OR: 9.28; 95% CI, 1.72-50.06; P=0.010), and D-dimer level ≥10 µg/mL (OR: 13.37; 95% CI, 2.18-81.97; P=0.005). Aortic rupture accounted for 47% of all in-hospital deaths among patient with ATAAD. Shock, pain requiring medication, a troponin level >0.7 ng/mL and a D-dimer level ≥10 µg/mL are independent risk factors for aortic rupture in these patients.

  18. Infestation of Japanese native honey bees by tracheal mite and virus from non-native European honey bees in Japan. (United States)

    Kojima, Yuriko; Toki, Taku; Morimoto, Tomomi; Yoshiyama, Mikio; Kimura, Kiyoshi; Kadowaki, Tatsuhiko


    Invasion of alien species has been shown to cause detrimental effects on habitats of native species. Insect pollinators represent such examples; the introduction of commercial bumble bee species for crop pollination has resulted in competition for an ecological niche with native species, genetic disturbance caused by mating with native species, and pathogen spillover to native species. The European honey bee, Apis mellifera, was first introduced into Japan for apiculture in 1877, and queen bees have been imported from several countries for many years. However, its effects on Japanese native honey bee, Apis cerana japonica, have never been addressed. We thus conducted the survey of honey bee viruses and Acarapis mites using both A. mellifera and A. c. japonica colonies to examine their infestation in native and non-native honey bee species in Japan. Honey bee viruses, Deformed wing virus (DWV), Black queen cell virus (BQCV), Israeli acute paralysis virus (IAPV), and Sacbrood virus (SBV), were found in both A. mellifera and A. c. japonica colonies; however, the infection frequency of viruses in A. c. japonica was lower than that in A. mellifera colonies. Based on the phylogenies of DWV, BQCV, and SBV isolates from A. mellifera and A. c. japonica, DWV and BQCV may infect both honey bee species; meanwhile, SBV has a clear species barrier. For the first time in Japan, tracheal mite (Acarapis woodi) was specifically found in the dead honey bees from collapsing A. c. japonica colonies. This paper thus provides further evidence that tracheal-mite-infested honey bee colonies can die during cool winters with no other disease present. These results demonstrate the infestation of native honey bees by parasite and pathogens of non-native honey bees that are traded globally.

  19. Intraocular pressure changes in a Nigerian population--effects of tracheal tube and laryngeal mask airway insertion and removal. (United States)

    Igboko, J O; Desalu, I; Akinsola, F B; Kushimo, O T


    Laryngoscopy and tracheal intubation lead to acute elevation in intraocular pressure (IOP); the ocular hypertensive response. The Laryngeal mask airway prevents sudden surges in IOP. We compared IOP changes to the insertion and removal of the Laryngeal mask airway (LMA) and the endotracheal tube (ETT). Seventy ASA I and II patients aged 18 to 60 years at the Lagos University Teaching Hospital between January and December 2003 were randomly allocated to receive either an LMA or ETT for airway management. Anaesthesia was induced with propofol and atracurium. Intraocular pressure was measured by applanation tonometry post induction (baseline) and prior to removal (pre-extubation), after insertion or removal (0 minute), at 1,2,3,5 and 10 minutes after insertion or removal. Insertion of the airway device caused an immediate rise in IOP of 4.6% in the LMA group (from 13.1 +/- 2.4 to 13.7 +/- 2.4 mmHg) and 49.2 in the ETT group (from 12.0 +/- 2.5 to 17.9 +/- 4.0 mmHg) (p<0.001). Removal of the airway device caused an immediate rise in IOP of 14.6 in the LMA group (from 11.26 +/- 2.4 to 12.9 +/-2.4 mmHg) and 50.3 in the ETT group (from 11.37 +/- 2.0 to 17.1 +/- 3.3 mmHg) (p<0.001). IOP thereafter declined towards baseline in both groups. Cardiovascular responses accompanied IOP changes. The mean insertion time was 39.8 +/- 9.1 seconds (ETT) vs 31.5 +/- 4.4 seconds (LMA). (p<0.001) Cough (17.1) and mild laryngeal spasm (2.9) occurred in the ETT group only following removal. The LMA produced better IOP stability following its insertion and removal compared to the tracheal tube.

  20. Size dependent rupture growth at the scale of real earthquake (United States)

    Colombelli, Simona; Festa, Gaetano; Zollo, Aldo


    When an earthquake starts, the rupture process may evolve in a variety of ways, resulting in the occurrence of different magnitude earthquakes, with variable areal extent and slip, and this may produce an unpredictable damage distribution around the fault zone. The cause of the observed diversity of the rupture process evolution is unknown. There are studies supporting the idea that all earthquakes arise in the same way, while the mechanical conditions of the fault zone may determine the propagation and generation of small or large earthquakes. Other studies show that small and large earthquakes are different from the initial stage of the rupture beginning. Among them, Colombelli et al. (2014) observed that the initial slope of the P-wave peak displacement could be a discriminant for the final earthquake size, so that small and large ruptures show a different behavior in their initial stage. In this work we perform a detailed analysis of the time evolution of the P-wave peak amplitude for a set of few, co-located events, during the 2008, Iwate-Miyagi (Japan) earthquake sequence. The events have magnitude between 3.2 and 7.2 and their epicentral coordinates vary in a narrow range, with a maximum distance among the epicenters of about 15 km. After applying a refined technique for data processing, we measured the initial Peak Displacement (Pd) as the absolute value of the vertical component of displacement records, starting from the P-wave arrival time and progressively expanding the time window. For each event, we corrected the observed Pd values at different stations for the distance effect and computed the average logarithm of Pd as a function of time. The overall shape of the Pd curves (in log-lin scale) is consistent with what has been previously observed for a larger dataset by Colombelli et al. (2014). The initial amplitude begins with small values and then increases with time, until a plateau level is reached. However, we observed essential differences in the

  1. Dynamic rupture process of the great 1668 Anatolian earthquake (United States)

    Kase, Yuko; Kondo, Hisao; Emre, Ömer


    al., 2009). We use a finite-difference method with a conventional grid formulated by Kase and Day (2006). Under the stress condition mentioned in the previous paragraph, a rupture initiating on the Erbaa segment propagates on the Niksar segment, but cannot jump across the 11-km-wide discontinuity between the Niksar and Resadiye segments. The result shows that the discontinuity acts as a geometrical barrier during ‘usual' earthquakes like ones in the 20th century earthquake sequence. In the Niksar segments, paleoslips of up to 8 m are observed as the 1668 earthquake. The paleoseismological data also show that the last earthquake before the 1668 earthquake was during the 6th century; thus, the interval between these was much longer than the 274 years between the 1942 and 1668 earthquakes. The 1668 earthquake following a long quiescent period had the capability for accumulating large strain. We thus assume larger values of stress drop for the Niksar and Erbaa segments, and simulate dynamic ruptures. When the stress drop is twice as large as in the 1942 earthquake, a rupture can jump across the 11-km-wide discontinuity and propagates onto the Resadiye segment. The maximum surface slip on the Niksar segment is 6.65 m. Although the simulated slip is less than the observed one, the rupture jump succeeds. The numerical result shows the possibility that the 1668 earthquake was a single multi-segment earthquake, therefore, it suggests that the 11 km-width jump in the 1668 earthquake was caused by large stress drop releasing the vast accumulation of strain during the preceding long quiescence.

