Sample records for proximal muscle rupture

  1. 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

  2. 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.

  3. [Clinical application of peroneal muscles tendon transposition in repair of Achilles tendon rupture]. (United States)

    Jin, Rihao; Jin, Yu; Fang, Xiulin


    To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3 females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture (8 cases of complete rupture and 2 cases of incomplete rupture). The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5 +/- 2.5 cm. The width of origin tendon was 0.9 +/- 0.2 cm and the thickness was 0.3 +/- 0.1 cm; the width on apex of lateral malleolus was 0.7 +/- 0.1 cm and the thickness was 0.4 +/- 0.1 cm, the width on head of cuboid was 0.7 +/- 0.1 cm and the thickness was 0.3 +/- 0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2,292.4 +/- 617.3 N on tendon calcaneus, 1,020.4 +/- 175.4 N on long peroneal muscles tendon, 752.0 +/- 165.4 N on peroneus brevis tendon and 938.2 +/- 216.7 N on tibialis posterior tendon. Ten cases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 18-24 months. No Achilles tendon re-rupture, necrosis of skin or other complications occurred

  4. 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.

  5. Clinical findings, treatment, and outcome in 11 dairy heifers with breakdown injury due to interosseous medius muscle rupture. (United States)

    Nuss, Karl; Boppart, Jasmin; Geyer, Hans


    To describe the diagnosis, treatment, and prognosis of fetlock breakdown due to interosseus medius muscle rupture in cattle. Retrospective clinical study. Dairy heifers with unilateral or bilateral interosseus medius muscle rupture (n = 11). Breakdown injury due to rupture of the interosseus medius muscle was documented clinically, radiographically, and ultrasonographically. Breakdown was bilateral in 4 heifers (3 in forelimbs, 1 in hind limbs) and unilateral in 7 (all hind limbs). One heifer with severe bilateral hind limb breakdown was slaughtered and the remaining 10 were treated by transfixation pin cast (1 heifer), box rest (n = 2), and/or a cast and splint (7). Hyperextension of the fetlock and hyperflexion of the proximal interphalangeal joints during weight bearing were characteristic for interosseus muscle breakdown. Ultrasonographically, the origin and body of the interosseus muscle and the branches to the sesamoid bones were primarily affected by the rupture. Conservative treatment was successful (used for their intended purpose) in 8 of 9 heifers with a median lifespan of 32 months after discharge from the clinic (range 6-83). Rupture of the interosseus medius muscle in young cattle may be more common than previously suggested in the literature. Imaging with ultrasound allowed more detailed localization of lesions of the musculo-tendinous structure. Interosseus medius muscle rupture had a favorable prognosis when treated conservatively in these heifers. © 2017 The American College of Veterinary Surgeons.


    Directory of Open Access Journals (Sweden)

    Damir Lukac

    Full Text Available ABSTRACT Introduction: Tennis leg, a common injury of the medial head of gastrocnemius muscle in the muscle-tendon junction, is usually reported in men during recreational sports. Sudden pain is the main symptom accompanied by the feeling of rupture in the calf. Clinical examination followed by ultrasound is the standard diagnostic procedure. Objective: The main objectives of this study are to compare clinical and ultrasonographic findings in cases of tennis leg, evaluate the location and type of lesion in the medial head of gastrocnemius muscle, and evaluate the edema volume and the presence of deep vein thrombosis (DVT. Second, the healing process was monitored with ultrasound to distinguish the level of recovery and to record the presence of chronic sequelae. Methods: Eighty-one subjects with clinical symptoms of rupture of the medial head of gastrocnemius muscle participated in the study. A linear probe (7-12 MHz was used for ultrasonographic (US and a Doppler was used to verify the presence of DVT. Results: In 78 of 81 subjects examined, we found obvious US changes (96.3% and three of them had no positive findings. In 67 of them, we diagnosed rupture of the medial head of the gastrocnemius muscle. Most of them had partial rupture (73.13% and the remaining had total rupture (26.87%. The edema (30.84% was found in the space between the aponeurosis of the gastrocnemius and soleus muscles. DVT with the clinical signs of tennis leg was observed in 5 of 81 patients (6.17%. Conclusion: Our findings indicate that ultrasound is very important for early diagnosis of muscle-tendon injuries in the leg. In addition, monitoring the healing process and assessing the chosen treatment showed a high efficiency. Ultrasonography is an effective method to identify and differentiate the sequelae of the injured muscles and vascular complications.

  7. Partial rupture of the quadriceps muscle in a child

    Directory of Open Access Journals (Sweden)

    Aydemir Gokhan


    Full Text Available Abstract Background The quadriceps femoris muscle ruptures usually occur in the middle-aged population. We present a 4-year-old patient with partial rupture of the quadriceps femoris muscle. To our knowledge, this is the youngest patient reported with a quadriceps femoris muscle rupture. Case Presentation A 4-year-old girl admitted to our clinic with left knee pain and limitation in knee movements. Her father reported that she felt pain while jumping on sofa. There was no direct trauma to thigh or knee. We located a palpable soft tissue swelling at distal anterolateral side of thigh. The history revealed that 10 days ago the patient was treated for upper tract respiratory infection with intramuscular Clindamycin for 7 days. When we consulted the patient with her previous doctor and nurse, we learnt that multiple daily injections might be injected to same side of left thigh. MRI showed a partial tear of vastus lateralis muscle matching with the injection sites. The patient treated with long leg half-casting for three weeks. Clinical examination and knee flexion had good results with conservative treatment. Conclusions Multiple intramuscular injections may contribute to damage muscles and make prone to tears with muscle contractions. Doctors and nurses must be cautious to inject from different parts of both thighs.

  8. Proximal and distal muscle fatigue differentially affect movement coordination. (United States)

    Cowley, Jeffrey C; Gates, Deanna H


    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p fatigue caused small but significant changes in trunk angles (2°, p fatigue protocols (p fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks.

  9. Proximal and distal muscle fatigue differentially affect movement coordination (United States)

    Cowley, Jeffrey C.


    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p fatigue caused small but significant changes in trunk angles (2°, p fatigue protocols (p fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks. PMID:28235005

  10. Proximal and distal muscle fatigue differentially affect movement coordination


    Cowley, Jeffrey C.; Gates, Deanna H.


    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proxim...

  11. Proximal and distal muscle fatigue differentially affect movement coordination.

    Directory of Open Access Journals (Sweden)

    Jeffrey C Cowley

    Full Text Available Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor or distal (finger flexor muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p < 0.005 in trunk lean and velocity, reduced humeral elevation (11°, p < 0.005, and increased elbow flexion (4°, p < 0.01. In contrast, distal fatigue caused small but significant changes in trunk angles (2°, p < 0.05, increased velocity of wrench movement relative to the hand (17°/s, p < 0.001, and earlier wrist extension (4%, p < 0.005. Movement variability increased at proximal joints but not distal joints after both fatigue protocols (p < 0.05. Varying movements at proximal joints may help people adapt to fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks.

  12. Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament rupture. (United States)

    Konishi, Yu; Oda, Toshiaki; Tsukazaki, Satoshi; Kinugasa, Ryuta; Hirose, Norikazu; Fukubayashi, Toru


    The purpose of this study was to obtain evidence to support the hypothesis that motor unit recruitment is reduced in the quadriceps femoris (QF) of patients with ACL rupture. We compared muscle torque per unit volume in the QF from injured and uninjured sides to normal subjects. If high-threshold motor unit recruitment is reduced in patients with ACL rupture, this reduction will theoretically lead to a reduction in muscle torque per unit volume compared to the control group. The subjects included 22 patients with ACL rupture and 22 subjects with no history of knee injury. To identify the muscle torque per unit volume, the isokinetic peak torque was divided by QF volume which was obtained by MRI. Tests revealed that the mean muscle torque per unit volume of the uninjured and injured sides was significantly lower than those of the control group. This study demonstrated that the values of the muscle torque per unit volume of both injured and uninjured sides of patients with ACL rupture were significantly lower than those of the control group, thereby providing indirect evidence of the hindrance of motor unit recruitment in these patients. The results of the present study also indicate that there may be bilateral QF weakness in patients with ACL rupture. Since persistent QF weakness is a significant barrier to effective rehabilitation in patients with ACL injuries, a better understanding of the underlying mechanisms will allow clinicians and scientists to develop more effective therapeutic strategies for patient rehabilitation.

  13. [Arthroscopic refixation of acute proximal anterior cruciate ligament rupture using suture anchors]. (United States)

    Achtnich, A; Rosslenbroich, S; Beitzel, K; Imhoff, A B; Petersen, W


    Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL. Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0‑0-0°, then 0‑0-90° for the following 4 weeks. A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.

  14. Anterolateral papillary muscle rupture after intervention of the right coronary artery. (United States)

    Morris, Liam; Desai, Anand; Akkus, Nuri Ilker


    Rupture of the anterolateral papillary muscle following a right coronary artery occlusion is extremely rare, and when complicated by a right ventricular infarction, can be fatal. The literature on optimal management of this complication is limited. We present an unusual case of anterolateral papillary muscle rupture following intervention of the right coronary artery. Published by Elsevier España.

  15. Method to measure tone of axial and proximal muscle. (United States)

    Gurfinkel, Victor S; Cacciatore, Timothy W; Cordo, Paul J; Horak, Fay B


    The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the vertical axis during stance, so as to twist the neck, trunk or hip regions. This twisting imposes length changes on axial muscles without changing the body's relationship to gravity. Because Twister does not provide postural support, tone must be regulated to counteract gravitational torques. We quantify this tonic regulation by the restive torque to twisting, which reflects the state of all muscles undergoing length changes, as well as by electromyography of relevant muscles. Because tone is characterized by long-lasting low-level muscle activity, tonic control is studied with slow movements that produce "tonic" changes in muscle length, without evoking fast "phasic" responses. Twister can be reconfigured to study various aspects of muscle tone, such as co-contraction, tonic modulation to postural changes, tonic interactions across body segments, as well as perceptual thresholds to slow axial rotation. Twister can also be used to provide a quantitative measurement of the effects of disease on axial and proximal postural tone and assess the efficacy of intervention.

  16. Method to Measure Tone of Axial and Proximal Muscle (United States)

    Gurfinkel, Victor S.; Cacciatore, Timothy W.; Cordo, Paul J.; Horak, Fay B.


    The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs1, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the vertical axis during stance, so as to twist the neck, trunk or hip regions. This twisting imposes length changes on axial muscles without changing the body's relationship to gravity. Because Twister does not provide postural support, tone must be regulated to counteract gravitational torques. We quantify this tonic regulation by the restive torque to twisting, which reflects the state of all muscles undergoing length changes, as well as by electromyography of relevant muscles. Because tone is characterized by long-lasting low-level muscle activity, tonic control is studied with slow movements that produce "tonic" changes in muscle length, without evoking fast "phasic" responses. Twister can be reconfigured to study various aspects of muscle tone, such as co-contraction, tonic modulation to postural changes, tonic interactions across body segments, as well as perceptual thresholds to slow axial rotation. Twister can also be used to provide a quantitative measurement of the effects of disease on axial and proximal postural tone and assess the efficacy of intervention. PMID:22214974

  17. Muscle rupture after minimal trauma of the spastic muscle: three case reports of patients with spinal cord injury. (United States)

    Carpentier, T J D; Kiekens, C; Peers, K H E


    Retrospective study of three cases. To report three cases of muscle rupture caused by minimal trauma in spinal cord injury (SCI) patients with severe spasticity and a literature review of the underlying mechanisms. Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Belgium Retrospective study of three cases of muscle ruptures in SCI patients with severe spasticity. All muscle lesions were diagnosed by ultrasound. Literature review (Pubmed) was performed to identify extrinsic and intrinsic risk factors. According to the literature and our clinical findings, several structural and mechanical alterations of the spastic muscle in combination with specific stretching during therapy or a transfer can cause a muscle rupture after minimal trauma. To the authors' knowledge, this is the first report of muscle rupture due to spasticity in SCI patients. Altered mechanical properties of the spastic muscle in combination with extreme stretching may cause partial or complete ruptur. Although this is a rare complication of spasticity, medical staff and therapists should be aware of the risk factors in order to prevent and quickly identify muscle lesions.

  18. Blunt traumatic aortic rupture of the proximal ascending aorta repaired by resection and direct anastomosis. (United States)

    Harmouche, Majid; Slimani, Eric Karim; Heraudeau, Adeline; Verhoye, Jean-Philippe


    Traumatic aortic injury represents 15% of motor vehicle related deaths with death occurring at the scene in 85% of the cases. Aortic disruptions usually occur at the isthmus in a transverse fashion with all three of the aortic layers being involved. Herein, we report the case of a 68-year old man with no prior medical history who was struck by a vehicle while riding his bicycle. The ruptured segment of aorta was resected circumferentially and interrupted horizontal mattress pledgeted prolene sutures were used to ensure full thickness aortic integrity of the proximal and distal aortic segments. The aorta was closed with a single-layer technique using 4/0 prolene suture. There were no postoperative complications and patient was discharged on Day 44. The case here discussed demonstrates a rare presentation of blunt aortic injury. The proximal ascending aorta is an unusual site of transection following blunt trauma with few reports in the literature. We were able to repair the aorta with direct suture, thus avoiding the use of artificial material.

  19. Comparison of the proximal tibial angles between Labrador Retrievers and other dog breeds with and without cranial cruciate ligament rupture

    Directory of Open Access Journals (Sweden)

    A. F. D. P. Arruda


    Full Text Available ABSTRACTThe influence of the proximal tibia conformation in the rupture of the cranial cruciate ligament (CCL in dogs is still controversial, especially in Labrador Retrievers. The aim of this study was to compare the angles of the proximal tibia between Labrador Retrievers and other large breeds of dogs, both groups with and without CCL rupture. Radiographic images of 64 stifle joints were obtained and divided into four groups of 16 images. Group 1 consisted of Labrador dogs without orthopedic disorders, group 2 consisted of Labrador dogs with CCL rupture, group 3 consisted of dogs of various large breeds without orthopedic disorders, and group 4 consisted of dogs of various large breeds with CCL rupture. The radiographs were performed in mediolateral projection with the stifle joint positioned at an approximate angle of 135°. The tibial plateau angle showed an overall average of 22.17°±4.20°, and there was no statistically significant difference between the groups. The patellar ligament angle in relation to the tibial plateau had a mean of 103°±4.20°, and there was a significant difference between groups 1 and 4. The patellar ligament angle in relation to the common tangent at the tibiofemoral contact point showed an average of 99.06°±6.08°, and there was no difference between the groups. The patellar ligament insertion angle had an overall average of 51.45°±5.06°, and there was a significant difference between the two groups of normal dogs and two groups of ruptured dogs. In conclusion, the tibial plateau angle, the patellar ligament angles and the patellar ligament insertion angle do not seem to be predisposing factors for rupture of the CCL in Labrador Retriever dogs. In general, there seems to be no relationship between the angles of the proximal tibia and the CCL rupture in dogs.

  20. Influence of muscle groups' activation on proximal femoral growth tendency. (United States)

    Yadav, Priti; Shefelbine, Sandra J; Pontén, Eva; Gutierrez-Farewik, Elena M


    Muscle and joint contact force influence stresses at the proximal growth plate of the femur and thus bone growth, affecting the neck shaft angle (NSA) and femoral anteversion (FA). This study aims to illustrate how different muscle groups' activation during gait affects NSA and FA development in able-bodied children. Subject-specific femur models were developed for three able-bodied children (ages 6, 7, and 11 years) using magnetic resonance images. Contributions of different muscle groups-hip flexors, hip extensors, hip adductors, hip abductors, and knee extensors-to overall hip contact force were computed. Specific growth rate for the growth plate was computed, and the growth was simulated in the principal stress direction at each element in the growth front. The predicted growth indicated decreased NSA and FA (of about [Formula: see text] over a four-month period) for able-bodied children. Hip abductors contributed the most, and hip adductors, the least, to growth rate. All muscles groups contributed to a decrease in predicted NSA ([Formula: see text]0.01[Formula: see text]-0.04[Formula: see text] and FA ([Formula: see text]0.004[Formula: see text]-[Formula: see text]), except hip extensors and hip adductors, which showed a tendency to increase the FA ([Formula: see text]0.004[Formula: see text]-[Formula: see text]). Understanding influences of different muscle groups on long bone growth tendency can help in treatment planning for growing children with affected gait.

  1. Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex. (United States)

    El Shewy, Mohamed Taha; El Barbary, Hassan Magdy; Abdel-Ghani, Hisham


    Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible. In this study, 2 intratendinous distally based flaps fashioned from the proximal gastrocnemiussoleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible. Case series; Level of evidence, 4. Eleven patients (9 male and 2 female) with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemiussoleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump. The patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system. This technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.

  2. Exact moment of tendon of pectoralis major muscle rupture captured on video. (United States)

    de Castro Pochini, Alberto; Pochini, Alberto Castro; Ejnisman, Benno; Andreoli, Carlos Vicente; Monteiro, Gustavo Cara; Fleury, Anna Maria; Faloppa, Flavio; Cohen, Moises; Albertoni, Walter Manna


    A powerlifting athlete ruptured his left tendon of the pectoralis major muscle while attempting to lift 160 kg in a Brazilian bench press championship. The injury seemed to occur in the concentric phase of exercise; however, the more common mechanism of rupture is during the eccentric phase. The tendon was reinserted to the humerus 3 weeks later with screws and washers. The athlete returned to competitive activities after 5 months. One year later he lifted 170 kg and won the national championship.

  3. Acute Compartment Syndrome after Non-Contact Peroneus Longus Muscle Rupture. (United States)

    Merriman, Jarrad; Villacis, Diego; Kephart, Curtis; Yi, Anthony; Romano, Russ; Hatch, George F Rick


    This case demonstrates a rare variation in the pattern of injury and the presentation of acute lateral compartment syndrome of the leg. Although uncommon, lateral compartment syndrome of the leg after an ankle inversion leading to peroneus longus muscle rupture has been previously documented. This case was unusual because there was no overt ankle injury and the patient was able to continue physical activity, in spite of a significant rupture of the peroneus longus muscle that was determined later. This case highlights the necessary vigilance clinicians must maintain when assessing non-contact injuries in patients with possible compartment syndrome.

  4. Determination of muscle effort at the proximal femur rotation osteotomy (United States)

    Sachenkov, O.; Hasanov, R.; Andreev, P.; Konoplev, Yu


    The paper formulates the problem of biomechanics of a new method for treatment of Legg-Calve-Perthes disease. Numerical calculations of the rotational flexion osteotomy have been carried out for a constructed mathematical model of the hip joint, taking into account the main set of muscles. The work presents the results of the calculations and their analysis. The results have been compared with the clinical data. The calculations of the reactive forces arising in the acetabulum and the proximal part of the femur allowed us to reveal that this reactive force changes both in value and direction. These data may be useful for assessing the stiffness of an external fixation device used in orthopedic intervention and for evaluating the compression in the joint.

  5. Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

    Directory of Open Access Journals (Sweden)

    Anna Maria Fleury


    Full Text Available INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically. Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20% for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively. The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%. CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

  6. Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration

    Energy Technology Data Exchange (ETDEWEB)

    Jinkins, Randy J. [Neuroimaging Research, Department of Radiologic Sciences, Medical College of Pennsylvania-Hahnemann, Drexel University, 245 North 15th Street-Mail Stop 206, Philadelphia, PA 19102-1192 (United States)


    The objective of this study was to demonstrate lumbosacral interspinous ligament rupture, with or without related acute intrinsic spinal muscle degeneration. This study consisted of a prospective imaging analysis of consecutive 100 MRI studies in adult patients (mean age 56 years) presenting with low back pain. Alterations from the normal in the inter- and perispinal structures of the spine and perispinal soft tissues (e.g., spinal ligaments, perispinal muscles) were sought based upon studies on young volunteers without low back pain (n=10; mean age 23 years). Compared with the group without low back pain, many index cases (n=71, 71%) demonstrated hyperintensity (i.e., sprain or frank ligamentous rupture) of the interspinous ligament(s) on T2-weighted, fat-suppressed MRI studies at one (20 of 71, 28%) or multiple (51 of 71, 72%) levels. Associated intrinsic spinal muscle (e.g., interspinalis, multifidus muscles) degeneration was observed in a minority of cases overall (n=7, 7%), but was only seen in association with cases also demonstrating interspinous ligament degeneration/rupture (7 of 71, 10%). Lumbosacral interspinous ligament sprain or frank rupture, as well as related acute-subacute autotraumatic intrinsic spinal muscle rupture/degeneration, may be overlooked by many observers if fat-suppressed, T2-weighted MRI is not acquired. These musculoligamentous alterations are on occasion the only abnormalities recognized on MRI of the lumbosacral spine and may theoretically be sources of low back morbidity that potentially may respond to specific therapy. Because this study was an observational one, based solely upon medical imaging, future research must focus upon the correlation of the relevance of these findings with an age-matched asymptomatic control group and longitudinal clinicoradiologic therapeutic trials. (orig.)

  7. Sequential bilateral complete rupture of the rectus femoris muscle in a patient with hereditary spastic paraplegia. (United States)

    Raes, Lize; Draulans, Nathalie; Van Campenhout, Anja; Ortibus, Els; Peers, Koen; Kiekens, Carlotte


    This case raises questions about the pathophysiology of muscle ruptures in highly functional patients with hereditary spastic paraplegia (HSP) who have only minor spasticity and no significant muscle shortening. Literature on the skeletal muscle changes secondary to spasticity or to the underlying disease, HSP, has been explored and compared with this clinical case. Two theoretical hypotheses are discussed. Firstly, chronic spasticity might be a risk factor for histopathological muscle alterations. Secondly, altered protein synthesis due to the underlying genetic mutation may play a role in the mechanical integrity of muscle tissue. This is the first case report of a sequential bilateral complete disruption of the rectus femoris muscle after minimal trauma, in a 55 year old man with HSP. Pain was the main complaint, without significant increase in spasticity. Walking ability was not significantly impaired. Conservative treatment resulted in resolution of the complaints. This unique case of a bilateral complete rectus femoris muscle rupture after minimal trauma in a patient with HSP presenting with minor spasticity raises questions on the pathophysiology of the skeletal muscle changes in HSP patients and more generally in spastic patients.

  8. Rupture

    CERN Multimedia

    Association du personnel


    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...

  9. 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

  10. The Difficult Diagnosis of Ischaemic Papillary Muscle Rupture; Case report from an urban emergency department

    Directory of Open Access Journals (Sweden)

    Christian T. Braun


    Full Text Available We present a rare case of severe ischaemic papillary muscle rupture in a 67-year-old male patient who was admitted to the Emergency Department of the University Hospital Bern, Switzerland, in November 2013 with acute chest pain. On admission, the patient’s blood pressure was 60/40 mm/Hg, his pulse was 110 beats per minute and his respiratory rate was 20 breaths per minute. An electrocardiogram was normal and focused assessment with sonography in trauma was negative. Transthoracic echocardiography showed possible thickening of the mitral valve leaflet with no indications of severe mitral insufficiency or wall motion abnormalities. Triple-ruleout computed tomography angiography revealed no pulmonary emboli or aortic dissection, although coronary atherosclerosis was present. Finally, severe insufficiency of the mitral valve with rupture of the papillary muscle, likely due to ischaemia, was observed via transoesophageal echocardiography. The patient underwent a successful surgical intervention and was discharged 10 days later in stable condition.

  11. 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.

  12. Rupture of the Gastrocnemius Muscle in Neonatal Thoroughbred Foals: A Report of Three Cases (United States)

    SATO, Fumio; SHIBATA, Ryo; SHIKICHI, Mitsumori; ITO, Katsumi; MURASE, Harutaka; UENO, Takanori; FURUOKA, Hidehumi; YAMADA, Kazutaka


    ABSTRACT Rupture of the gastrocnemius muscle is occasionally found in neonatal foals associated with dystocia and assisted delivery. In this report, 3 cases of gastrocnemius muscle disruption in newborn Thoroughbred foals (6, 5 and 2 days old) are reported. In all cases, the foals were presented with inability to rise unassisted postpartum, a dropped tarsus and swelling in the caudal aspect of the thigh accompanied by a hematoma. Ultrasonography, radiography, computerized tomography (CT) and subsequent autopsy were performed to confirm the clinical and pathological features of these cases. PMID:25320553

  13. Isokinetic strength and endurance in proximal and distal muscles in patients with peripheral artery disease. (United States)

    Câmara, Lucas Caseri; Ritti-Dias, Raphael Mendes; Menêses, Annelise Lins; D'Andréa Greve, Júlia Maria; Filho, Wilson Jacob; Santarém, José Maria; Forjaz, Cláudia Lúcia de Moraes; Puech-Leão, Pedro; Wolosker, Nelson


    The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements (P strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  14. Age factor and proximate compositions of the muscle of ...

    African Journals Online (AJOL)

    Signiicant decreases (P < 005) in the EE content of the fish muscle could be attributed to the harmful effects of petroleum-relatedaromatic compound (ACs) on animals. These ACs might have caused decreases in the muscle triglycerides of the total lipid (EE) content of thethree age groups of the fish. Significant increases (P ...

  15. Calf Muscle Performance Deficits Remain 7 Years After an Achilles Tendon Rupture. (United States)

    Brorsson, Annelie; Grävare Silbernagel, Karin; Olsson, Nicklas; Nilsson Helander, Katarina


    Optimizing calf muscle performance seems to play an important role in minimizing impairments and symptoms after an Achilles tendon rupture (ATR). The literature lacks long-term follow-up studies after ATR that describe calf muscle performance over time. The primary aim was to evaluate calf muscle performance and patient-reported outcomes at a mean of 7 years after ATR in patients included in a prospective, randomized controlled trial. A secondary aim was to evaluate whether improvement in calf muscle performance continued after the 2-year follow-up. Cohort study; Level of evidence, 2. Sixty-six subjects (13 women, 53 men) with a mean age of 50 years (SD, 8.5 years) were evaluated at a mean of 7 years (SD, 1 year) years after their ATR. Thirty-four subjects had surgical treatment and 32 had nonsurgical treatment. Patient-reported outcomes were evaluated with Achilles tendon Total Rupture Score (ATRS) and Physical Activity Scale (PAS). Calf muscle performance was evaluated with single-leg standing heel-rise test, concentric strength power heel-rise test, and single-legged hop for distance. Limb Symmetry Index (LSI = injured side/healthy side × 100) was calculated for side-to-side differences. Seven years after ATR, the injured side showed decreased values in all calf muscle performance tests ( P performance did not continue after the 2-year follow-up. Heel-rise height increased significantly ( P = .002) between the 1-year (10.8 cm) and the 7-year (11.5 cm) follow-up assessments. The median ATRS was 96 (of a possible score of 100) and the median PAS was 4 (of a possible score of 6), indicating minor patient-reported symptoms and fairly high physical activity. No significant differences were found in calf muscle performance or patient-reported outcomes between the treatment groups except for the LSI for heel-rise repetitions. Continued deficits in calf muscle endurance and strength remained 7 years after ATR. No continued improvement in calf muscle performance

  16. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

    Directory of Open Access Journals (Sweden)

    Ilić Radoje


    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  17. A novel MYH7 mutation with prominent paraspinal and proximal muscle involvement. (United States)

    Park, Jin-Mo; Kim, Ye Jin; Yoo, Jeong Hyun; Hong, Young Bin; Park, Ji Hoon; Koo, Heasoo; Chung, Ki Wha; Choi, Byung-Ok


    Laing distal myopathy (LDM) is caused by mutations in the MYH7 gene, and known to have muscle weakness of distal limbs and neck flexors. Through whole exome sequencing, we identified a novel p.Ala1439Pro MYH7 mutation in a Korean LDM family. This missense mutation is located in more N-terminal than any reported rod domain LDM mutations. In the early stage of disease, the present patients showed similar clinical patterns to the previously described patients of LDM. However, in the later stage, fatty replacement and atrophy of paraspinal or proximal leg muscles was more severely marked than lower leg muscles, and asymmetric atrophies were observed in trapezius, subscapularis and adductor magnus muscles. Distal myopathy like LDM showed marked and predominant fatty infiltrations in paraspinal or proximal leg muscles with marked asymmetry. These observations expand the clinical spectrum of LDM with the MYH7 mutation. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Fatigue-related firing of distal muscle nociceptors reduces voluntary activation of proximal muscles of the same limb. (United States)

    Kennedy, David S; McNeil, Chris J; Gandevia, Simon C; Taylor, Janet L


    With fatiguing exercise, firing of group III/IV muscle afferents reduces voluntary activation and force of the exercised muscles. These afferents can also act across agonist/antagonist pairs, reducing voluntary activation and force in nonfatigued muscles. We hypothesized that maintained firing of group III/IV muscle afferents after a fatiguing adductor pollicis (AP) contraction would decrease voluntary activation and force of AP and ipsilateral elbow flexors. In two experiments (n = 10) we examined voluntary activation of AP and elbow flexors by measuring changes in superimposed twitches evoked by ulnar nerve stimulation and transcranial magnetic stimulation of the motor cortex, respectively. Inflation of a sphygmomanometer cuff after a 2-min AP maximal voluntary contraction (MVC) blocked circulation of the hand for 2 min and maintained firing of group III/IV muscle afferents. After a 2-min AP MVC, maximal AP voluntary activation was lower with than without ischemia (56.2 ± 17.7% vs. 76.3 ± 14.6%; mean ± SD; P muscle afferents from the hand decreased voluntary drive and force of AP. Moreover, this effect decreased voluntary drive and torque of proximal unfatigued muscles, the elbow flexors. Fatigue-sensitive group III/IV muscle nociceptors act to limit voluntary drive not only to fatigued muscles but also to unfatigued muscles within the same limb.