  2. Regulated Crb accumulation controls apical constriction and invagination in Drosophila tracheal cells. (United States)

    Letizia, Annalisa; Sotillos, Sol; Campuzano, Sonsoles; Llimargas, Marta


    Many epithelial tissues undergo extensive remodelling during morphogenesis. How their epithelial features, such as apicobasal polarity or adhesion, are maintained and remodelled and how adhesion and polarity proteins contribute to morphogenesis are two important questions in development. Here, we approach these issues by investigating the role of the apical determinant protein Crumbs (Crb) during the morphogenesis of the embryonic Drosophila tracheal system. Crb accumulates differentially throughout tracheal development and is required for different tracheal events. The earliest requirement for Crb is for tracheal invagination, which is preceded by an enhanced accumulation of Crb in the invagination domain. There, Crb, acting in parallel with the epidermal growth factor receptor (Egfr) pathway, is required for tracheal cell apical constriction and for organising an actomyosin complex, which we propose is mediated by Crb recruitment of moesin (Moe). The ability of a Crb isoform unable to rescue polarity in crb mutants to otherwise rescue their invagination phenotype, and the converse inability of a FERM-binding domain mutant Crb to rescue faulty invagination, support our hypothesis that it is the absence of Crb-dependent Moe enrichment, and not the polarity defect, that mainly underlies the crb invagination phenotype. This hypothesis is supported by the phenotype of lethal giant larvae (lgl); crb double mutants. These results unveil a link between Crb and the organisation of the actin cytoskeleton during morphogenesis.

  3. Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.

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    Maharaj, C H


    The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.

  4. Tracheal Agenesis: A Challenging Prenatal Diagnosis—Contribution of Fetal MRI

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    Charline Bertholdt


    Full Text Available Tracheal agenesis is a rare congenital anomaly. The prevalence is less than 1 : 50 000 with a male to female ratio of 2 : 1. This anomaly may be isolated but, in 93% of cases, it is part of polymalformative syndrome. The most evocative diagnosis situation is the ultrasonographic congenital high airway obstruction syndrome. Dilated airways, enlarged lungs with flattened diaphragm, fetal ascites and severe nonimmune hydrops can be observed. In the absence of a congenital high airway obstruction syndrome, the antenatal diagnosis of tracheal agenesis is difficult. Tracheal agenesis should be suspected in the presence of an unexplained polyhydramnios associated with congenital malformations. The fetal airway exploration should then be systematically performed by fetal thoracic magnetic resonance imaging. A case of Floyd’s type II tracheal agenesis, detected during the postnatal period, is reported here. The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis would have been easy if a systematical examination of upper airways had been performed. Prenatal diagnosis of tracheal agenesis is possible with fetal MRI but the really challenge is to think about this pathology.

  5. Comparison between tracheal ratio methods used by three observers at three occasions in English Bulldogs. (United States)

    Ingman, Jessica; Näslund, Veronica; Hansson, Kerstin


    Tracheal hypoplasia is a congenital condition described in mainly brachycephalic breeds and is one component of the brachycephalic obstructive airway syndrome (BOAS). Two radiographic methods have been described to evaluate the dimensions of the tracheal diameter in dogs and to distinguish between hypoplastic and non-hypoplastic tracheas: the tracheal lumen diameter to thoracic inlet distance ratio (TD/TI) and the ratio between the thoracic tracheal luminal diameter and the width of the proximal third of the third rib (TT/3R). The purpose of this study was to compare these two published radiographic methods between observers, different measuring occasions and to investigate the effect on classification of dogs as having hypoplastic or non-hypoplastic tracheas using four previously published mean ratios as cut-offs (dogs for each method and occasion was determined using tracheal hypoplastic or non-hypoplastic, depending on measuring method, cut-off value and observer. The diagnostic value of both the TD/TI and TT/3R methods with such poor agreement is questionable, and significantly impacts their reliability for both clinical evaluation of dogs and use in health screening programs.

  6. The roentgenographic findings of achilles tendon rupture

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    Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)


    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.

  7. Outbreak of an Unusual Tracheal Mite, Ptilonyssus morofskyi (Acarina: Rhinonyssidae), in Canaries ( Serinus canaria ) With Concurrent Infection With Staphylococcus aureus and Macrorhabdus ornithogaster. (United States)

    Arabkhazaeli, Fatemeh; Madani, Seyed Ahmad; Ghavami, Samare


    Mortalities in a flock of canaries ( Serinus canaria ) with respiratory acariasis, pododermatitis caused by Staphylococcus aureus , and macrorhabdosis were investigated by postmortem examination. After a thorough parasitologic study, the tracheal mites were identified as Ptilonyssus morofskyi. Cleaning and disinfection of cages and perches, ivermectin application on the cervical skin of individual birds, enrofloxacin medication, and drinking water acidification with vinegar were used to control mortality. To the best of our knowledge, this is the first report of the occurrence of Ptilonyssus species in captive passerine birds.

  8. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm


    Lee, Chung Won; Bae, Miju; Chung, Sung Woon


    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

  9. Bilateraly Diaphragmatic Traumatic Rupture with Delayed and Liver Herniation of Right Diaphragmatic Rupture


    Hatice Öztürkmen Akay; Refik Ülkü


    Bilateraly diyafragmatic rupture is a rare pathology. The incidence isregarded 0.8-5%. Here we reported a bilateraly diyafragmatic rupture withdelayed right diyafragmatic liver herniation. We review the literature andwe mentioned the important radiologic findings of the patology withultrasonoghraphy, Computed tomography, and magnetic resonanceimaging.

  10. Bilateraly Diaphragmatic Traumatic Rupture with Delayed and Liver Herniation of Right Diaphragmatic Rupture

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    Hatice Öztürkmen Akay


    Full Text Available Bilateraly diyafragmatic rupture is a rare pathology. The incidence isregarded 0.8-5%. Here we reported a bilateraly diyafragmatic rupture withdelayed right diyafragmatic liver herniation. We review the literature andwe mentioned the important radiologic findings of the patology withultrasonoghraphy, Computed tomography, and magnetic resonanceimaging.

  11. Ruptured superior gluteal artery pseudoaneurysm with hemorrhagic shock: Case report

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    Kerem Seref Corbacioglu


    Full Text Available Pseudoaneurysm of the superior gluteal artery (SGA is very rare and the most common causes are blunt or penetrating pelvic traumas. Although pseudoaneurysm can be asymptomatic at the time of initial trauma, it can be symptomatic weeks, months, even years after initial trauma. We present a case of a ruptured superior gluteal artery pseudoaneurysm with hemorrhagic shock twenty days after a bomb injury in the Syria civil war. In addition, we review the anatomy of the SGA, clinical presentation and pitfalls of pseudoaneurysm, and imaging and treatment options. Keywords: Pseudoaneurysm, Superior gluteal artery, Pitfall, Angiography

  12. Coil embolization of ruptured frontopolar artery aneurysm: case report. (United States)

    Castaño-Leon, Ana M; Cicuendez, Marta; Paredes, Igor; Alen, Jose F; Navia, Pedro; Lagares, Alfonso


    Distal anterior cerebral artery aneurysms are infrequent. The most common location is at the bifurcation of the pericallosal and callosomarginal arteries. Cerebral artery anomalies can sometimes, at least partially, explain aneurysm formation in less common locations in relation to hemodynamic stress caused on the vascular wall. We report a very rare case of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm as a part of an anomalous anterior cerebral artery complex that was, for the first time, treated with endovascular coiling. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  13. Fatal recto-sigmoid rupture by compressed air

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    Varun Pai


    Full Text Available Compressed air is a concentrated stream of air at high pressure and high speed that can cause fatal injury to the operator and the people around him when handled inappropriately. The case herein reported is that of a victim of a practical joke, who suffered a fatal recto – sigmoid rupture due to transanal insufflation of compressed air at his workplace. The case highlights the need for implementation of guidelines for safe handling of compressed gases and it also calls for appropriate work place etiquette to avoid such fatal practical jokes at work.