  19. An anatomical and histological study of the structures surrounding the proximal attachment of the hamstring muscles. (United States)

    Pérez-Bellmunt, Albert; Miguel-Pérez, Maribel; Brugué, Marc Blasi; Cabús, Juan Blasi; Casals, Martí; Martinoli, Carlo; Kuisma, Raija


    The proximal attachment of hamstring muscles has a very high incidence of injuries due to a wide number of factors and its morphology may be one of the underlying factors as scientific literature points out. The connective tissue component of the attachment of hamstring muscles is not well known. For this reason the aim of this study is to describe the anatomy and histology surrounding the proximal attachment of the hamstring muscles (PAHM) and its direct anatomic relations. Forty-eight cryopreserved lower limbs have sequentially been studied by means of dissection, anatomical sections and histology. All specimens studied presented an annular connective tissue structure that resembles a retinaculum, which covers and adapts to the attachment of hamstring muscles on the ischial tuberosity. The results show how this retinaculum is continuous with the long head of biceps femoris muscle, however there is a layer of loose connective tissue between the retinaculum and the semitendinosus muscle. Furthermore, this structure receives expansions of the anterior epimysium of the gluteus maximus muscle (GIM). Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Concomitant Contracture of the Knee and Ankle Joint After Gastrocnemius Muscle Rupture: A Case Report. (United States)

    Ryu, Dong Jin; Kim, Joon Mee; Kim, Bom Soo

    Injury of the medial head of the gastrocnemius, also called "tennis leg," is known to heal uneventfully in most cases with compression and immobilization therapy. Failure to heal or long-term complications, including ongoing pain and pes equinus, have been documented in only a limited number of case reports. To the best of our knowledge, a severe concomitant contracture of the knee and ankle joint as a consequence of a maltreated gastrocnemius muscle rupture has not been previously reported in English-language reports. The purpose of the present study was to report a serious complication of neglected tennis leg with a review of the published data. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture

    NARCIS (Netherlands)

    Bouma, Wobbe; Hamer, Inez J. Wijdh-den; Koene, Bart M.; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E.; van der Horst, Iwan C. C.; Gorman, Joseph H.; Gorman, Robert C.; Mariani, Massimo A.


    Background: Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear

  2. [Isolated rupture of the distal tendon of the biceps femoris muscle in a sport climber: an uncommon injury]. (United States)

    Geronikolakis, S; Best, R


    An isolated rupture of the distal tendon of the biceps femoris muscle without a direct trauma is an extremely rare injury. To date only a few case reports have been described in the literature. For sport climbers such an injury has never been described before. We report about a 41-year-old male sport climber complaining of such an injury after indoor rock-climbing. Unlike the previously described reports, the rupture occured during a phase of maximum static tension, without acceleration or movement of the knee joint. History and clinical characteristics, sonography and magnetic resonance imaging confirm the diagnosis and should always be performed to exclude other injuries. Early operative treatment with anatomic refixation of the ruptured tendon is necessary to restore function, although there are differences in the type of postoperative treatment. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Ruptures of the pectoralis major muscle and it’s tendon: review of the literature and our experience in the treatment

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky


    Full Text Available Tendon ruptures of the pectoralis major muscle are considered a rare type of injury, but there is a tendency for a greater frequency of occurrence in such cases, which is associated with an increased interest in sport and fitness among the population. Despite the seeming simplicity of diagnosis, many complete ruptures remain unrecognized and many patients do not seek medical help or being treated for bruises, sprains and partial damage, although in fact there a complete ruptures of the pectoralis major muscle or it’s tendon. Currently there is no consensus on diagnostic tactics, surgical approach, the optimal method of fixation, indications for use of plastic material; disputable tactics of chronic ruptures and rehabilitation program in the treatment of tendon ruptures of the pectoralis major muscle.

  4. Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal

    Directory of Open Access Journals (Sweden)

    Jörn Kircher


    Full Text Available Jörn Kircher, Christoph Ziskoven, Thilo Patzer, Daniela Zaps, Bernd Bittersohl, Rüdiger KrauspeUniversity Hospital, Orthopaedic Department, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyAbstract: The complete rupture of the pectoralis major tendon is an uncommon injury but has become increasingly common among athletes in recent years. This may be due to a higher number of individuals taking part in high-impact sports and weightlifting as well as the use of anabolic substances, which can make muscles and tendons vulnerable to injury. In recent literature, there are only few recommendations to rely on conservative treatment alone, but there are a number of reports and case series recommending early surgical intervention. Comparing the results of the two treatment regimens, there is clear evidence for a superior outcome after surgical repair with better cosmesis, better functional results, regaining of muscle power, and return to sports compared with the conservative treatment. In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes.Keywords: pectoralis major, rupture, athlete, conservative treatment, surgical treatment, steroid, tendon, sports injury

  5. A pseudotumoral lesion diagnosed for a hypertrofic fibrosis at the proximal stump in anterior tibialis tendon missed rupture: a case report. (United States)

    Samaila, Elena M; Luiso, Filippo; Trivellin, Giacomo; Brunelli, Matteo; Magnan, Bruno


    The Anterior Tibialis is the most important muscle in ankle dorsiflexion. The anterior tibialis tendon (ATT)'s rupture is an infrequent condition which can be both traumatic and spontaneous. Clinic is poor and it is necessary to confirm the suspect by US or MRI. The reported case refers to a 40 years old man who had a direct trauma at ankle and midfoot which was originally conservatively treated for an ankle sprain. Three months later he returned with pain, swelling and paresthesia. MRI was performed showing a neoformation in the contest of ATT's rupture. The patient underwent open excisional biopsy which was diagnostic for hypertrofic fibrosis. After two weeks, the symptoms were completely decreased and patient didn't want to undergo surgery for tendon reconstruction because he had no limitation in daily activity life.

  6. Selective effects of arm proximal and distal muscles fatigue on force coordination in manipulation tasks. (United States)

    Emge, Nicholas; Uygur, Mehmet; Radivoj, Mandic; Kaminski, Thomas W; Royer, Todd; Jaric, Slobodan


    Effects of muscle fatigue on force coordination and task performance of various manipulation tasks are explored. Grip force (GF; normal force component acting at the digits-object contact area) and load force (LF; tangential component that lifts and holds objects) were recorded prior to and after fatiguing the distal (DAM; i.e., GF producing) and proximal arm muscles (PAM; LF producing). Results reveal a deterioration of GF scaling (i.e., averaged GF-LF ratio), GF-LF coupling (their correlation), and task performance (ability to exert a prescribed LF pattern) associated with DAM, but not PAM fatigue. Deteriorated force coordination clearly increases the likelihood of dropping an object; however, the observed selective effects of DAM and PAM fatigue represent a novel finding deserving of further research.

  7. Muscle-tendon glucose uptake in Achilles tendon rupture and tendinopathy before and after eccentric rehabilitation: Comparative case reports. (United States)

    Masood, Tahir; Kalliokoski, Kari; Bojsen-Møller, Jens; Finni, Taija


    Achilles tendon rupture (ATR) is the most common tendon rupture injury. The consequences of ATR on metabolic activity of the Achilles tendon and ankle plantarflexors are unknown. Furthermore, the effects of eccentric rehabilitation on metabolic activity patterns of Achilles tendon and ankle plantarflexors in ATR patients have not been reported thus far. We present a case study demonstrating glucose uptake (GU) in the Achilles tendon, the triceps surae, and the flexor hallucis longus of a post-surgical ATR patient before and after a 5-month eccentric rehabilitation. At baseline, three months post-surgery, all muscles and Achilles tendon displayed much higher GU in the ATR patient compared to a healthy individual despite lower plantarflexion force. After the rehabilitation, plantarflexion force increased in the operated leg while muscle GU was considerably reduced. The triceps surae muscles showed similar values to the healthy control. When compared to the healthy or a matched patient with Achilles tendon pain after 12 weeks of rehabilitation, Achilles tendon GU levels of ATR patient remained greater after the rehabilitation. Past studies have shown a shift in the metabolic fuel utilization towards glycolysis due to immobilization. Further research, combined with immuno-histological investigation, is needed to fully understand the mechanism behind excessive glucose uptake in ATR cases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Proactive Selective Inhibition Targeted at the Neck Muscles: This Proximal Constraint Facilitates Learning and Regulates Global Control. (United States)

    Loram, Ian D; Bate, Brian; Harding, Pete; Cunningham, Ryan; Loram, Alison


    While individual muscle function is known, the sensory and motor value of muscles within the whole-body sensorimotor network is complicated. Specifically, the relationship between neck muscle action and distal muscle synergies is unknown. This work demonstrates a causal relationship between regulation of the neck muscles and global motor control. Studying violinists performing unskilled and skilled manual tasks, we provided ultrasound feedback of the neck muscles with instruction to minimize neck muscle change during task performance and observed the indirect effect on whole-body movement. Analysis of ultrasound, kinematic, electromyographic and electrodermal recordings showed that proactive inhibition targeted at neck muscles had an indirect global effect reducing the cost of movement, reducing complex involuntary, task-irrelevant movement patterns and improving balance. This effect was distinct from the effect of gaze alignment which increased physiological cost and reduced laboratory-referenced movement. Neck muscle inhibition imposes a proximal constraint on the global motor plan, forcing a change in highly automated sensorimotor control. The proximal location ensures global influence. The criterion, inhibition of unnecessary action, ensures reduced cost while facilitating task-relevant variation. This mechanism regulates global motor function and facilitates reinforcement learning to change engrained, maladapted sensorimotor control associated with chronic pain, injury and performance limitation.

  9. 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

  10. Rupture of the Distal Biceps Tendon Combined with a Supinator Muscle Tear in a 51-Year-Old Woman: A Case Report

    Directory of Open Access Journals (Sweden)

    Samir Nayyar


    Full Text Available Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique.

  11. Stimulus-response characteristics of motor evoked potentials and silent periods in proximal and distal upper-extremity muscles.

    NARCIS (Netherlands)

    Kuijk, A.A. van; Anker, L.C.; Pasman, J.W.; Hendriks, J.C.M.; Elswijk, G.A.F. van; Geurts, A.C.H.


    OBJECTIVE: To compare stimulus-response characteristics of both motor evoked potentials (MEP) and silent periods (SP) induced by transcranial magnetic stimulation (TMS) in proximal and distal upper-extremity muscles. METHODS: Stimulus-response curves of MEPs and SPs were obtained from the biceps

  12. [A case of rupture of the left ventricle free wall with papillary muscle dysfunction following acute myocardial infarction, operated on successfully]. (United States)

    de Lima, R; Perdigão, C; Neves, L; Cravino, J; Dantas, M; Bordalo, A; Pais, F; Diogo, A N; Ferreira, R; Ribeiro, C


    The authors present a case of left ventricular free wall rupture post acute myocardial infarction, associated with mitral papillary posterior muscle necrosis, operated by infartectomy and mitral valvular protesis replacement. They refer the various complications occurred during the hospital staying, and discuss its medical and surgical approach. The patient was discharged alive and six months after the infarction keeps a moderate activity.

  13. Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture: Long-Term Follow-up of Patients in a Previous Study. (United States)

    Heikkinen, Juuso; Lantto, Iikka; Piilonen, Juuso; Flinkkilä, Tapio; Ohtonen, Pasi; Siira, Pertti; Laine, Vesa; Niinimäki, Jaakko; Pajala, Ari; Leppilahti, Juhana


    In this prospective study, we used magnetic resonance imaging (MRI) to assess long-term Achilles tendon length, calf muscle volume, and muscle fatty degeneration after surgery for acute Achilles tendon rupture. From 1998 to 2001, 60 patients at our center underwent surgery for acute Achilles tendon rupture followed by early functional postoperative rehabilitation. Fifty-five patients were reexamined after a minimum duration of follow-up of 13 years (mean, 14 years), and 52 of them were included in the present study. Outcome measures included Achilles tendon length, calf muscle volume, and fatty degeneration measured with MRI of both the affected and the uninjured leg. The isokinetic plantar flexion strength of both calves was measured and was correlated with the structural findings. The Achilles tendon was, on average, 12 mm (95% confidence interval [CI] = 8.6 to 15.6 mm; p Achilles tendon length correlated substantially with the strength deficit (ρ = 0.51, p Achilles tendon length is associated with smaller calf muscle volumes and persistent plantar flexion strength deficits after surgical repair of Achilles tendon rupture. Strength deficits and muscle volume deficits are partly compensated for by FHL hypertrophy, but 11% to 13% deficits in soleus and gastrocnemius muscle volumes and 12% to 18% deficits in plantar flexion strength persist even after long-term follow-up. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  14. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN) (United States)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  15. Reconstitution of the complete rupture in musculotendinous junction using skeletal muscle-derived multipotent stem cell sheet-pellets as a “bio-bond”

    Directory of Open Access Journals (Sweden)

    Hiroyuki Hashimoto


    Full Text Available Background. Significant and/or complete rupture in the musculotendinous junction (MTJ is a challenging lesion to treat because of the lack of reliable suture methods. Skeletal muscle-derived multipotent stem cell (Sk-MSC sheet-pellets, which are able to reconstitute peripheral nerve and muscular/vascular tissues with robust connective tissue networks, have been applied as a “bio-bond”. Methods. Sk-MSC sheet-pellets, derived from GFP transgenic-mice after 7 days of expansion culture, were detached with EDTA to maintain cell–cell connections. A completely ruptured MTJ model was prepared in the right tibialis anterior (TA of the recipient mice, and was covered with sheet-pellets. The left side was preserved as a contralateral control. The control group received the same amount of the cell-free medium. The sheet-pellet transplantation (SP group was further divided into two groups; as the short term (4–8 weeks and long term (14–18 weeks recovery group. At each time point after transplantation, tetanic tension output was measured through the electrical stimulation of the sciatic nerve. The behavior of engrafted GFP+ tissues and cells was analyzed by fluorescence immunohistochemistry. Results. The SP short term recovery group showed average 64% recovery of muscle mass, and 36% recovery of tetanic tension output relative to the contralateral side. Then, the SP long term recovery group showed increased recovery of average muscle mass (77% and tetanic tension output (49%. However, the control group showed no recovery of continuity between muscle and tendon, and demonstrated increased muscle atrophy, with coalescence to the tibia during 4–8 weeks after operation. Histological evidence also supported the above functional recovery of SP group. Engrafted Sk-MSCs primarily formed the connective tissues and muscle fibers, including nerve-vascular networks, and bridged the ruptured tendon–muscle fiber units, with differentiation into skeletal

  16. 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 ...