  14. Continuous postoperative infusion of remifentanil inhibits the stress responses to tracheal extubation of patients under general anesthesia

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    Zhao G


    responses during the peri-extubation period. The appropriate quantity of remifentanil was found to be 0.2 μg/kg/min, as this dosage caused no side effects. Keywords: remifentanil, continuous infusion, stress response, coughing, tracheal extubation, anesthesia

  15. Animal and lung model studies of tracheal gas insufflation. (United States)

    Nahum, A


    Tracheal gas insufflation (TGI) is the continuous or phasic insufflation of fresh gas into the central airways for the purpose of improving the efficiency of alveolar ventilation and/or minimizing the ventilatory pressure requirements. Fresh gas is insufflated near the main carina, usually at flow rates of 2-15 L/min. During expiration, TGI clears the anatomic and apparatus dead space proximal to the catheter tip, thus improving carbon dioxide (CO2) clearance. Moreover, at high catheter flow rates turbulence generated at the tip of the catheter may enhance distal gas mixing. CO2 elimination during TGI depends on catheter flow rate, as at higher flow rates a greater portion of the proximal dead space is flushed clear of CO2. Consequently, as TGI flow is increased, arterial carbon dioxide tension (PaCO2) decreases. Eventually, with increasing catheter flow rate, fresh gas completely flushes the available dead space during expiration and the PaCO2 reaches a plateau. At that point, increasing catheter flow rate decreases PaCO2 much less, probably because of turbulent mixing in the airways distal to the catheter tip. In clinical practice, TGI can be applied either to decrease PaCO2 while maintaining tidal volume constant or to decrease tidal volume while keeping PaCO2 constant. In the former strategy, TGI is used to protect pH, whereas in the latter it is used to minimize the stretch forces acting on the lung parenchyma, to minimize ventilator-associated lung injury.

  16. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture. (United States)

    Leong, Wei Yee; Gheorghiu, Daniel; Rao, Janardhan


    There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR) in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient.

  17. Fratura proximal de tíbia após cirurgia extracapsular para correção de ruptura de ligamento cruzado cranial em cão Tibial fracture caused by complications after an extracapsular suture for the repair of cranial cruciate ligament rupture in a dog

    Directory of Open Access Journals (Sweden)

    Jaqueline França dos Santos


    Full Text Available Ruptura de ligamento cruzado cranial (RLCCr é a afecção ortopédica mais frequente no joelho de cães e a sutura fabelo-tibial é frequentemente utilizada na sua correção. Essa técnica pode estar associada com complicações incisionais, lesão tardia de menisco, edema associado ao material de sutura e infecção. O objetivo desta nota foi relatar a ocorrência de fratura proximal de tíbia em um cão, causada por complicação em sutura fabelo-tibial para correção de RLCCr. Um canino atendido em outro serviço foi submetido à osteossíntese com placa 2,0mm para correção de complicação em técnica extra-capsular, na qual houve fratura da tíbia na região do orifício criado para confecção da sutura fabelo-tibial. Houve falha dos implantes e a placa foi removida. A fratura foi estabilizada com fixador esquelético externo circular, sendo constatada, após 120 dias, consolidação.Cranial cruciate ligament rupture (CCLR is one of the most common orthopedic diseases in dogs and extracapsular suture with nylon is often used for its correction. This technique may be associated with incisional complications, post-surgical meniscus injury, swelling associated with suture material and infection. The objective of this study is to report a tibial fracture in a dog, caused by complications after an extracapsular suture for the repair of CCLR. An adult dog, which suffered a tibial fracture after an extracapsular fixation for a CCLR, underwent surgery for the fixation of the fracture with a 2.0mm plate, by a referring veterinarian, but the implant failed. The plate was removed and the fracture was stabilized with a circular fixator. Bone consolidation was observed after 120 days.

  18. Reconstruction of tracheal wall defect with a mesh patch of nickel-titanium shape-memory alloy. (United States)

    Luo, Jia-Sheng; Cui, Peng-Cheng; Gao, Peng-Fei; Nan, Hou; Liu, Zhi; Sun, Yong-Zhu


    We explored the feasibility of reconstructing tracheal wall defects with a mesh patch fashioned from a nickel-titanium shape-memory alloy. A tracheal wall defect was first constructed surgically by resecting the anterior half of the tracheal wall between the second and sixth tracheal rings. The defect was reconstructed in 8 experimental animals by replacing the resected tracheal mucosa and tracheal cartilage with a pedicle skin flap, which was then enclosed in the mesh patch. In 4 control animals, only a pedicle skin flap with strap muscles was used in the reconstruction procedure. The performance of the animals was observed after surgery. At the end of the experiments, the reconstructed segment was harvested for anatomic evaluation. In the experimental group, 1 animal died 5 days after the operation. Endoscopic and anatomic examination of the 7 animals that survived the observation period showed that the reconstructed trachea was stable, with sufficient airway space for breathing. All 4 control animals died after the operation. After observing successful completion of this operation in animals, we successfully used this method to repair a tracheal wall defect in a human victim of a traffic accident. Tracheal defects can be successfully reconstructed by use of a mesh patch of nickel-titanium shape-memory alloy as an extraluminal stent--a method that avoids complications associated with intraluminal stents.

  19. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Aman Jyoti


    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  20. [Changes in serous acinar cells of the tracheal gland in diabetic rats]. (United States)

    Tsuda, T


    Histochemical and ultrastructural changes in tracheal glands of rats with artificially induced diabetes were studied. The diabetic condition was induced by streptozotocin. The tracheal gland is composed of a duct and secretory units, mucus tubules and serous acini in diabetic as well as normal rats. In normal rats, the serous acinar cells contained only neutral polysaccharides. In diabetic rats, on the other hand, the serous acinar cells contained not only neutral but also moderate amounts of what appeared to be sialic acid containing compounds. On the ultrastructural level, two kinds of serous cells were observed in diabetic rats, one of which contained homogeneous granules while the other containing heterogeneous granules. The ratio between the number of cells containing heterogeneous granules and cells with homogeneous granules increased with the duration of the diabetic condition in the rat. Changes within the serous cells of diabetic rats might depress tracheal host defense mechanisms and could explain why airway infections are common in patients suffering from diabetes.

  1. Two tracheal BALT lymphoma patients successfully treated with chemotherapy including rituximab. (United States)

    Hiraishi, Yoshihisa; Iikura, Motoyasu; Kogure, Yoshihito; Hirashima, Junko; Izumi, Shinyu; Sugiyama, Haruhito


    Bronchus-associated lymphoid tissue (BALT) lymphoma of the trachea, an important differential diagnosis for tracheal tumors, is a rare disease with characteristic bronchoscopic findings. In this study, we reviewed 2 cases of patients who were symptomatic at the time of diagnosis, with tumors in the trachea and left main bronchus, putting them at high risk for asphyxia. Chemotherapies including rituximab were administered, and complete remission was confirmed in both cases. Because tracheal tumors often have a pernicious course, it might be beneficial to initiate a chemotherapeutic treatment regimen instead of adopting the "wait-and-see" approach in patients with symptomatic tracheal BALT lymphoma. © 2013 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  2. Non-Anastomotic Rupture of a Woven Dacron Graft in the Descending Thoracic Aorta Treated with Endovascular Stent Grafting

    Directory of Open Access Journals (Sweden)

    Youngok Lee


    Full Text Available The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.

  3. Non-Anastomotic Rupture of a Woven Dacron Graft in the Descending Thoracic Aorta Treated with Endovascular Stent Grafting. (United States)

    Lee, Youngok; Kim, Gun-Jik; Kim, Young Eun; Hong, Seong Wook; Lee, Jong Tae


    The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.