  17. Complete rupture of the long head of the biceps tendon and the ...

    African Journals Online (AJOL)

    The most common injury to the biceps muscle is rupture of the long head of the biceps tendon. A tear can occur proximally, distally or at the musculotendinous junction. Two cases are discussed, in both of which the patients felt a sudden sharp pain in the upper arm, at the shoulder and elbow respectively, and presented ...

  18. Prevalence of adult Pompe disease in patients with proximal myopathic syndrome and undiagnosed muscle biopsy. (United States)

    Golsari, Amir; Nasimzadah, Arzoo; Thomalla, Götz; Keller, Sarah; Gerloff, Christian; Magnus, Tim


    We examined patients with limb-girdle muscle weakness and/or hyper-CKaemia and undiagnosed muscle biopsy for late onset Pompe disease (LOPD). Patients with an inconclusive limb-girdle muscle weakness who presented at our neuromuscular centre between 2005 and 2015 with undiagnosed muscle biopsies were examined by dry blood spot testing (DBS) including determination of the enzyme activity of acid alpha-glucosidase (GAA). In the case of depressed enzyme activity, additional gene testing of the GAA gene was carried out. Of the 340 evaluated muscle biopsies, 69 patients fulfilled the inclusion criteria and were examined with DBS. Among those patients, 76% showed a limb-girdle muscle weakness and 14% showed a hyper-CKaemia. A diagnosis of LOPD could be established in the case of two patients (2.9%) with reduced GAA enzyme activity and proof of mutations in the GAA gene. One of the two patients presents in the muscle biopsy suggestive features of Pompe disease including vacuoles with positive acid phosphatase reaction. In summary, our results show that a muscle biopsy can be helpful in identifying LOPD patients, but vacuolation with glycogen storage can also be absent. An inconspicuous muscle biopsy does not rule out Pompe disease. Consequently, all patients with limb-girdle muscle weakness should be examined by DBS before conducting a muscle biopsy. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. A Rare Case of Quadratus Femoris Muscle Rupture After Yoga Exercises. (United States)

    Tzaveas, Alexandros; Anastasopoulos, Nikolaos; Paraskevas, George; Natsis, Konstantinos


    We present a case of a female patient with left groin pain after intense yoga exercises. The patient presented abnormal pattern of gait with no swelling over the groin, thigh, or buttock. Magnetic resonance imaging demonstrated a tear of the quadratus femoris muscle with an associated extensive hematoma formation. Patient was treated with a rehabilitation program consisting of nonsteroidal anti-inflammatory drugs and physiotherapy. At the follow-up control, the patient had improved her pain and flexibility of the hip, and gradually she returned to daily activities and yoga exercises. Such an entity is a rare cause of hip pain after exercise and should be kept in mind by the orthopedic surgeon, in cases of gluteal pain after intense physical activity. Moreover, such a condition should be included in the diagnostic algorithm of unknown origin hip pain.

  20. Latissimus dorsi fine needle muscle biopsy: a novel and efficient approach to study proximal muscles of upper limbs. (United States)

    Paoli, Antonio; Pacelli, Quirico F; Toniolo, Luana; Miotti, Danilo; Reggiani, Carlo


    The muscle biopsy based on the Bergström needle has been widely used for more than 40 y for diagnosis and experimental studies on muscle. More recently, thinner needles and tru-cut needles have also been introduced. Such techniques have been largely tested on various muscles, including the quadriceps, with few studies on upper limb muscles like deltoid, and no studies on latissimus dorsi muscle (LDM). In this study, we implemented and validated a protocol to collect samples of LDM for experimental purposes, causing minimal discomfort to volunteers. Two main problems were considered: the anatomical localization of the biopsy site and the selection of an appropriate needle. A strict protocol of palpatory anatomy was adopted and validated with ultrasonography to localize the biopsy site in LDM in subjects with various degrees of muscle development. A 14 gauge tru-cut needle was selected as the smallest and still effective device for sampling. Biopsy sampling was performed in 18 subjects without any complications, or complains of pain or functional limitations. Approximately 4 mg of tissue were recovered from each introduction of the inner notched cannula of the needle. With three consecutive samplings, an amount of tissue sufficient to prepare proteins for gel electrophoresis and Western blot and to dissect single fiber segment for functional experiments, was obtained. Taken together, the results suggest that this biopsy technique opens to experimental studies muscles until now never considered accessible. Copyright © 2010 Elsevier Inc. All rights reserved.

  1. Complete semimembranosus rupture following therapeutic stretching after a traumatic brain injury. (United States)

    Chua, S G Karen; Kong, K H


    Acute hamstring rupture is an uncommon event often occurring during high impact sports. Such events have not been previously reported during neurological rehabilitation. This case report describes a 30 year-old Chinese male presenting in a minimally responsive state 5 years after a severe traumatic brain injury. He was tetraplegic and bed-bound with spasticity involving all four limbs and flexion contracture of the right knee. During an episode of inpatient rehabilitation, he developed acute swelling and bruising of the posterior proximal thigh region associated with fever, tachycardia and diaphoresis. MRI showed a large soft tissue rim-enhancing mass in the right proximal hamstring muscle. During surgical exploration, complete rupture of the right semi-membranosus muscle was found without evidence of pus. The possible causative factors of hamstring rupture in this subject and a brief literature review are discussed. To the authors' knowledge, this is the first such reported case.

  2. Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle

    DEFF Research Database (Denmark)

    Sakse, A; Secher, N J; Ottesen, M


    OBJECTIVES: To perform three-dimensional endoanal ultrasound (EAUS) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well...... as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. METHODS: EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR...

  3. 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

  4. Total rupture of the quadriceps muscle in an adolescent Ruptura total do músculo quadríceps em um adolescente

    Directory of Open Access Journals (Sweden)

    Rodrigo Pires e Albuquerque


    Full Text Available The total rupture of the quadriceps muscle in an adolescent is a rare lesion. We report a case of a 13 year old boy who suffered a direct trauma to the left knee. No predisposing factors have been diagnosed. The lesion was treated with surgical repair and transosseus sutures. The aim of this study was to present a rare case of rupture of the quadriceps muscle in an adolescent and the therapy used.A ruptura total do músculo quadríceps em um adolescente é uma lesão rara. Nós relatamos um caso de um menino de 13 anos que sofreu um trauma direto no joelho esquerdo. Não foram diagnosticados fatores predisponentes. A lesão foi tratada com o reparo cirúrgico e suturas transósseas. O objetivo desta pesquisa foi apresentar um caso raro de ruptura do músculo quadríceps em um adolescente e a terapêutica adotada.

  5. [18F]FDG uptake in proximal muscles assessed by PET/CT reflects both global and local muscular inflammation and provides useful information in the management of patients with polymyositis/dermatomyositis. (United States)

    Tanaka, Shigeru; Ikeda, Kei; Uchiyama, Katsuhiro; Iwamoto, Taro; Sanayama, Yoshie; Okubo, Ayako; Nakagomi, Daiki; Takahashi, Kentaro; Yokota, Masaya; Suto, Akira; Suzuki, Kotaro; Nakajima, Hiroshi


    This study aimed to determine whether [(18)F]fluorodeoxyglucose-PET/CT ([(18)F]FDG-PET/CT) discriminates PM/DM from non-muscular diseases and also whether FDG uptake in proximal muscles reflects the activity and severity of muscular inflammation in PM/DM. Twenty treatment-naïve PM/DM patients who underwent [(18)F]FDG-PET/CT were retrospectively identified by reviewing medical records. The same number of age- and sex-matched control patients with non-muscular diseases were also identified. Standardized uptake value (SUV) was calculated for each of the seven proximal muscles. For patient-based assessment, mean proximal muscle SUV was calculated by averaging the SUVs for these proximal muscles bilaterally. Mean proximal muscle SUVs were significantly greater in PM/DM patients than in control patients (median 1.05 vs 0.69, P muscle SUVs significantly correlated with mean proximal manual muscle test scores (ρ = 0.49, P = 0.028) and serum levels of creatine kinase (ρ = 0.54, P = 0.015) and aldolase (ρ = 0.64, P = 0.002). Furthermore, SUVs in proximal muscles from which biopsy specimens were obtained significantly correlated with histological grade for inflammatory cell infiltration (ρ = 0.66, P = 0.002). Our results suggest that [(18)F]FDG-PET/CT is useful in the diagnosis of PM/DM when inflammation in proximal muscles is globally assessed with quantitative measurements. Our results also indicate that local FDG uptake in a proximal muscle reflects the activity of inflammation in the same muscle and provides useful information in determining the region for muscle biopsy.

  6. Effects of load on the acute response of muscles proximal and distal to blood flow restriction. (United States)

    Jessee, Matthew B; Mouser, J Grant; Buckner, Samuel L; Dankel, Scott J; Mattocks, Kevin T; Abe, Takashi; Loenneke, Jeremy P


    To determine the effects of load and blood flow restriction (BFR) on muscular responses, we asked 12 participants to perform chest presses under four different conditions [30/0, 30/40, 50/0, and 50/40, presented as percentage one-repetition maximum (1RM)/percentage arterial occlusion pressure (AOP)]. Muscle thickness increased pre- to post-exercise [chest: mean 0.29, 95% confidence interval (CI) 0.21, 0.37 cm; triceps: mean 0.44, 95% CI 0.34, 0.54 cm], remaining elevated for 15 min post-exercise. Electromyography amplitude was greater with 50% 1RM and increased over time for the first three repetitions of each set of chest presses. The last three repetitions differed across time only. AOP increased from pre- to post-exercise, augmented by BFR [30/0: mean 31, 95% CI 18, 44 mmHg; 30/40: mean 39, 95% CI 28, 50 mmHg; 50/0: mean 32, 95% CI 23, 41 mmHg; 50/40: mean 46, 95% CI 32, 59 mmHg). Tranquility decreased and physical exhaustion increased from the pre- to post-condition, with both parameters returning to the baseline 15 min post-exercise level. In conclusion, load and BFR do not elicit meaningful differences in the acute response of chest press exercise taken to failure.

  7. Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal


    Kircher, J?rn; Ziskoven, Christoph; Patzer, Thilo; Zaps, Daniela; Bittersohl, Bernd; Krauspe, R?diger


    Jörn Kircher, Christoph Ziskoven, Thilo Patzer, Daniela Zaps, Bernd Bittersohl, Rüdiger KrauspeUniversity Hospital, Orthopaedic Department, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyAbstract: The complete rupture of the pectoralis major tendon is an uncommon injury but has become increasingly common among athletes in recent years. This may be due to a higher number of individuals taking part in high-impact sports and weightlifting as well as ...

  8. The influence of different non-articular proximal forearm orthoses (brace) widths in the wrist extensors muscle activity, range of motion and grip strength in healthy volunteers. (United States)

    Marcolino, Alexandre Márcio; Fonseca, Marisa de Cássia Registro; Leonardi, Naiara Tais; Barbosa, Rafael Inácio; Neves, Lais Mara Siqueira das; de Jesus Guirro, Rinaldo Roberto


    The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects. Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM. The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear model with mixed effects. According to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01). A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings.

  9. Remote dose-dependent effects of dry needling at distant myofascial trigger spots of rabbit skeletal muscles on reduction of substance P levels of proximal muscle and spinal cords. (United States)

    Hsieh, Yueh-Ling; Yang, Chen-Chia; Liu, Szu-Yu; Chou, Li-Wei; Hong, Chang-Zern


    Dry needling at distant myofascial trigger points is an effective pain management in patients with myofascial pain. However, the biochemical effects of remote dry needling are not well understood. This study evaluates the remote effects of dry needling with different dosages on the expressions of substance P (SP) in the proximal muscle, spinal dorsal horns of rabbits. Male New Zealand rabbits (2.5-3.0 kg) received dry needling at myofascial trigger spots of a gastrocnemius (distant muscle) in one (1D) or five sessions (5D). Bilateral biceps femoris (proximal muscles) and superficial laminaes of L5-S2, T2-T5, and C2-C5 were sampled immediately and 5 days after dry needling to determine the levels of SP using immunohistochemistry and western blot. Immediately after dry needling for 1D and 5D, the expressions of SP were significantly decreased in ipsilateral biceps femoris and bilateral spinal superficial laminaes (P dry needling, these reduced immunoactivities of SP were found only in animals receiving 5D dry needling (P dry needling involves the reduction of SP levels in proximal muscle and spinal superficial laminaes, which may be closely associated with the control of myofascial pain.

  10. Remote Dose-Dependent Effects of Dry Needling at Distant Myofascial Trigger Spots of Rabbit Skeletal Muscles on Reduction of Substance P Levels of Proximal Muscle and Spinal Cords

    Directory of Open Access Journals (Sweden)

    Yueh-Ling Hsieh


    Full Text Available Background. Dry needling at distant myofascial trigger points is an effective pain management in patients with myofascial pain. However, the biochemical effects of remote dry needling are not well understood. This study evaluates the remote effects of dry needling with different dosages on the expressions of substance P (SP in the proximal muscle, spinal dorsal horns of rabbits. Methods. Male New Zealand rabbits (2.5–3.0 kg received dry needling at myofascial trigger spots of a gastrocnemius (distant muscle in one (1D or five sessions (5D. Bilateral biceps femoris (proximal muscles and superficial laminaes of L5-S2, T2-T5, and C2-C5 were sampled immediately and 5 days after dry needling to determine the levels of SP using immunohistochemistry and western blot. Results. Immediately after dry needling for 1D and 5D, the expressions of SP were significantly decreased in ipsilateral biceps femoris and bilateral spinal superficial laminaes (P<.05. Five days after dry needling, these reduced immunoactivities of SP were found only in animals receiving 5D dry needling (P<.05. Conclusions. This remote effect of dry needling involves the reduction of SP levels in proximal muscle and spinal superficial laminaes, which may be closely associated with the control of myofascial pain.

  11. Association between insulin resistance, lean mass and muscle torque/force in proximal versus distal body parts in healthy young men. (United States)

    Gysel, T; Calders, P; Cambier, D; Roman de Mettelinge, T; Kaufman, J-M; Taes, Y; Zmierczak, H-G; Goemaere, S


    The purpose of this study was to investigate whether there is already an association of insulin resistance (IR) with muscle mass and -force/torque in an adult population and whether this relationship is the same in distal and proximal body parts. 358 Healthy young men were divided into a more insulin sensitive (MIS) (n=89) and a less insulin sensitive (LIS) group (n=89), respectively using lower and upper quartiles of HOMA-IR index (Homeostasis Model Assessment of IR). Muscle force/torque and lean mass, were compared between the two groups. LIS subjects had higher absolute thigh lean mass, but not higher thigh muscle torque, resulting in a lower torque per kg muscle. In upper arm, lean mass was higher in LIS subjects, but also absolute muscle torque resulted higher. For handgrip force, the LIS and MIS group had similar results, despite a trend towards higher forearm lean mass in LIS subjects. Lean mass % of total lean mass is lower in LIS subjects in more distal body parts. Already in a young healthy population, IR seems to be associated with lower force/torque per muscle mass and lower lean mass % of total lean mass predominantly in more distal body parts.

  12. 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

  13. Remote Dose-Dependent Effects of Dry Needling at Distant Myofascial Trigger Spots of Rabbit Skeletal Muscles on Reduction of Substance P Levels of Proximal Muscle and Spinal Cords


    Yueh-Ling Hsieh; Chen-Chia Yang; Szu-Yu Liu; Li-Wei Chou; Chang-Zern Hong


    Background. Dry needling at distant myofascial trigger points is an effective pain management in patients with myofascial pain. However, the biochemical effects of remote dry needling are not well understood. This study evaluates the remote effects of dry needling with different dosages on the expressions of substance P (SP) in the proximal muscle, spinal dorsal horns of rabbits. Methods. Male New Zealand rabbits (2.5–3.0 kg) received dry needling at myofascial trigger spots of a gastrocnemiu...

  14. 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 ...

  15. Remote Dose-Dependent Effects of Dry Needling at Distant Myofascial Trigger Spots of Rabbit Skeletal Muscles on Reduction of Substance P Levels of Proximal Muscle and Spinal Cords (United States)

    Hsieh, Yueh-Ling; Liu, Szu-Yu; Hong, Chang-Zern


    Background. Dry needling at distant myofascial trigger points is an effective pain management in patients with myofascial pain. However, the biochemical effects of remote dry needling are not well understood. This study evaluates the remote effects of dry needling with different dosages on the expressions of substance P (SP) in the proximal muscle, spinal dorsal horns of rabbits. Methods. Male New Zealand rabbits (2.5–3.0 kg) received dry needling at myofascial trigger spots of a gastrocnemius (distant muscle) in one (1D) or five sessions (5D). Bilateral biceps femoris (proximal muscles) and superficial laminaes of L5-S2, T2-T5, and C2-C5 were sampled immediately and 5 days after dry needling to determine the levels of SP using immunohistochemistry and western blot. Results. Immediately after dry needling for 1D and 5D, the expressions of SP were significantly decreased in ipsilateral biceps femoris and bilateral spinal superficial laminaes (P myofascial pain. PMID:25276839

  16. Effects of Replacement of Fishmeal with other Alternative Plant Sources in the Feed on Proximate Composition of Muscle, Liver and Ovary in Tilapia (Oreochromis nioloticus

    Directory of Open Access Journals (Sweden)

    Khalid Al-Ghanim


    Full Text Available ABSTRACT The major objective of this experiment was to assess the effect of alternate plant protein sources as a replacement for fish meal in feed on the proximate composition of muscle, liver and tissue in Oreochromis niloticus. O. niloticus of average size (average Weight 45.00±1.25 g, total length 13.28±1.42 cm were stocked in 100 L glass aquarium. Fish were fed with three experimental feeds (A, B and C and reference commercial feed (D for 16 weeks. Feed A, B and C was prepared from four different plant sources and fish meal (40 % crude protein. Fish were fed at the rate 3 % of body weight daily. It has been observed that tilapia fed with feed B in which 20 % fish meal was replaced compared to feed C with other plant sources of protein, had shown significantly higher total protein in their muscle compared to diet other experimental and commercial feeds. In O. niloticus minimum lipid content was recorded in fish fed with diet B compared to A, C and commercial feed. It has been concluded that 20-40% level of fish meal can be replaced in the diet of fish without having any impact on growth and chemical composition of muscle.

  17. Review Paper: Myocardial Rupture After Acute Myocardial Infarction ...

    African Journals Online (AJOL)

    Myocardial rupture complications after acute myocardial infarction are infrequent but lethal. They mainly involve rupture of the ventricular free wall, ventricular septum, papillary muscle, or combined. We compare features of different kinds of myocardial ruptures after acute myocardial infarction by reviewing the clinical ...

  18. Morphology and morphometry of the ulnar head of the pronator teres muscle in relation to median nerve compression at the proximal forearm. (United States)

    Gurses, I A; Altinel, L; Gayretli, O; Akgul, T; Uzun, I; Dikici, F


    The pronator syndrome is a rare compression neuropathy of the median nerve. Ulnar head of the pronator teres muscle may cause compression at proximal forearm. Detailed morphologic and morphometric studies on the anatomy of the ulnar head of pronator teres is scarce. We dissected 112 forearms of fresh cadavers. We evaluated the morphology and morphometry of the ulnar head of pronator teres muscle. The average ulnar head width was 16.3±8.2mm. The median nerve passed anterior to the ulnar head at a distance of 50.4±10.7mm from the interepicondylar line. We classified the morphology of the ulnar head into 5 types. In type 1, the ulnar head was fibromuscular in 60 forearms (53.6%). In type 2, it was muscular in 23 forearms (20.5%). In type 3, it was just a fibrotic band in 18 forearms (16.1%). In type 4, it was absent in 9 forearms (8%). In type 5, the ulnar head had two arches in 2 forearms (1.8%). In 80 forearms (71.5%: types 1, 3, and 5), the ulnar head was either fibromuscular or a fibrotic band. Although the pronator syndrome is a rare compression syndrome, the ulnar head of pronator teres is reported as the major cause of entrapment in the majority of the cases. The location of the compression of the median nerve in relation to the ulnar head of pronator teres muscle and the morphology of the ulnar head is important for open or minimally-invasive surgical treatment. Sectional study. Basic science study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Effects of hyperbaric oxygen therapy on biochemical and histological parameters of muscle groups in proximity to the distracted rat tibia. (United States)

    Kaynar, A; Civelek, S; Kasymova, Z; Keklikoglu, N; Toklu, S; Uzun, H


    We investigated the effect of hyperbaric oxygen therapy (HBOT) on rat muscles during tibial distraction osteogenesis (DO) at normal and hyperdistraction rates. Animals in groups 1 and 2 were distracted by 0.5 mm/day and those in groups 3 and 4 by 1 mm/day. Groups 2 and 4 received HBOT during distraction. Group 5 served as control. Superoxide dismutase (SOD; U/g protein), malondialdehyde (nmol/g protein), glutathione (mmol/g protein), and protein levels (g/dl) were determined. SOD was significantly higher in group 2 (4.59 ± 0.97) than in controls (2.19 ± 0.7) (P = 0.0001), and lower in group 4 (3.74 ± 1.70) than in group 2 (P=0.011). Malondialdehyde was significantly higher in group 2 (0.72 ± 0.23) than in controls (0.38 ± 0.10) (P=0.005). Total protein levels were better preserved with HBOT in distracted muscles: group 2 (3.24 ± 0.37) vs. group 1 (1.88 ± 0.60), and group 4 (3.45 ± 0.70) vs. group 3 (2.03 ± 0.75) (both P=0.0001). Numbers of fibres were lower in group 1 (4.88 ± 0.59) than in group 2 (6.07 ± 0.86), and in group 3 (5.13 ± 0.36) than in group 4 (6.14 ± 0.74) (both P=0.001). Numbers of nuclei were higher in group 1 (11.29 ± 2.47) than in group 2 (9.03 ± 1.53) (P=0.04), and in group 3 (12.43 ± 3.32) than in group 4 (9.08 ± 1.58) (P=0.001). Fibres and nuclei with HBOT were similar to those of controls. HBOT decreased the inflammatory cell infiltrate for group 1 (19.8 ± 8.54) vs. group 2 (4.2 ± 2.53) and group 3 (36.54 ± 11.29) vs. group 4 (21.5 ± 9.23) (both P=0.001). HBOT improves the adaptation of distracted muscle by increasing fibres and antioxidants while decreasing inflammation. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. 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.

  1. 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.

  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. 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.

  4. Imaging of rectus femoris proximal tendinopathies

    Energy Technology Data Exchange (ETDEWEB)

    Pesquer, Lionel; Poussange, Nicolas; Meyer, Philippe; Dallaudiere, Benjamin; Feldis, Matthieu [Clinique du Sport de Bordeaux, Centre d' Imagerie Osteo-articulaire, Merignac (France); Sonnery-Cottet, Bertrand [Groupe Ramsay Generale de Sante - Hopital Prive Jean Mermoz, Centre Orthopedique Santy, Lyon (France); Graveleau, Nicolas [Clinique du Sport de Bordeaux, Centre de Chirurgie Orthopedique et Sportive, Merignac (France)


    The rectus femoris is the most commonly injured muscle of the anterior thigh among athletes, especially soccer players. Although the injury pattern of the muscle belly is well documented, less is known about the anatomy and specific lesions of the proximal tendons. For each head, three distinctive patterns may be encountered according to the location of the injury, which can be at the enthesis, within the tendon, or at the musculotendinous junction. In children, injuries correspond most commonly to avulsion of the anteroinferior iliac spine from the direct head and can lead to subspine impingement. Calcific tendinitis and traumatic tears may be encountered in adults. Recent studies have shown that traumatic injuries of the indirect head may be underdiagnosed and that injuries of both heads may have a surgical issue. Finally, in the case of tears, functional outcome and treatment may vary if the rupture involves one or both tendons and if the tear is partial or complete. Thus, it is mandatory for the radiologist to know the different ultrasound and magnetic resonance imaging (MRI) patterns of these lesions in order to provide accurate diagnosis and treatment. The purpose of this article is to recall the anatomy of the two heads of rectus femoris, describe a reliable method of assessment with ultrasound and MRI and know the main injury patterns, through our own experience and literature review. (orig.)

  5. Distal rupture of the adductor longus in a skier. (United States)

    Greditzer, Harry G; Nawabi, Danyal; Li, Angela Eh; Jawetz, Shari T

    Acute adductor longus ruptures occur infrequently and have been rarely described in the literature. Schlegel et al. reviewed a series of adductor longus tendon ruptures and found that all ruptured proximally. A 42-year-old man with right hip pain 3 weeks following a skiing injury underwent magnetic resonance imaging (MRI), which demonstrated a distal adductor longus avulsion. The diagnosis of acute adductor longus injury can be difficult on physical examination alone, but MRI can accurately depict the site of injury. Surgery may be indicated for a proximal avulsion, but a distal injury may heal with nonoperative treatment, as in our case. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [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.

  7. 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.

  8. Proximal Hypospadias (United States)

    Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.


    Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications. PMID:21516286

  9. Closed traumatic rupture of finger flexor pulleys. (United States)

    Bowers, W H; Kuzma, G R; Bynum, D K


    Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.

  10. Tear patterns, surgical repair, and clinical outcomes of patellar tendon ruptures after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. (United States)

    Benner, Rodney W; Shelbourne, K Donald; Urch, Scott E; Lazarus, David


    Patellar tendon ruptures are rare after graft harvest for anterior cruciate ligament (ACL) reconstruction. Few reports are available in the literature. To report the common tear patterns and results of treatment with tendon repair and cable augmentation. Case series; Level of evidence, 4. All tendon ruptures were repaired to bone with suture anchors and augmented with a Dall-Miles cable, followed by an aggressive rehabilitation protocol. The tear location was recorded. Range of motion, strength, and subjective survey testing were conducted preoperatively and postoperatively. Thirteen patellar tendon ruptures were found from our database of 5364 ACL reconstructions, for an incidence of 0.24%. Seven ruptures occurred from the patellar origin medially and the tibial attachment laterally in a Z-shaped pattern. Four were completely distal, and 2 were completely proximal ruptures. All patients exhibited early flexion loss, but 11 of 13 patients maintained full, terminal hyperextension throughout treatment. The mean postoperative side-to-side flexion deficit was 33° at 1 month, 6° at 3 months, and 3° at latest follow-up at a mean of 4.8 years after tendon repair (range, 1-16 years). By International Knee Documentation Committee (IKDC) criteria, 10 patients had normal flexion, and 3 were nearly normal at latest follow-up. Twelve patients had normal extension, and 1 had nearly normal extension at latest follow-up. Mean isokinetic quadriceps muscle strength was 68.7% of the other side at 3 months after repair and 100.0% at latest follow-up, occurring at a mean of 47.5 months (range, 12-120 months). At a mean of 2 years (range, 1-4 years) after repair, the mean modified Noyes subjective score was 89.8 ± 9.2. Patellar tendon ruptures are rare after ACL graft harvest. These ruptures usually occur in either a proximal-medial and distal-lateral pattern or an entirely distal pattern, in contrast to the proximal-only tear pattern commonly observed in unharvested patellar

  11. Adductor longus tendon rupture mistaken for incarcerated inguinal hernia. (United States)

    Aerts, Bas R J; Plaisier, Peter W; Jakma, Tijs S C


    An incarcerated inguinal hernia is a common diagnosis, since the risk of an inguinal hernia incarcerating or strangulating is around 0.3-3%. An acute rupture of the adductor longus tendon is rarely seen and mostly affects (semi-) professional sportsmen. We present a case of a patient with an assumed incarcerated inguinal hernia which turned out to be a proximal adductor longus tendon rupture. If patients without a history of inguinal hernia present themselves with acute groin pain after suddenly exorotating the upper leg, a rupture of the adductor longus tendon should be considered. Both surgical and non-surgical treatment can be performed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. 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 ...