  4. Tracheal extubation practices following adenotonsillectomy in children: effects on operating room efficiency between two institutions. (United States)

    Kako, Hiromi; Corridore, Marco; Seo, Sarah; Elmaraghy, Charles; Lind, Meredith; Tobias, Joseph D


    Adenotonsillectomy is one of the most commonly performed operative procedures in children. It is imperative to find the most efficient and cost-effective methods of practice to facilitate operating room management while maintaining patient safety. We investigated the efficiency of two different approaches of tracheal extubation in pediatric patients following adenotonsillectomy at two tertiary care pediatric hospitals with large surgical volumes. The primary aim of the study was to determine the difference in the operating room time according to the institutional practice of tracheal extubation in the postanesthesia care unit (PACU) as compared to the operating room. After obtaining IRB approval, a retrospective chart review was performed over a 12-month period at two large, tertiary care children's hospitals including the first hospital, where patients undergo tracheal extubation in the operating room after completion of the surgical procedure and a second hospital, where patients are brought directly to the PACU and undergo tracheal extubation in the PACU by nurses, with immediate availability of the pediatric anesthesiology faculty. Patients ≤12 years of age undergoing adenotonsillectomy were eligible for inclusion in the study. Patients with significant cardiopulmonary disease or scheduled for recovery in the critical care unit were excluded. Patient demographics, total time in the operating room, surgical time, total time in the PACU, and, when applicable, time until tracheal extubation, were noted. The study cohort included 672 patients from the first hospital and 700 patients from the second hospital. Average operating room time was 17 min shorter at the first hospital than at the other, with most of the difference due to a reduction in the time between surgery end and transport from the operating room. PACU times were also 26 min shorter at the first hospital than at the second children's hospital. Tracheal extubation in the PACU is an efficient use of

  5. Intestinal rupture in a Mexican gray wolf (Canis lupus baileyi) in association with ingestion of a diazinon-impregnated cattle ear tag. (United States)

    Kagan, Rebecca


    A free-ranging Mexican gray wolf (Canis lupus baileyi) suffered intestinal rupture following ingestion of an insecticidal cattle ear tag. Subsequent organophosphate toxicosis as a cause of the rupture was speculated. Insecticidal ear tags could represent a poisoning risk in canids and other wildlife scavengers.

  6. [Tracheal Injury Successfully Treated without Surgery;Report of a Case]. (United States)

    Ikeda, Toshihiro; Nakano, Jun; Yokomise, Hiroyasu


    A 73-year-old man was injured after crashing his automobile into a concrete wall, and was admitted to our hospital with breathing difficulties. Chest computed tomography showed extensive mediastinal emphysema, right traumatic pneumothorax, and a suspected tracheal injury at the membranous region. Because of the associated tracheomalacia, the site of the tracheal injury was difficult to find by bronchoscopy. In addition, as the patient's respiratory condition was stable, surgical treatment was not chosen. Due to the continuous air leakage from the right lung, the patient underwent surgery after mediastinal and subcutaneous emphysema improved. The postoperative course was uneventful.

  7. Laryngeal mask airway guided tracheal intubation in a neonate with the Pierre Robin syndrome

    DEFF Research Database (Denmark)

    Hansen, T G; Joensen, H; Henneberg, S W


    Endotracheal intubation in infants with the Pierre Robin syndrome may sometimes be impossible to accomplish by conventional means. To aid difficult tracheal intubation many different techniques have been described. We present a case, in which we successfully intubated a small-for-date newborn boy...... with the Pierre Robin syndrome by using a modified laryngeal mask airway (no. 1) as a guide for the endotracheal tube. The technique is easy to perform, less traumatic and less time-consuming than multiple attempts at laryngoscopy or blind tracheal intubation....

  8. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD?

    Directory of Open Access Journals (Sweden)

    Camiciottoli G


    Full Text Available Gianna Camiciottoli,1 Stefano Diciotti,2 Francesca Bigazzi,1 Simone Lombardo,3 Maurizio Bartolucci,4 Matteo Paoletti,1 Mario Mascalchi,3 Massimo Pistolesi1 1Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy; 2Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi,” University of Bologna, Cesena, Italy; 3Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy; 4Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy Abstract: A substantial proportion of patients with chronic obstructive pulmonary disease (COPD develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory–expiratory low dose computed tomography (CT and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28 and in females (n=27. Women with a predominant conductive airway phenotype (n=10 showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001. Intrathoracic tracheal collapsibility was directly correlated with inspiratory–expiratory volume variation at CT and with forced expiratory volume (1 second, and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD

  9. Tracheal Chondrosarcoma: Systematic Review of Tumor Characteristics, Diagnosis, and Treatment Outcomes with Case Report

    Directory of Open Access Journals (Sweden)

    Emily A. Kutzner


    Full Text Available To our knowledge this is the first systematic review of tracheal chondrosarcoma treatment outcomes. Management insights are thoroughly discussed. Men constitute 93.8% of cases, and most of these occur in the distal trachea. The most common symptom, dyspnea, occurs in virtually all patients. Extratracheal extension had occurred in 78.6% of patients. Definitive treatment with tracheal resection showed no recurrences in 10 patients with mean follow-up of 3.1 years. Adjuvant radiotherapy may be utilized for improving local control when open complete resection cannot be performed, but only after endoscopic excision of gross tumor.

  10. Correlation Between Endotracheal Tube Cuff Pressure and Tracheal Wall Pressure Using Air and Saline Filled Cuffs (United States)


    Pressures within air-filled tracheal cuffs at altitude--an in vivo study. Anaesthesia . 2004;59(3):252-254. 5. Smith RP, McArdle BH. Pressure in the...cuffs of tracheal tubes at altitude. Anaesthesia . 2002; 57(4):374-378. 6. Britton T, Blakeman TC, Eggert J, Rodriquez D, Ortiz H, Branson RD. Managing...a comparison of three different in vitro techniques. Anaesthesia . 2008; 63(4):418-422. 15. Li Bassi G, Ranzani OT, Marti JD, Giunta V, Luque N, et

  11. Tracheal reconstruction in children with unilateral lung agenesis or severe hypoplasia. (United States)

    Backer, Carl Lewis; Kelle, Angela M; Mavroudis, Constantine; Rigsby, Cynthia K; Kaushal, Sunjay; Holinger, Lauren D


    Infants with congenital tracheal stenosis may also have unilateral lung agenesis or severe lung hypoplasia. The purpose of this review is to evaluate our results with these patients and compare their presentations and outcomes to those of tracheal stenosis patients with two lungs. Our database was queried for patients undergoing tracheal stenosis repair since 1982. Patients were divided into two groups based on pulmonary anatomy of single lung (SL = unilateral lung agenesis or severe hypoplasia) or two lungs (BL = bilateral lungs) and analyzed to compare presentation and outcomes. From 1982 to 2008, 71 patients had tracheal stenosis repair. Bilateral lungs were present in 60 patients; 9 patients had an absent (4) or severely hypoplastic (5) right lung, and 2 patients had an absent left lung (SL = 11). Age at repair was similar between groups; median age 0.42 years in the SL group (mean 0.80 +/- 1.0 years) versus 0.37 years in the BL group (mean 0.91 +/- 2.1 years, p = not significant [ns]). In the SL group 8 of 11 (73%) were intubated preoperatively versus 15 of 60 (25%) in the BL group (p = 0.004). In the SL group 4 of 11 (36%) patients had pulmonary artery sling versus 20 of 60 (33%) of BL patients (p = ns). In the SL group 2 of 11 (18%) versus 14 of 60 (23%) in the BL group had intracardiac anomalies requiring simultaneous repair (p = ns). Procedures included pericardial tracheoplasty (2 vs 26), tracheal autograft (4 vs 16), slide tracheoplasty (3 vs 8), and tracheal resection (2 vs 10). Overall mortality (operative and late) was 2 of 11 (18%) SL versus 10 of 60 (17%) BL (p = ns). Median postoperative length of stay was 43 days SL (mean 48.6 +/- 40) versus 30 days BL (mean 52.2 +/- 65) (p = ns). The incidence of postoperative tracheostomy (SL group) was 0 of 3 for slide tracheoplasty and 5 of 8 for the other techniques (p = 0.12). Despite the increased severity of pathology and increased critical presentation of tracheal stenosis patients with unilateral lung

  12. Scanning electron microscopic study of hamster tracheal organ cultures infected with Bordetella pertussis. (United States)

    Muse, K E; Collier, A M; Baseman, J B


    Hamster tracheal organculture was employed as a model for the study of the pathogenesis of infection due to bordetella pertusis. Scanning electron microscopy provided a three-dimensional view of the surface infection of the tracheal explants. Phase I B. pertussis attached only to the ciliated epithelial cells, and a sequence of events involving the injury, expulsion, and destruction of these differentiated cells occurred. This in vitro model provides insights into the mechanisms by which B. pertussis mediates host cell injury at the site of infection.

  13. Rupture of pectoralis major muscle: review article

    Directory of Open Access Journals (Sweden)

    Guity MR


    Full Text Available "nBackground: Rupture of pectoralis major muscle is a very rare and often athletic injury. These days in our country this injury occurs more frequently. This could be due to increase in professional participation of amateur people in different types of sport, like body building and weight-lifting (especially bench-pressing without adequate preparation, training and taking necessary precautions. In this article, we have tried to review several aspects of complex anatomy of pectoralis major muscle, epidemiology, mechanism, clinical presentations, imaging modalities, surgical indications and techniques of its rupture. Complex and especial anatomy of pectoralis major muscle, in its humeral insertion particularly, have a major role of its vulnerability to sudden and eccentric contraction as the main mechanism of rupture. Also, restoration of this complex anatomy seems to be important during surgical repair to have normal function of the muscle again.

  14. Right ventricular hydatid cyst ruptured to pericardium

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi


    Full Text Available Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

  15. A Late Presentation of Spontaneous Bladder Rupture During Labor

    Directory of Open Access Journals (Sweden)

    A. Farahzadi


    Full Text Available Spontaneous bladder rupture is usually due to bladder diseases. Bladder rupture during labor or postpartum is extremely rare. Acute abdomen is the usual presentation of spontaneous bladder rupture. Patients may complain of suprapubic pain, anuria and hematuria. Some patients with intraperitoneal bladder rupture may have no abdominal pain and can pass urine without any symptoms so the diagnosis of intraperitoneal rupture may be difficult in these situations. We report a nulliparous woman with abdominal pain and distension about 20 days after normal vaginal delivery. There was intraperitoneal rupture of bladder in dome of bladder which was sealed by jejunum.

  16. Linguine sign in musculoskeletal imaging: calf silicone implant rupture

    Energy Technology Data Exchange (ETDEWEB)

    Duryea, Dennis; Petscavage-Thomas, Jonelle [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Frauenhoffer, Elizabeth E. [Milton S. Hershey Medical Center, Department of Pathology, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Walker, Eric A. [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Nuclear Medicine, Bethesda, MD, 20814 (United States)


    Imaging findings of breast silicone implant rupture are well described in the literature. On MRI, the linguine sign indicates intracapsular rupture, while the presence of silicone particles outside the fibrous capsule indicates extracapsular rupture. The linguine sign is described as the thin, wavy hypodense wall of the implant within the hyperintense silicone on T2-weighted images indicative of rupture of the implant within the naturally formed fibrous capsule. Hyperintense T2 signal outside of the fibrous capsule is indicative of an extracapsular rupture with silicone granuloma formation. We present a rare case of a patient with a silicone calf implant rupture and discuss the MRI findings associated with this condition. (orig.)

  17. Fan-head shear rupture mechanism as a source of off-fault tensile cracking (United States)

    Tarasov, Boris


    This presentation discusses the role of a recently identified fan-head shear rupture mechanism [1] in the creation of off-fault tensile cracks observed in earthquake laboratory experiments conducted on brittle photoelastic specimens [2,3]. According to the fan-mechanism the shear rupture propagation is associated with consecutive creation of small slabs in the fracture tip which, due to rotation caused by shear displacement of the fracture interfaces, form a fan-structure representing the fracture head. The fan-head combines such unique features as: extremely low shear resistance (below the frictional strength) and self-sustaining tensile stress intensification along one side of the interface. The variation of tensile stress within the fan-head zone is like this: it increases with distance from the fracture tip up to a maximum value and then decreases. For the initial formation of the fan-head high local stresses corresponding to the fracture strength should be applied in a small area, however after completions of the fan-head it can propagate dynamically through the material at low shear stresses (even below the frictional strength). The fan-mechanism allows explaining all unique features associated with the off-fault cracking process observed in photoelastic experiments [2,3]. In these experiments spontaneous shear ruptures were nucleated in a bonded, precut, inclined and pre-stressed interface by producing a local pressure pulse in a small area. Isochromatic fringe patterns around a shear rupture propagating along bonded interface indicate the following features of the off-fault tensile crack development: tensile cracks nucleate and grow periodically along one side of the interface at a roughly constant angle (about 80 degrees) relative to the shear rupture interface; the tensile crack nucleation takes place some distance behind the rupture tip; with distance from the point of nucleation tensile cracks grow up to a certain length within the rupture head zone

  18. Blunt traumatic cardiac rupture: therapeutic options and outcomes. (United States)

    Nan, Yu-Yun; Lu, Ming-Shian; Liu, Kuo-Sheng; Huang, Yao-Kuang; Tsai, Feng-Chun; Chu, Jaw-Ji; Lin, Pyng Jing


    Cardiac rupture following blunt thoracic trauma is rarely encountered by clinicians, since it commonly causes death at the scene. With advances in traumatology, blunt cardiac rupture had been increasingly disclosed in various ways. This study reviews our experience of patients with suspected blunt traumatic cardiac rupture and proposes treatment protocols for the same. This is a 5-year retrospective study of trauma patients confirmed with blunt traumatic cardiac rupture admitted to a university-affiliated tertiary trauma referral centre. The following information was collected from the patients: age, sex, mechanism of injury, initial effective diagnostic tool used for diagnosing blunt cardiac rupture, location and size of the cardiac injury, associated injury and injury severity score (ISS), reversed trauma score (RTS), survival probability of trauma and injury severity scoring (TRISS), vital signs and biochemical lab data on arrival at the trauma centre, time elapsed from injury to diagnosis and surgery, surgical details, hospital course and final outcome. The study comprised 8 men and 3 women with a median age of 39 years (range: 24-73 years) and the median follow-up was 5.5 months (range: 1-35 months). The ISS, RTS, and TRISS scores of the patients were 32.18+/-5.7 (range: 25-43), 6.267+/-1.684 (range: 2.628-7.841), and 72.4+/-25.6% (range: 28.6-95.5%), respectively. Cardiac injuries were first detected using focused assessment with sonography for trauma (FAST) in 4 (36.3%) patients, using transthoracic echocardiography in 3 (27.3%) patients, chest CT in 1 (9%) patient, and intra-operatively in 3 (27.3%) patients. The sites of cardiac injury comprised the superior vena cava/right atrium junction (n=4), right atrial auricle (n=1), right ventricle (n=4), left ventricular contusion (n=1), and diffuse endomyocardial dissection over the right and left ventricles (n=1). Notably, 2 had pericardial lacerations presenting as a massive haemothorax, which initially masked

  19. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Wei Yee Leong


    Full Text Available Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. Conclusion: The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient. Keywords: Quadriceps tendon rupture; Achilles tendon rupture; Bilateral.

  20. Unexpected ruptured aneurysm during posterior fossa surgery. (United States)

    Chenin, L; Capel, C; N'Da, H; Lefranc, M; Peltier, J


    Surgery is the recommended treatment for unique significant cerebellar metastasis, particularly in cases of hydrocephalus. Complications of posterior fossa surgery are associated with high risk of morbidity and mortality. We present a unique case of unexpected peroperative rupture of a cerebellar superior artery aneurysm during posterior fossa surgery. During posterior cranial fossa surgery, severe arterial bleeding occurred in front of the medulla oblongata. Immediate postoperative computed tomographic (CT) angiography revealed a fusiform aneurysm from a distal branch of the left superior cerebellar artery. To our knowledge, this is the first reported operative case of unexpected infratentorial ruptured aneurysm during posterior fossa surgery. Copyright © 2014. Published by Elsevier Masson SAS.