  13. 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

  14. Use of extended curettage with osteotomy and fenestration followed by reconstruction with conservation of muscle insertion in the treatment of Enneking stage II locally aggressive bone tumor of the proximal extremities: resection and treatment of bone tumors (United States)


    Background The purpose of this study was to investigate the clinical efficacy of extended resection with osteotomy, fenestration and conservation of muscle (tendon) insertion in the treatment of bone tumors. Methods A total of 15 patients with locally aggressive bone tumors (Enneking stage II) in the adjacent muscle (tendon) insertion of the proximal extremity were enrolled in the present study (mean age of 29 years). Extended curettage of lesions with osteotomy, fenestration and/or conservation of muscle (tendon) insertion and internal fixation with a bone graft or bone cement was performed at stage I. Postsurgical brace protection was used for 4 to 12 weeks and the patients were periodically followed-up by X-ray and functional assessment. Recurrence, postsurgical Enneking score and outcome rating were assessed. Results Treated cases included 15 patients aged 29 ±7.75 years (range, 18 to 42) with a male to female ratio of 8:7. Six had a femoral tumor and nine had a humeral tumor. These tumors comprised three chondroblastomas, five giant-cell tumors and seven aneurysmal bone cysts. Follow-up for 48 ±12.95 months (range, 25 to 72) revealed that 13 of 15 (87%) patients exhibited no recurrence. Local recurrence was observed in a patient with an aneurysmal bone cyst (nine months) and one with a giant-cell tumor (12 months). Mean Enneking scores were 27 ±4.07 (range, 18 to 29). Except for the patient with the recurrent giant-cell tumor, all patients reported good (13%, 2 out of 15) or very good (80%, 12 out of 15) outcomes. Very good outcomes were reported in 92% of patients (12 out of 13) without recurrence. Conclusions The procedures used in this study achieved high clinical efficacy, complete lesion removal, reduced recurrence and good restoration of joint function in patients with primary locally aggressive Enneking stage II bone tumors of the proximal extremities. PMID:23497479

  15. Unusual balloon rupture during direct stenting with a TaxusExpress stent in a venous graft complicated by vessel rupture: a device-related fatal event

    DEFF Research Database (Denmark)

    Christiansen, Evald H


    distal anastomoses, had two significant stenoses. Percutaneous coronary intervention with distal protection, and direct stenting with a drug-eluting stent, was planned. A 3.00 x 16 mm TaxusExpress (Boston Scientific) was used. At an inflation pressure of 10 atm the stent balloon seemed to extend 20 mm...... proximally with a diameter of 4.5 mm, and the balloon ruptured. Angiography showed rupture of the vessel proximal to the implanted stent, and the patient developed severe hypotension. The rupture was treated with a covered stent and pericardiocentesis was performed with evacuation of 600 mL blood. However...

  16. Characteristics of elongated and ruptured anterior cruciate ligament grafts: An analysis of 21 consecutive revision cases

    Directory of Open Access Journals (Sweden)

    Kohei Iio


    Conclusion: The location of the original femoral tunnel was more proximal in patients with elongated grafts than in those with ruptured grafts. Different bone tunnel position from native ACL might lead to graft elongation.

  17. 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

  18. Bilateral simultaneous spontaneous rupture of the quadriceps tendons

    African Journals Online (AJOL)

    simultaneous rupture of the quadriceps tendons. The injury occurs most often in elderly people and delay in the diagnosis is not uncommon. Early operative repair is recommended. By using a metal wire passing through a transverse hole in the superior pole of the patella and through the tendon proximal to the repair site, ...

  19. 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

  20. Moderate exercise of rainbow trout induces only minor differences in fatty acid profile, texture, white muscle fibres and proximate chemical composition of fillets

    DEFF Research Database (Denmark)

    Rasmussen, Richard Skøtt; Heinrich, Maike Timm; Hyldig, Grethe


    g after nine weeks of experiment at 15.0 °C. The fatty acid composition in fillets differed only marginally between exercised fish (excF) and control fish (ctrlF) kept in standing water. ExcF fillets had a significantly lower content of fatty acids 16:0 (Pb0.05) and 18:1 (n−7) (Pb0.01) and a higher...... significantly among the two groups (Pb0.01). Moreover, moderate exercise induced small but significant changes in fibre circularity (excF: circ.=0.724; ctrlF:=0.720, Pb0.05) but neither muscle fibre diameter nor circularity was significantly related to fillet texture. Altogether, the results suggest...

  1. 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.

  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. 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

  8. Proximal renal tubular acidosis (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  9. 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.

  10. 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

  11. Treatment of Chronic Achilles Tendon Ruptures With Large Defects. (United States)

    Ahmad, Jamal; Jones, Kennis; Raikin, Steven M


    Background When Achilles tendon ruptures become chronic, a defect often forms at the rupture site. There is scant literature regarding the treatment of chronic Achilles ruptures with defects of 6 cm or larger. We examined outcomes from combining a turndown of the proximal, central Achilles with a flexor hallucis longus (FHL) tendon transfer to treat this condition. Materials Between September 2002 and December 2013, 32 patients presented with a chronic Achilles rupture and a defect of 6 cm or more. Twenty patients were male and 12 were female. Patient age was between 20 and 74 years, with a mean of 53.3 years. Eighteen and 14 patients had their right and left Achilles tendon affected, respectively. The number of days between injury and surgery ranged from 30 to 315 days, with a mean of 102 days. Reconstruction of the Achilles involved a turndown of the proximal, central tendon and FHL augmentation. Final patient follow-up ranged from 18 to 150 months, with a mean of 62.3 months. At surgery, the gap between the ruptured ends of the Achilles ranged from 6 to 12 cm, with a mean gap of 7.5 cm. Full healing was achieved in all 32 patients (100%) by 5 months postoperatively. Mean Foot and Ankle Ability Measures scores increased from 36.3% to 90.2% between initial and latest follow-up (P Achilles ruptures with large defects are scant within the orthopaedic literature. Our method of Achilles reconstruction results in a high rate of improved function and pain relief. Therapeutic, Level IV: Case series. © 2016 The Author(s).

  12. Nonoperative, dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch


    ° dorsiflexion, the stiffness during slow stretching, and the maximal strength were measured in both limbs. The stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was significantly increased (p = .024) in the non-weightbearing group at 12 months. The peak passive torque......Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle......-tendon complex in patients randomized to early weightbearing or non-weightbearing in the nonoperative treatment of Achilles tendon rupture. A total of 60 patients were randomized to full weightbearing from day 1 of treatment or non-weightbearing for 6 weeks. After 6 and 12 months, the peak passive torque at 20...

  13. Retrospective Review of Pectoralis Major Ruptures in Rodeo Steer Wrestlers

    Directory of Open Access Journals (Sweden)

    Breda H. F. Lau


    Full Text Available Background. Pectoralis major tendon ruptures have been reported in the literature as occupational injuries, accidental injuries, and sporting activities. Few cases have been reported with respect to rodeo activities. Purpose. To describe a series of PM tendon ruptures in professional steer wrestlers. Study Design. Case series, level of evidence, 4. Methods. A retrospective analysis of PM ruptures in a steer wrestling cohort was performed. Injury data between 1992 and 2008 were reviewed using medical records from the University of Calgary Sport Medicine Center. Results. Nine cases of pectoralis major ruptures in professional steer wrestlers were identified. Injuries occurred during the throwing phase of the steer or while breaking a fall. All athletes reported unexpected or abnormal behavior of the steer that contributed to the mechanism of injury. Seven cases were surgically repaired, while two cases opted for nonsurgical intervention. Eight cases reported successful return to competition following the injury. Conclusion. Steer wrestlers represent a unique cohort of PM rupture case studies. Steer wrestling is a demanding sport that involves throwing maneuvers that may predispose the muscle to rupture. All cases demonstrated good functional outcomes regardless of surgical or non-surgical treatment.

  14. [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.

  15. 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...

  16. The Danish anal sphincter rupture questionnaire: Validity and reliability

    DEFF Research Database (Denmark)

    Due, Ulla; Ottesen, Marianne


    Objective. To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. Setting and background. Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been...... offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth. Method. The original questionnaire was revised and a pilot test was performed...

  17. Rupture of an expander prosthesis mimics axillary cancer recurrence.

    LENUS (Irish Health Repository)

    Ismael, T


    Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.

  18. [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.

  19. 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.

  20. 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

  1. [Four family members with proximal myotonic myopathy

    NARCIS (Netherlands)

    Tieleman, A.A.; Velden, M.P. van der; Visser, M.C.; Wokke, J.H.J.; Scheffer, H.; Engelen, B.G.M. van


    A 41-year-old woman had a 15-year history of pain in her thighs and arms, which also became weaker, and a decrease in visual acuity. Her 35-year-old brother, their 38-year-old sister and their 64-year-old mother also had myalgia, myotonia and proximal muscle weakness, and the women also had

  2. 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.

  3. [Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture]. (United States)

    Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J


    The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. Treatment is somewhat empirical, given that uncertainties remain in our understanding of the pathophysiology of this vascular complication, which involves structural and biochemical changes in the endothelium and smooth muscle of vessels. Vasospasm that is refractory to treatment leads to cerebral infarction. Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.

  4. 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.

  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. Multiset proximity spaces

    Directory of Open Access Journals (Sweden)

    A. Kandil


    Full Text Available A multiset is a collection of objects in which repetition of elements is essential. This paper is an attempt to explore the theoretical aspects of multiset by extending the notions of compact, proximity relation and proximal neighborhood to the multiset context. Examples of new multiset topologies, open multiset cover, compact multiset and many identities involving the concept of multiset have been introduced. Further, an integral examples of multiset proximity relations are obtained. A multiset topology induced by a multiset proximity relation on a multiset M has been presented. Also the concept of multiset δ- neighborhood in the multiset proximity space which furnishes an alternative approach to the study of multiset proximity spaces has been mentioned. Finally, some results on this new approach have been obtained and one of the most important results is: every T4- multiset space is semi-compatible with multiset proximity relation δ on M (Theorem 5.10.

  8. Ground Motion Simulations of Scenario Earthquake Ruptures of the Hayward Fault (United States)

    Aagaard, B.; Graves, R.; Larsen, S.; Ma, S.; Rodgers, A.; Brocher, T.; Graymer, R.; Harris, R.; Lienkaemper, J.; Ponce, D.; Schwartz, D.; Simpson, R.; Spudich, P.; Dreger, D.; Petersson, A.; Boatwright, J.


    rupture length, the synthetic ground motions exhibit the strongest sensitivity to the distribution of slip and proximity to sedimentary basins. The hypocenter also exerts a strong influence on the amplitude of the shaking due to rupture directivity. The synthetic waveforms exhibit a weaker sensitivity to the rupture speed and are relatively insensitive to the rise time.

  9. 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...

  10. 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.

  11. 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.

  12. Proximal Probes Facility (United States)

    Federal Laboratory Consortium — The Proximal Probes Facility consists of laboratories for microscopy, spectroscopy, and probing of nanostructured materials and their functional properties. At the...

  13. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Han, Moon Hee; Kang, Hyun Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyoung [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Lim, Jeong Wook [Dept. of Neurosurgery, Sun Hospital, Daejeon (Korea, Republic of)


    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  14. 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

  15. Modelling and Analysis of Proximity Effect in IGBT Fuses

    DEFF Research Database (Denmark)

    Iov, Florin; Blaabjerg, Frede; Rasmussen, Henrik


    . Even with an active protection, a high power IGBT still has a risk of exhibiting a violent rupture in the case of a fault if e.g. IGBT fuses are not protecting it. By introducing fuses into voltage source converters a better protection of IGBT's can be achieved. However, skin and proximity effects...... affect the current distribution in a fuse due to the high frequency currents and thus a need for de-rating the fuse. This paper shows an analytical model for studying the proximity effect into a fuse. The results obtained using this model are compared with experiments....

  16. 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.

  17. Evaluation of finger A3 pulley rupture in the crimp grip position - a magnetic resonance imaging cadaver study

    Energy Technology Data Exchange (ETDEWEB)

    Bayer, Thomas; Uder, Michael; Janka, Rolf [University of Erlangen-Nuremberg, Department of Radiology, Erlangen (Germany); Adler, Werner [University of Erlangen-Nuremberg, Department of Biometry and Epidemiology, Erlangen (Germany); Schweizer, Andreas [Balgrist, University of Zurich, Department of Orthopaedics, Zurich (Switzerland); Schoeffl, Isabelle [Klinikum Bamberg, Department of Pediatrics, Bamberg (Germany)


    The correct diagnosis of an A3 pulley rupture is challenging for musculoskeletal radiologists. An A3 pulley rupture should in theory influence the shape of the proximal interphalangeal joint volar plate (VP) and the amount of bowstringing at level of the VP during finger flexion. The purpose of this study was to perform MRI with metric analysis of the VP configuration and VP bowstringing in cadaver fingers in the crimp grip position and to determine cut points for A3 pulley rupture. MRI in the crimp grip position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (fingers with A3 pulley rupture n = 16, fingers without A3 pulley rupture n = 5). The distances of the translation of the VP relative to the middle phalanx base, the distances between the flexor tendons and the VP body, and the distances between the flexor tendon and bone (TB) were measured. Statistical analysis showed significantly lower VP translation distances and significantly higher VP tendon distances if the A3 pulley was ruptured. A2 TB and A4 TB distances did not differ significantly in specimens with and without A3 pulley rupture. The optimal cut points for A3 pulley rupture were a VP translation distance <2.8 mm and a VP tendon distance >1.4 mm. Reduction of the VP translation distance and augmentation of the VP tendon distance are suitable indirect signs of A3 pulley rupture. (orig.)

  18. Diagnosis and Follow-up US Evaluation of Ruptures of the Medial Head of the Gastrocnemius

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Hyo-Sung; Han, Young-Min; Lee, Sang-Yong; Kim, Ki-Nam; Chung, Gyung Ho [Chonbuk National University Medical School, Chonju (Korea, Republic of)


    The purpose of this study was to demonstrate the ultrasonographic (US) findings of rupture and the healing process of the medial head of the gastrocnemius ('Tennis Leg'). Twenty-two patients (age range: 30 to 45 years) with clinically suspected ruptures of the medial head of the gastrocnemius were referred to us for US examination. All the patients underwent US of the affected limb and the contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients were performed at two-week intervals during the month after injury and at one-month intervals during the following six months. Of the 22 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in seven patients (31.8%); the remaining 15 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 20 patients (90.9%). The thickness of the fluid collection, including the hematoma in the patients with complete rupture (mean: 9.7 mm), was significantly greater than that seen in the patients with partial tear (mean: 6.8 mm) (p < 0.01). The primary union of the medial head of the gastrocnemius with the soleus muscle in all the patients with muscle rupture and fluid collection was recognized via the hypoechoic tissue after four weeks. Ultrasonography is a useful imaging modality for the diagnosis and follow-up examination for the patients suffering with rupture of the medial head of the gastrocnemius.

  19. 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.

  20. Surgical approach to acute pectoralis major tendon rupture. (United States)

    Merolla, G; Campi, F; Paladini, P; Porcellini, G


    Pectoralis major rupture is a very uncommon injury first time described by Patissier in 1822. Tears are classified on the type (partial and complete) or on the site (tendinous, myotendinous junction, intramuscular). Ruptures are reported in young high-performance athletes as results of eccentric contractions of the musculotendinous unit. The most probable mechanism in elderly patients is a brisk tearing movement applied to stiff atrophic muscle. Injuries generally involve the sternal portion; the localization to the clavicular portion is rare and can be misdiagnosed as muscle sprain. Preoperative planning include MRI as gold standard regarding operative versus non operative treatment decisions. Surgical repair is recommended in cases of complete tears because of loss of strenght in adduction, flexion and internal rotation. Aim of the current study is to describe the surgical repair of acute pectoralis major tendon rupture in 5 patients. Surgery was performed through a modified delto-pectoral approach; pectoralis major tendon was attached at its anatomic insertion using two metallic anchors. The patient as been immobilized in a sling for 30 days and then assisted physiotherapy begun; strenght exercises were allowed at 90 days. At a mean follow-up of 24 months results were excellent in all cases with restoration of strenght and coming back to previously sports activity.

  1. 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.

  2. 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.

  3. HydroCoil embolization of a ruptured infectious aneurysm in a pediatric patient: case report and review of the literature. (United States)

    Eddleman, Christopher; Nikas, Dimitrios; Shaibani, Ali; Khan, Pervez; Dipatri, Arthur J; Tomita, Tadanori


    Intracranial infectious aneurysms in the pediatric population are rare. Although surgery has been the traditional treatment of ruptured pediatric infectious aneurysms, endovascular coil embolization has become an attractive alternative due to its low rate of morbidity and mortality. A 9-year-old boy with a significant medical history of aortic valve replacement, antibiotic-treated infective endocarditis, and multiple embolic cerebral infarcts presented with a high-grade intraventricular hemorrhage due to the rupture of a large infectious proximal posterior circulation aneurysm. Computed tomography and cerebral angiogram demonstrated a right crural/ambient cistern hematoma and an associated infectious aneurysm of the right proximal posterior cerebral artery. The ruptured infectious aneurysm was coil-embolized with hydrogel-coated platinum coils without sacrifice of the distal parent artery. The aneurysm was completely occluded, and the patient regained all neurological function. Ruptured infectious aneurysms in the pediatric population occur despite aggressive medical therapy. Patients with infective endocarditis and embolic infarcts should be followed closely due to the risk of major hemorrhagic events, including aneurysm rupture. Hybrid coil embolization of ruptured infectious aneurysms with preservation of the distal parent artery is exceedingly rare and effective in the management of ruptured infectious aneurysms in the pediatric population.

  4. Desequilíbrios musculares entre flexores dorsais e plantares do tornozelo após tratamento conservador e acelerado da ruptura do tendão calcâneo Muscle imbalance between ankle dorsiflexors and plantarflexors after conservative and accelerated treatment of Achilles tendon rupture

    Directory of Open Access Journals (Sweden)

    Alexandre Mayer


    Full Text Available A ruptura do tendão calcâneo (TC reduz a sobrecarga mecânica dos flexores plantares (FP do tornozelo. Essa alteração muda o equilíbrio natural entre os FP e flexores dorsais (FD do tornozelo. O objetivo do estudo foi avaliar as razões isocinéticas concêntricas convencionais de torque de pacientes submetidos a tratamento cirúrgico de ruptura aguda do TC após dois protocolos diferentes de reabilitação. Após procedimento cirúrgico para reconstrução do TC, a amostra foi dividida de forma intencional em dois grupos: conservador (GC, 11 homens, 41,3±7,9 anos e grupo acelerado (GA, 13 homens, 43,5±13,7 anos. O GC permaneceu com imobilização gessada no tornozelo por seis semanas (tratamento tradicional, enquanto o GA usou uma órtese robofoot em posição neutra e, após duas semanas, iniciou mobilização e apoio precoce do tornozelo, com reabilitação por seis semanas. Após 3 meses de pós-operatório, a razão do torque concêntrico máximo dos FD pelos FP do tornozelo foi avaliada por dinamômetro isocinético. As razões de torque do lado operado se mantiveram superiores às do lado saudável mesmo após 3 meses de pós-operatório (pAchilles tendon rupture reduces ankle plantarflexor (PF muscles mechanical overload. This change in the ankle joint mechanics changes the natural muscle balance between dorsiflexor (DF and PF muscles. The purpose of this study was to assess such imbalance by concentric conventional isokinetic torque ratios of patients who underwent different rehabilitation protocols after surgical repair of the Achilles tendon. After surgery, subjects were assigned to either a conservative or to an accelerated rehabilitation group. The conservative group (11 men, 41.3±7.9 years old remained with a plaster cast for 6 weeks after surgery. The accelerated group (13 men, 43.5±13,7 years old used a"robofoot" cast for 2 weeks and underwent ankle mobilization and early weight bearing for a period of 6 weeks post

  5. 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.

  6. 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.

  7. 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

  8. Spontaneous Splenic Rupture in Melanoma

    Directory of Open Access Journals (Sweden)

    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.

  9. ACL Rupture in Collegiate Wrestler

    Directory of Open Access Journals (Sweden)

    Lindsay A. Palmer


    Full Text Available Objective: To educate others on unique Anterior Cruciate Ligament tears and percentage of usage of the ACL in normal daily function. Background: Patient is an eighteen year old male participating in wrestling and football at the time of the injury. Patient now only participates in wrestling. No previous knee or chronic injuries were reported prior to this injury. Patient was playing football during the time of injury. The patient stated that he planted his foot down and was tackled at the same time when the injury occurred. The patient felt his knee twist and buckle. Patient complained of clicking inside the knee and had minimal swelling. He also complained of it being difficult to bear weight at the time. The patient did not seek further treatment until two months after the injury occurred when he received an MRI. His MRI showed a positive finding for an Anterior Cruciate Ligament rupture. His previous Athletic Trainer could not find a positive diagnosis for the patient prior to the MRI. Differential Diagnosis: Possible meniscal or ACL injury. Treatment: Doctors officially diagnosed the injury as a complete rupture of the ACL. The patient did not receive surgery immediately. Doctors have stated that he only uses about 50% of his ACL on a daily basis compared to a normal person who uses about 95% of their ACL daily. Because of this, the patient played on his rupture for seven months before receiving surgery. He played a whole season of high school football and a whole season of wrestling his senior year with the ACL ruptured. The patient only used a brace for better comfort during the seven months. The patient then received reconstructive surgery to repair the rupture. A hamstring tendon graft was used to repair the ruptured ACL. Because a tendon was taken from the hamstring, patient experienced a tight ACL and hamstring of the left leg post-surgery. The patient participated in Physical Therapy for five months to strengthen and stretch the new

  10. “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.

  11. Surgical treatment of distal biceps tendon rupture: a case report

    Directory of Open Access Journals (Sweden)

    Cristina N. Cozma


    Full Text Available Objectives. Distal biceps tendon rupture affects the functional upperextremity movement, impairing supination and flexion strength. According to age, profession and additional risks treatment might be nonoperative or surgical. Methods. We describe the case of a 43 years old male patient who sustained an injury to his right distal biceps and was diagnosed with acute right distal biceps rupture. Surgical treatment was decided and biceps tendon was reinserted to the radius tuberosity using a combination of a cortical button fixation associated with an interference screw. Results. Postoperative functional result was favorable with no complications and with no movement limitation after one month. Conclusions. When possible, distal biceps tendon repair should be realized surgically because this permits restoring of the muscle strength to near normal levels with no loss of motion. Nerve complications are common; therefore the surgery should be realized by experienced upper extremity surgeons.

  12. Endoscopic-assisted achilles tendon reconstruction with free hamstring tendon autograft for chronic rupture of achilles tendon: clinical and isokinetic evaluation. (United States)

    El Shazly, Ossama; Abou El Soud, Maged M; El Mikkawy, Dalia M E; El Ganzoury, Ibrahim; Ibrahim, Ayman Mohamed


    To evaluate the clinical and functional outcome of endoscopic-assisted reconstruction of chronic ruptures of the Achilles tendon using free hamstring tendon autograft. We present a case series of 15 patients who had chronic ruptures of the Achilles tendon (>6 weeks earlier) and underwent endoscopic-assisted reconstruction with a free hamstring autograft. The graft loop was passed through and fixed to the proximal stump of the tendon. The graft was then passed through suture to the distal stump and finally inserted into a tunnel in the anterior calcaneus to the Achilles tendon insertion and fixed with an bioabsorbable interference screw. The mean follow-up period was 27 months (SD, 3 months; range, 24 to 33 months). All patients underwent magnetic resonance imaging preoperatively, immediately postoperatively, and at follow-up 2 years postoperatively. All patients were functionally evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) score for the hindfoot preoperatively and postoperatively. Calf muscle power was evaluated by isokinetic strength testing at 2 years' follow-up. The mean size of the gap on preoperative magnetic resonance imaging was 49 mm (SD, 9 mm). The mean preoperative AOFAS score was 32.6 (SD, 7.5). There was a statistically significant improvement in the postoperative AOFAS score after 2 years to 90.8 (SD, 3.54) (P Achilles tendon reconstruction with free hamstring tendon autograft for chronic ruptures of the Achilles tendon showed good to excellent results in all patients. Isokinetic testing showed a nonsignificant deficit between the involved and uninvolved sides at 2 years' follow-up. Level IV, therapeutic cases series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Muscle injuries: optimising recovery. (United States)

    Järvinen, Tero A H; Järvinen, Teppo L N; Kääriäinen, Minna; Aärimaa, Ville; Vaittinen, Samuli; Kalimo, Hannu; Järvinen, Markku


    Muscle injuries are one of the most common traumas occurring in sports. Despite their clinical importance, there are only a few clinical studies on the treatment of muscle injuries. Lack of clinical studies is most probably attributable to the fact that there is not only a high heterogeneity in the severity of injuries, but also the injuries take place in different muscles, making it very demanding to carry out clinical trials. Accordingly, the current treatment principles of muscle injuries have either been derived from experimental studies or been tested empirically only. Clinically, first aid for muscle injuries follows the RICE (Rest, Ice, Compression and Elevation) principle. The objective of RICE is to stop the injury-induced bleeding into the muscle tissue and thereby minimise the extent of the injury. Clinical examination should be carried out immediately after the injury and 5-7 days after the initial trauma, at which point the severity of the injury can be assessed more reliably. At that time, a more detailed characterisation of the injury can be made using imaging diagnostic modalities (ultrasound or MRI) if desired. The treatment of injured skeletal muscle should be carried out by immediate immobilisation of the injured muscle (clinically, relative immobility/avoidance of muscle contractions). However, the duration of immobilisation should be limited to a period sufficient to produce a scar of sufficient strength to bear the forces induced by remobilisation without re-rupture and the return to activity (mobilisation) should then be started gradually within the limits of pain. Early return to activity is needed to optimise the regeneration of healing muscle and recovery of the flexibility and strength of the injured skeletal muscle to pre-injury levels. The rehabilitation programme should be built around progressive agility and trunk stabilisation exercises, as these exercises seem to yield better outcome for injured skeletal muscle than programmes based

  14. EMG monitoring during functional non-surgical therapy of Achilles tendon rupture. (United States)

    Hüfner, Tobias; Wohifarth, Kai; Fink, Matthias; Thermann, H; Rollnik, Jens D


    After surgical therapy of Achilles tendon rupture, neuromuscular changes may persist, even one year after surgery. We were interested whether these changes are also evident following a non-surgical functional therapy (Variostabil therapy boot/Adidas). Twenty-one patients with complete Achilles tendon rupture were enrolled in the study (mean age 38.5 years, range 24 to 60; 18 men, three women) and followed-up clinically and with surface EMG of the gastrocnemius muscles after four, eight, 12 weeks, and one year after rupture. EMG differences between the affected and non-affected side could only be observed at baseline and after four weeks following Achilles tendon rupture. The results from our study show that EMG changes are not found following non-surgical functional therapy.

  15. Capacitive proximity sensor (United States)

    Kronberg, James W.