    Energy Technology Data Exchange (ETDEWEB)

    P. Macheret


    The objective of this calculation is to compare several creep rupture correlations for use in calculating creep strain accrued by the Zircaloy cladding of spent nuclear fuel when it has been emplaced in the repository. These correlations are used to calculate creep strain values that are then compared to a large set of experimentally measured creep strain data, taken from four different research articles, making it possible to determine the best fitting correlation. The scope of the calculation extends to six different creep rupture correlations.

  2. Experimental Investigation of Thrust Fault Rupture Mechanics (United States)

    Gabuchian, Vahe

    Thrust fault earthquakes are investigated in the laboratory by generating dynamic shear ruptures along pre-existing frictional faults in rectangular plates. A considerable body of evidence suggests that dip-slip earthquakes exhibit enhanced ground motions in the acute hanging wall wedge as an outcome of broken symmetry between hanging and foot wall plates with respect to the earth surface. To understand the physical behavior of thrust fault earthquakes, particularly ground motions near the earth surface, ruptures are nucleated in analog laboratory experiments and guided up-dip towards the simulated earth surface. The transient slip event and emitted radiation mimic a natural thrust earthquake. High-speed photography and laser velocimeters capture the rupture evolution, outputting a full-field view of photo-elastic fringe contours proportional to maximum shearing stresses as well as continuous ground motion velocity records at discrete points on the specimen. Earth surface-normal measurements validate selective enhancement of hanging wall ground motions for both sub-Rayleigh and super-shear rupture speeds. The earth surface breaks upon rupture tip arrival to the fault trace, generating prominent Rayleigh surface waves. A rupture wave is sensed in the hanging wall but is, however, absent from the foot wall plate: a direct consequence of proximity from fault to seismometer. Signatures in earth surface-normal records attenuate with distance from the fault trace. Super-shear earthquakes feature greater amplitudes of ground shaking profiles, as expected from the increased tectonic pressures required to induce super-shear transition. Paired stations measure fault parallel and fault normal ground motions at various depths, which yield slip and opening rates through direct subtraction of like components. Peak fault slip and opening rates associated with the rupture tip increase with proximity to the fault trace, a result of selective ground motion amplification in the

  3. [Partial uterine rupture--case report]. (United States)

    Sikora, Wacław; Michalak, Zenon; Sikora-Szcześniak, Dobrosława


    We have presented a case of partial rupture of the uterus along the left margin with both lamina of the broad uterine ligament torn off and tear of the left ovarian proper ligament in a 32-year-old patient in 36 weeks gestation. The patient, with no history of either surgery on the uterine muscles or incidents of abdominal trauma, presented with no contractions. She was qualified for an emergency laparotomy, underwent Caesarean section and the rupture of the uterine muscle was sutured. 14 days after surgery the mother and her baby were discharged from hospital in overall good condition.


    Directory of Open Access Journals (Sweden)

    Miroslav Kezunović


    Full Text Available One of the most important goals of the treatment of sports injuries is athletes’ early return to normal sporting activities. Time when the athletes will return to normal sporting activities, after Achilles tendon acute rupture, depends on the level of sports involvement. Average time of return to sport is usually between 5-6 months after rupture. Patients, who are treated using postoperative functional cast, can expect an average return to their sport a month earlier than those who after surgery used solid cast immobilization. The most important signs that indicate possible slow rehabilitation process are the pain and swelling after activity and late recovery of the tissue.

  5. Metabolic detoxication pathways for sterigmatocystin in primary tracheal epithelial cells. (United States)

    Cabaret, Odile; Puel, Olivier; Botterel, Françoise; Pean, Michel; Khoufache, Khaled; Costa, Jean-Marc; Delaforge, Marcel; Bretagne, Stéphane


    Human health effects of inhaled mycotoxins remain poorly documented, despite the large amounts present in bioaerosols. Among these mycotoxins, sterigmatocystin is one of the most prevalent. Our aim was to study the metabolism and cellular consequences of sterigmatocystin once it is in contact with the airway epithelium. Metabolites were analyzed first in vitro, using recombinant P450 1A1, 1A2, 2A6, 2A13, and 3A4 enzymes, and subsequently in porcine tracheal epithelial cell (PTEC) primary cultures at an air-liquid interface. Expressed enzymes and PTECs were exposed to sterigmatocystin, uniformly enriched with (13)C to confirm the relationship between sterigmatocystin and metabolites. Induction of the expression of xenobiotic-metabolizing enzymes upon sterigmatocystin exposure was examined by real-time quantitative real-time polymerase chain reaction. Incubation of 50 μM sterigmatocystin with recombinant P450 1A1 led to the formation of three metabolites: monohydroxy-sterigmatocystin (M1), dihydroxy-sterigmatocystin (M2), and one glutathione adduct (M3), the latter after the formation of a transient epoxide. Recombinant P450 1A2 also led to M1 and M3. P450 3A4 led to only M3. In PTEC, 1 μM sterigmatocystin metabolism resulted in a glucuro conjugate (M4) mainly excreted at the basal side of cells. If PTEC were treated with β-naphthoflavone prior to sterigmatocystin incubation, two other products were detected, i.e., a sulfo conjugate (M5) and a glucoro conjugate (M6) of hydroxy-sterigmatocystin. Exposure of PTEC for 24 h to 1 μM sterigmatocystin induced an 18-fold increase in the mRNA levels of P450 1A1, without significantly induced 7-ethoxyresorufin O-deethylation activity. These data suggest that sterigmatocystin is mainly detoxified and is unable to produce significant amounts of reactive epoxide metabolites in respiratory cells. However, sterigmatocystin increases the P450 1A1 mRNA levels with unknown long-term consequences. These in vitro results obtained in

  6. The association between obesity and difficult prehospital tracheal intubation. (United States)

    Holmberg, Timothy J; Bowman, Stephen M; Warner, Keir J; Vavilala, Monica S; Bulger, Eileen M; Copass, Michael K; Sharar, Sam R


    Nonphysician advanced life support (ALS) providers often perform tracheal intubation (TI) for cardiac arrest or other life-threatening indications in the prehospital setting, where airway assessment and airway management tools are limited. However, the frequency of difficult TI in obese patients in this setting is unclear. In this study we determined factors associated with TI success, and determined TI difficulty as a function of body mass index (BMI) in a system of ALS providers experienced in TI, to guide future prehospital education efforts. A retrospective review was performed of all patients ≥15 years of age who underwent prehospital TI by paramedics in the Seattle Medic One system over a 4-year period, and were transported to the regional level 1 trauma center (Harborview Medical Center). Data were abstracted from a prospectively collected prehospital airway management database and from the hospital medical records, including demographic information, number of TI attempts, TI success or failure, and body weight/height (BMI). Descriptive statistics and multivariable logistic regression were calculated, with the primary end point being difficult TI (defined as ≥4 TI attempts or the need to use an alternative airway management technique). Of 80,501 patient contacts in whom 4114 TIs were attempted during the 4-year study period, 823 met study entry criteria (including a calculable BMI). The overall TI success rate in the study population was 98.5% (811 out of 823), with 6.8% (56 out of 823) meeting the predetermined definition for difficult TI. There was no significant association between difficult TI and patient age, gender, use of succinylcholine, or medical diagnosis (trauma vs. nontrauma). In comparison with the lean patient subgroup (BMI 40 kg/m(2)) had a significant association with difficult TI (odds ratio 3.68; confidence interval [CI] 1.27-10.59), whereas those with class I/II obesity (BMI ≥30 kg/m(2) and education for such providers should

  7. Forecasting magma-chamber rupture at Santorini volcano, Greece. (United States)

    Browning, John; Drymoni, Kyriaki; Gudmundsson, Agust


    How much magma needs to be added to a shallow magma chamber to cause rupture, dyke injection, and a potential eruption? Models that yield reliable answers to this question are needed in order to facilitate eruption forecasting. Development of a long-lived shallow magma chamber requires periodic influx of magmas from a parental body at depth. This redistribution process does not necessarily cause an eruption but produces a net volume change that can be measured geodetically by inversion techniques. Using continuum-mechanics and fracture-mechanics principles, we calculate the amount of magma contained at shallow depth beneath Santorini volcano, Greece. We demonstrate through structural analysis of dykes exposed within the Santorini caldera, previously published data on the volume of recent eruptions, and geodetic measurements of the 2011-2012 unrest period, that the measured 0.02% increase in volume of Santorini's shallow magma chamber was associated with magmatic excess pressure increase of around 1.1 MPa. This excess pressure was high enough to bring the chamber roof close to rupture and dyke injection. For volcanoes with known typical extrusion and intrusion (dyke) volumes, the new methodology presented here makes it possible to forecast the conditions for magma-chamber failure and dyke injection at any geodetically well-monitored volcano.

  8. Conservative Management of Azygous Vein Rupture in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Cian McDermott


    Full Text Available We report a case of successful conservative management of acute traumatic rupture of the azygous vein. A 48-year-old male was involved in a motor vehicle collision. Primary survey revealed acute right intrathoracic haemorrhage. He remained haemodynamically stable with rapid infusion of warmed crystalloid solution and blood. Computed tomographic imaging showed a contained haematoma of the azygous vein. The patient was managed conservatively in the intensive care. Azygous vein laceration resulting from blunt thoracic trauma is a rare condition that carries a universally poor prognosis unless the appropriate treatment is instituted. Clinical features include acute hypovolaemic shock, widened mediastinum on chest radiograph, and a right-sided haemothorax. Haemodynamic collapse necessitates immediate resuscitative thoracotomy. Interest in this injury stems from the severity of the clinical condition, difficulty in diagnosis, the onset of a rapidly deteriorating clinical course all of which can be promptly reversed by timely and appropriate treatment. Although it is a rare cause of intramediastinal haemorrhage, it is proposed that a ruptured azygous vein should be considered in every trauma case causing a right-sided haemothorax or widened mediastinum. All cases described in the literature to date involved operative management. We present a case of successful conservative management of this condition.

  9. Acute inflammatory responses of nanoparticles in an intra-tracheal instillation rat model.

    Directory of Open Access Journals (Sweden)

    Andrea L Armstead

    Full Text Available Exposure to hard metal tungsten carbide cobalt (WC-Co "dusts" in enclosed industrial environments is known to contribute to the development of hard metal lung disease and an increased risk for lung cancer. Currently, the influence of local and systemic inflammation on disease progression following WC-Co exposure remains unclear. To better understand the relationship between WC-Co nanoparticle (NP exposure and its resultant effects, the acute local pulmonary and systemic inflammatory responses caused by WC-Co NPs were explored using an intra-tracheal instillation (IT model and compared to those of CeO2 (another occupational hazard NP exposure. Sprague-Dawley rats were given an IT dose (0-500 μg per rat of WC-Co or CeO2 NPs. Following 24-hr exposure, broncho-alveolar lavage fluid and whole blood were collected and analyzed. A consistent lack of acute local pulmonary inflammation was observed in terms of the broncho-alveolar lavage fluid parameters examined (i.e. LDH, albumin, and macrophage activation in animals exposed to WC-Co NP; however, significant acute pulmonary inflammation was observed in the CeO2 NP group. The lack of acute inflammation following WC-Co NP exposure contrasts with earlier in vivo reports regarding WC-Co toxicity in rats, illuminating the critical role of NP dose and exposure time and bringing into question the potential role of impurities in particle samples. Further, we demonstrated that WC-Co NP exposure does not induce acute systemic effects since no significant increase in circulating inflammatory cytokines were observed. Taken together, the results of this in vivo study illustrate the distinct differences in acute local pulmonary and systemic inflammatory responses to NPs composed of WC-Co and CeO2; therefore, it is important that the outcomes of pulmonary exposure to one type of NPs may not be implicitly extrapolated to other types of NPs.

  10. Uterine rupture: A seven year review at a tertiary care hospital in New Delhi, India

    Directory of Open Access Journals (Sweden)

    Maruti Sinha


    Full Text Available Objective: To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi. Materials and Methods: A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied. Results: The incidence of rupture was one in 1,633 deliveries (0.061%. The vast majority of patients had prior low transverse cesarean section (84.8%. The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths. Conclusions: Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.

  11. The influence of sex hormones on anterior cruciate ligament ruptures in males. (United States)

    Stijak, Lazar; Kadija, Marko; Djulejić, Vuk; Aksić, Milan; Petronijević, Nataša; Aleksić, Dubravka; Radonjić, Vidosava; Bumbaširević, Marko; Filipović, Branislav


    The purpose of this study is to determine the difference in the concentrations of testosterone, 17-β estradiol and progesterone between male patients with and without ACL rupture, as well as the possible effect of these hormones on generalized joint laxity. Male subjects with non-contact knee joint injury were included in this study. Two groups were formed: the examined group, consisting of subjects with ACL rupture and the control group consisting of patients without ACL rupture. After this, the patients from these two groups were paired off on the basis of three factors, level of professional involvement in sports (including the type of sports activity), left or right side of the body and the age of the subjects. In the end, there were 29 pairs (58 subjects). The concentration of sex hormones was determined from saliva specimens with the aid of the Salimetrics enzyme immunoassay. The testing of generalized joint laxity was performed with the aid of the "laxity score" according to Beighton et al. Subjects with ACL rupture have highly statistically significantly greater concentrations of testosterone (p < 0.01), statistically significantly greater concentrations of 17-β estradiol (p < 0.05), and a highly statistically significantly greater generalized joint laxity score than subjects with an intact ACL (p < 0.01). Increased concentrations of testosterone or 17-β estradiol may be a risk factor leading to ACL rupture. Also, generalized joint laxity may be a factor leading to ACL rupture, but none of the monitored hormones can be set down as the cause of its existence. Young male athletes with higher concentrations of testosterone and greater hyperelasticity should plan preventive programs of physiotherapy for ACL preservation since they present a vulnerable group susceptible to ACL rupture. Diagnostic study, Level II.

  12. The biomechanical and histological effects of posterior cruciate ligament rupture on the medial tibial plateau. (United States)

    Deng, Zhenhan; Li, Yusheng; Lin, Zhangyuan; Zhu, Yong; Zhao, Ruibo


    The objective of this study was to investigate the biomechanical and histological effects of the posterior cruciate ligament (PCL) on the medial tibial plateau. A total of 12 cadaveric human knee specimens were collected and grouped as follows: the PCL intact group (n = 12), the anterolateral bundle rupture group (n = 6), the postmedial bundle rupture group (n = 6), and the PCL rupture group (n = 12). The strain on the anterior, middle, and posterior parts of the medial tibial plateau with an axial loading force at different flexion angles was measured and analyzed, respectively. Forty-eight rabbits were chosen for animal study: surgery was performed on the one side of each rabbit randomly (experimental group), while the other side was taken as control (control group). Every 12 rabbits were culled at each of the four selected time points to collect the medial tibial plateau for morphological and histological observation. The PCL rupture, either partial or complete, may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all positions. Noticeable time-dependent degenerative histological changes of the medial tibial plateau were observed in the rabbit models of PCL rupture. Compared with the control group, all the PCL rupture groups exhibited a higher expression of the matrix metalloproteinase-7 (MMP-7) and the tissue inhibitors of metalloproteinase-1 (TIMP-1) at all the time points. Either partial or complete PCL rupture may generate an abnormal load on all the parts of the medial tibial plateau with axial loading at all the positions and may cause cartilage degeneration on the medial tibial plateau.

  13. A microfluidic model to study fluid dynamics of mucus plug rupture in small lung airways (United States)

    Hu, Yingying; Bian, Shiyao; Grotberg, John; Filoche, Marcel; White, Joshua; Takayama, Shuichi; Grotberg, James B.


    Fluid dynamics of mucus plug rupture is important to understand mucus clearance in lung airways and potential effects of mucus plug rupture on epithelial cells at lung airway walls. We established a microfluidic model to study mucus plug rupture in a collapsed airway of the 12th generation. Mucus plugs were simulated using Carbopol 940 (C940) gels at concentrations of 0.15%, 0.2%, 0.25%, and 0.3%, which have non-Newtonian properties close to healthy and diseased lung mucus. The airway was modeled with a polydimethylsiloxane microfluidic channel. Plug motion was driven by pressurized air. Global strain rates and shear stress were defined to quantitatively describe plug deformation and rupture. Results show that a plug needs to overcome yield stress before deformation and rupture. The plug takes relatively long time to yield at the high Bingham number. Plug length shortening is the more significant deformation than shearing at gel concentration higher than 0.15%. Although strain rates increase dramatically at rupture, the transient shear stress drops due to the shear-thinning effect of the C940 gels. Dimensionless time-averaged shear stress, Txy, linearly increases from 3.7 to 5.6 times the Bingham number as the Bingham number varies from 0.018 to 0.1. The dimensionless time-averaged shear rate simply equals to Txy/2. In dimension, shear stress magnitude is about one order lower than the pressure drop, and one order higher than yield stress. Mucus with high yield stress leads to high shear stress, and therefore would be more likely to cause epithelial cell damage. Crackling sounds produced with plug rupture might be more detectable for gels with higher concentration. PMID:26392827

  14. CTA analysis and assessment of morphological factors related to rupture in 413 posterior communicating artery aneurysms. (United States)

    Huhtakangas, Justiina; Lehecka, Martin; Lehto, Hanna; Jahromi, Behnam Rezai; Niemelä, Mika; Kivisaari, Riku


    Posterior communicating artery (PcomA) aneurysms are frequently encountered, but there are few publications on their morphology. A growing number of aneurysms are incidental findings, which makes evaluation of rupture risk important. Our goal was to identify morphological features and anatomical variants associated with PComA aneurysms and to assess parameters related to rupture. We studied CT angiographies of 391 consecutive patients treated between 2000 and 2014 at a single institution. We determined clinically important morphological parameters and performed univariate and multivariate analysis. There were a total of 413 PComA aneurysms: 258 (62%) were ruptured and 155 (38%) unruptured. Ruptured PComA aneurysms had the potential to cause severe bleeding with IVH and/or temporal ICH (n = 170, 66% of ruptured). The main types of PComA origin were classified as follows: (1) separate (32%), (2) side by side (21%) and (3) a joint neck with the aneurysm (6%). After the multivariate logistic regression, the morphological parameters related to PComA aneurysm rupture were an irregular aneurysm dome, neck diameter, and aspect ratio >1.5. The most marked morphological features of the PComA aneurysms were: saccular nature (99%), infero-posterior dome orientation (42%), infrequency of large or giant aneurysms (4%), narrow neck compared to the aneurysm size, PComA originating directly from the aneurysm neck or the dome (28%), and fetal or dominant PComA on the side of the aneurysm (35%). There were location-related parameters that were more strongly associated with PComA aneurysm rupture than aneurysm size: an irregular aneurysm dome, larger diameter of the aneurysm neck and aspect ratio >1.5.



    Vijayalakshmi; Divya


    Uterine rupture stands as a single obstetric accident during pregnancy and child birth, and one of the leading causes for maternal and fetal morbidity and mortality. Although there is decline in different studies, it is a potentially catastrophic event in which the integrity of myometrial wall is breeched . ( 1) Survivors are often e...

  16. Umbilical hernia rupture with evisceration of omentum from massive ascites: a case report.

    LENUS (Irish Health Repository)

    Good, Daniel W


    The incidence of hernias is increased in patients with alcoholic liver disease with ascites. To the best of our knowledge, this is the first report of an acute rise in intra-abdominal pressure from straining for stool as the cause of a ruptured umbilical hernia.

  17. Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture


    Lui, Tun Hing


    Tendon adhesion is one of the most common causes of disability following tendon surgery. A case of extensive peritendinous adhesions of the Achilles tendon and tibialis posterior tendon after compound rupture of the tendons was reported. This was managed by endoscopic adhesiolysis of both tendons. The endoscopic approach allows early postoperative mobilisation which can relieve the tendon adhesion.

  18. Rupture characteristics of the 2016 Meinong earthquake revealed by the back projection and directivity analysis of teleseismic broadband waveforms (United States)

    Jian, Pei-Ru; Hung, Shu-Huei; Meng, Lingsen; Sun, Daoyuan


    The 2016 Mw 6.4 Meinong earthquake struck a previously unrecognized fault zone in midcrust beneath south Taiwan and inflicted heavy causalities in the populated Tainan City about 30 km northwest of the epicenter. Because of its relatively short rupture duration and P wave trains contaminated by large-amplitude depth phases and reverberations generated in the source region, accurate characterization of the rupture process and source properties for such a shallow strong earthquake remains challenging. Here we present a first high-resolution MUltiple SIgnal Classification back projection source image by using both P and depth-phase sP waves recorded at two large and dense arrays to understand the source behavior and consequent hazards of this peculiar catastrophic event. The results further corroborated by the directivity analysis indicate a unilateral rupture propagating northwestward and slightly downward on the shallow NE-dipping fault plane. The source radiation process is primarily characterized by one single peak, 7 s duration, with a total rupture length of 17 km and average rupture speed of 2.4 km/s. The rupture terminated immediately east of the prominent off-fault aftershock cluster about 20 km northwest of the hypocenter. Synergistic amplification of ground shaking by the directivity and strong excitation of sP and reverberations mainly caused the destruction concentrated in the area further to the northwest away from the rupture zone.

  19. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. (United States)

    Moreno, Daniel H; Cacione, Daniel G; Baptista-Silva, Jose C C


    An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair. The management of haemorrhagic shock is crucial for the person's outcome and aims to restore organ perfusion and systolic blood pressure above 100 mm Hg through immediate and aggressive fluid replacement. This rapid fluid replacement is known as the normotensive resuscitation strategy. However, evidence suggests that infusing large volumes of cold fluid causes dilutional and hypothermic coagulopathy. The association of these factors may exacerbate bleeding, resulting in a 'lethal triad' of hypothermia, acidaemia, and coagulopathy. An alternative to the normotensive resuscitation strategy is the controlled (permissive) hypotension resuscitation strategy, with a target systolic blood pressure of 50 to 100 mm Hg. The principle of controlled or hypotensive resuscitation has been used in some management protocols for endovascular repair of ruptured AAA. It may be beneficial in preventing blood loss by avoiding the clot disruption caused by the rapid increase in systolic blood pressure; avoiding dilution of clotting factors, platelets and fibrinogen; and by avoiding the temperature decrease that inhibits enzyme activity involved in platelet and clotting factor function. To compare the effects of controlled (permissive) hypotension resuscitation and normotensive resuscitation strategies for people with ruptured AAA. The Cochrane Vascular Information Specialist searched the Specialised Register (April 2016) and the Cochrane Register of Studies (CENTRAL (2016

  20. Use of veno-arterial extracorporeal membrane oxygenation in a case of tracheal injury repair in a patient with severe relapsing polychondritis. (United States)

    Laliberte, Anne-Sophie; McDonald, Christine; Waddell, Tom; Yasufuku, Kazuhiro


    Tracheobronchial malacia occurs in 50% of patients with relapsing polychondritis (RP), and is often managed with stent insertion. While severe complications have been described after silicone tracheal stent insertion, there are few reports describing tracheal injury in patients with RP. We present a case of tracheal perforation secondary to Dumon ® stent manipulation in a patient with RP. The tracheal injury was successfully repaired with a silicone Y-stent inserted via right thoracotomy using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for ventilatory support. It is safe and feasible to introduce a silicone Y-stent through a thoracotomy for a tracheal trauma in combination with VA-ECMO support.