    A proximity sensor based on a closed field circuit. The circuit comprises a ring oscillator using a symmetrical array of plates that creates an oscillating displacement current. The displacement current varies as a function of the proximity of objects to the plate array. Preferably the plates are in the form of a group of three pair of symmetric plates having a common center, arranged in a hexagonal pattern with opposing plates linked as a pair. The sensor produces logic level pulses suitable for interfacing with a computer or process controller. The proximity sensor can be incorporated into a load cell, a differential pressure gauge, or a device for measuring the consistency of a characteristic of a material where a variation in the consistency causes the dielectric constant of the material to change.

  16. Neighborhoods and manageable proximity

    Directory of Open Access Journals (Sweden)

    Stavros Stavrides


    Full Text Available The theatricality of urban encounters is above all a theatricality of distances which allow for the encounter. The absolute “strangeness” of the crowd (Simmel 1997: 74 expressed, in its purest form, in the absolute proximity of a crowded subway train, does not generally allow for any movements of approach, but only for nervous hostile reactions and submissive hypnotic gestures. Neither forced intersections in the course of pedestrians or vehicles, nor the instantaneous crossing of distances by the technology of live broadcasting and remote control give birth to places of encounter. In the forced proximity of the metropolitan crowd which haunted the city of the 19th and 20th century, as well as in the forced proximity of the tele-presence which haunts the dystopic prospect of the future “omnipolis” (Virilio 1997: 74, the necessary distance, which is the stage of an encounter between different instances of otherness, is dissipated.

  17. Atrofia muscular proximal familiar

    Directory of Open Access Journals (Sweden)

    José Antonio Levy


    Full Text Available Os autores relatam dois casos de atrofia muscular proximal familiar, moléstia caracterizada por déficit motor e atrofias musculares de distribuição proximal, secundárias a lesão de neurônios periféricos. Assim, como em outros casos descritos na literatura, foi feito inicialmente o diagnóstico de distrofia muscular progressiva. O diagnóstico correto foi conseguido com auxílio da eletromiografia e da biopsia muscular.

  18. Spontaneous Rupture of Bladder in Puerperium without Uterine Rupture

    Directory of Open Access Journals (Sweden)

    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.

  19. Your Muscles (United States)

    ... Should You Go to School? Breast Cancer Your Muscles KidsHealth > For Kids > Your Muscles Print A A ... and skeletal (say: SKEL-uh-tul) muscle. Smooth Muscles Smooth muscles — sometimes also called involuntary muscles — are ...

  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. [Experimental proximal carpectomy. Biodynamics]. (United States)

    Kuhlmann, J N


    Proximal carpectomy was performed in 10 fresh cadavre wrists. Dynamic x-rays were taken and the forces necessary to obtain different movements before and after the operation were measured. Comparison of these parameters clearly defines the advantages and limitations of carpectomy and indicates the reasons.

  2. Proximate Analysis of Coal (United States)

    Donahue, Craig J.; Rais, Elizabeth A.


    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…

  3. Proximal Tibial Bone Graft (United States)

    ... the Big Toe Ailments of the Smaller Toes Diabetic Foot Treatments Currently selected Injections and other Procedures Treatments ... from which the bone was taken if the foot/ankle surgeries done at the same time allow for it. ... problems after a PTBG include infection, fracture of the proximal tibia and pain related ...

  4. [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.

  5. 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

  6. Density of muscle spindle profiles in the intrinsic forelimb muscles of the dog. (United States)

    Buxton, D F; Peck, D


    The concept of parallel muscle combinations, in which spindle density is significantly higher in small muscles compared to their larger counterparts in large-small muscle combinations acting across a joint, is supported by the results of this study regardless of the joint. Analysis of the canine data as well as previously published guinea pig forelimb and human pelvic limb data revealed no significant difference in spindle density between antigravity and non-antigravity muscles. Furthermore, a gradual increase in spindle density from proximal to distal on the limb was not found, although spindle density was significantly higher in the intrinsic manus or pes muscles compared to more proximal limb muscles in all three species. The significant differences in spindle densities in parallel muscle combinations and in manus/pes versus proximal muscles are discussed relative to their possible role in the control of locomotion.

  7. 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.

  8. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi


    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  9. Proximal humeral fractures


    Mauro, Craig S.


    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  10. Inflammation and intracranial aneurysms: mechanisms of initiation, growth, and rupture

    Directory of Open Access Journals (Sweden)

    Peter S Amenta


    Full Text Available Outcomes following aneurysmal subarachnoid hemorrhage remain poor in many patients, despite advances in microsurgical and endovascular management. Consequently, considerable effort has been placed in determining the mechanisms of aneurysm formation, growth, and rupture. Various environmental and genetic factors are implicated as key components in the aneurysm pathogenesis. Currently, sufficient evidence exists to incriminate the inflammatory response as the common pathway leading to aneurysm generation and rupture. Central to this model is the interaction between the vessel wall and inflammatory cells. Dysfunction of the endothelium and vascular smooth muscle cells (VSMCs promotes a chronic pathological inflammatory response that progressively weakens the vessel wall. We review the literature pertaining to the cellular and chemical mechanisms of inflammation that contribute to aneurysm development. Hemodynamic stress and alterations in blood flow are discussed regarding their role in promoting chronic inflammation. Endothelial cell and VSMC dysfunction are examined concerning vascular remodeling. The contribution of inflammatory cytokines, especially tumor necrosis factor-α is illustrated. Inflammatory cell infiltration, particularly macrophage-mediated deterioration of vascular integrity, is reviewed. We discuss the inflammation as a means to determine aneurysms at greatest risk of rupture. Finally, future therapeutic implications of pharmacologic modulation of the inflammation are discussed.

  11. 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...

  12. Proximate, Vitamins and Mineral Composition of Vitex doniana ...

    African Journals Online (AJOL)

    Keywords: Vitex doniana, micronutrients, proximate, vitamins and mineral composition, Fruit. ... Vitamin B2 and Spectrophotometric method for. Vitamin B6, while titremetric method was used for Vitamin C. Mineral content: Mineral analysis was carried out after sample .... to calcium for bone, teeth and muscles growth.

  13. 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...

  14. Distribution, density, and structure of muscle spindles in the vastus intermedius and the peroneus longus muscles of sheep. (United States)

    Watanabe, K; Suzuki, A


    Muscle spindles are not always distributed more in postural muscles with many slow-twitch-oxidative (SO) myofibers than in locomotory muscles with few SO myofibers. The purpose of present study was to examine the distribution, density, and structure of muscle spindles in the vastus intermedius muscle: an antigravity muscle and the peroneus longus muscle: a locomotory muscle in the sheep. Muscle spindles were reconstructed from serial sections at 300 microns intervals throughout the muscles. Myofiber types were classified into SO, fast-twitch-oxidative-glycolytic, and fast-twitch-glycolytic myofibers by differences in histochemical reactivity. No significant difference in the density of muscle spindles (DMS) existed between the vastus intermedius (DMS: 5.3) and peroneus longus (DMS: 5.7) muscles. The muscle spindles were distributed more in the distal portion than in the proximal portion of the vastus intermedius muscle. The muscle spindles were distributed in the proximal and middle portion but hardly in the distal portion of the peroneus longus muscle. Muscle spindles were classified into simple, tandem, and compound muscle spindles. Most of the muscle spindles were the simple type. The differences in size of the muscle spindle and numbers of the intrafusal myofibers were not significant between the two muscles. The results show that the density and structure of the muscle spindles do not differ between the postural and locomotory muscles in the sheep.

  15. The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb. (United States)

    Boesmueller, Sandra; Huf, Wolfgang; Rettl, Gregor; Dahm, Falko; Meznik, Alexander; Muschitz, Gabriela; Kitzinger, Hugo; Bukaty, Adam; Fialka, Christian; Vierhapper, Martin


    Although sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL. This study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis. In total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9-90 years). Taking into account the effects of sex on trauma intensity (ptrauma intensity on rupture site (ptrauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site. The results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.

  16. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation

    Directory of Open Access Journals (Sweden)

    Wurl Peter


    Full Text Available Abstract Cough can be associated with many complications. In this article, we present a 59 year old male patient with a very rare combination of a cough related stress fracture of the ninth rib, a traumatic rupture of the diaphragm, and an abdominal wall herniation. The hernia was repaired through surgical treatment without bowel resection, the diaphragm and the internal and oblique abdominal muscle were adapted, and the abdomen was reinforced with a prolene net. Although each individual injury is well documented in the literature, the combination of rib fracture, abdominal herniation and diaphragm rupture has not been reported.

  17. Spontaneous rupture of the urinary bladder in a woman with radiation cystitis. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kurizaki, Yoshiki; Ishizuka, Osamu [Kofu Municipal Hospital, Yamanashi (Japan)


    A 79-year-old woman was admitted to our hospital with gross hematuria and abdominal pain. She had had a uterine cancer 11 years previously and received 56 Gy {sup 60}Co external irradiation combined with 129 Gy {sup 137}Cs internal irradiation. She had a sign of pan-peritonitis. An emergency operation revealed an intraperitoneal rupture of the dome of the urinary bladder 8 cm in length. Because a primary suturing of the bladder wall was unsuccessful, bilateral cutaneous ureterostomy was performed. Histologically, the ruptured bladder wall showed a mucosal erosion and fibrosis of the muscle layer. (author)

  18. 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.

  19. Treatment of acute achilles tendon rupture with the panda rope bridge technique. (United States)

    Yin, Liangjun; Wu, Yahong; Ren, Changsong; Wang, Yizhong; Fu, Ting; Cheng, Xiangjun; Li, Ruidong; Nie, Mao; Mu, Yuan


    Although nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described. Patient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively. PBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6. The PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. Rupture Properties of Blood Vessel Walls Measured by Pressure-Imposed Test (United States)

    Ohashi, Toshiro; Sugita, Syukei; Matsumoto, Takeo; Kumagai, Kiichiro; Akimoto, Hiroji; Tabayashi, Koichi; Sato, Masaaki

    It is expected to be clinically useful to know the mechanical properties of human aortic aneurysms in assessing the potential for aneurysm rupture. For this purpose, a newly designed experimental setup was fabricated to measure the rupture properties of blood vessel walls. A square specimen of porcine thoracic aortas is inflated by air pressure at a rate of 10mmHg/s (≈1.3MPa/s) until rupture occurs. Mean breaking stress was 1.8±0.4 MPa (mean±SD) for the specimens proximal to the heart and 2.3±0.8MPa for the distal specimens, which are not significantly different to those values obtained longitudinally from conventional tensile tests. Moreover, the local breaking stretch ratio in the longitudinal direction was significantly higher at the ruptured site (2.7±0.5) than at the unruptured site (2.2±0.4). This testing system for studying the rupture properties of aortic walls is expected to be applicable to aortic aneurysms. Experimental verification of the present technique for the homogeneous, isotropic material is also presented.

  1. Evaluation of surface blood flow in intact and ruptured canine cruciate ligaments using laser Doppler flowmetry. (United States)

    Testuz, Joakim; Howard, Judith; Pozzi, Antonio; Rytz, Ulrich; Krudewig, Christiane; Spreng, David; Forterre, Simone


    To evaluate the usefulness of laser Doppler flowmetry (LDF) to measure surface blood flow in canine cruciate ligaments, compare measurements in different sites of intact and partially ruptured canine cranial cruciate ligaments (CrCL) and intact caudal cruciate ligaments (CaCL), and investigate any association between surface blood flow in partially ruptured CrCL and synovitis or duration of clinical signs. Case-controlled clinical study. Sixteen dogs with partially ruptured CrCL and five dogs with intact CrCL. Blood cell flux (BCF) readings during three measurement cycles using LDF at two sites in each ligament (mid-substance and the distal portion of the CrCL, and mid-substance and the proximal portion of the CaCL) were recorded. Synovial changes were graded grossly and histologically using the Osteoarthritis Research Society International histopathology scoring system. The within-run coefficients of variation (CV) for a single BCF measurement cycle were 12.2% and 12.7% in the ruptured and intact CrCL groups, respectively. The between-run CV for three measurement cycles was 20.8% and 14.8%, respectively. The intraclass correlation coefficient (ICC, absolute agreement) was 0.66 for a single measurement cycle and 0.86 for the average of three cycles. No difference in average BCF readings was found between any two sites in either group, but BCF readings in both CrCL sites were significantly higher in the ruptured CrCL group than the intact CrCL group. No associations between BCF and synovial grades or duration of lameness were identified. Laser Doppler flowmetry can be used to assess surface blood flow in intact and partially ruptured canine cruciate ligaments with acceptable precision. Using this method, surface blood flow appears greater in partially ruptured canine CrCL than intact CrCL. Further studies are required to determine if this is a sequela of trauma or synovitis.

  2. Chronic Achilles Tendon Rupture Reconstructed With Achilles Tendon Allograft and Xenograft Combination. (United States)

    Hollawell, Shane; Baione, William


    More than 20% of acute Achilles tendon injuries are misdiagnosed, leading to chronic or neglected ruptures. Some controversy exists regarding how to best manage an acute Achilles tendon rupture. However, a general consensus has been reached that chronic rupture with ≥3 cm of separation is associated with functional morbidity and, therefore, should be managed operatively. It has been demonstrated that the functional outcomes of surgically treated Achilles ruptures are superior to the nonoperative outcomes in a chronic setting. In the present report, we reviewed 4 patients with chronic Achilles tendon ruptures that were successfully treated with an Achilles tendon interposition allograft and simultaneous augmentation with a xenograft. The median duration of rupture was 11 (range 8 to 16) weeks, the median gap between the proximal and distal segments of the tendon was 4.75 (range 3.5 to 6) cm, and the patients were able to return pain-free to all preinjury activities at a median of 14.5 (range 13.8 to 15.5) weeks, without the need for tendon transfer, lengthening, or additional intervention. The median duration of follow up was 37.25 (range 15.25 to 51.5) months, at which point the mean Foot and Ankle Outcomes Instrument core scale score was 97 ± 1 (mean normative score 53 ± 1), and the Foot and Ankle Outcomes Instrument shoe comfort core scale score was 100 ± 0 (mean normative score 59 ± 0). The combined Achilles allograft plus xenograft augmentation technique appears to be a reasonable option for the surgical treatment of chronic Achilles tendon rupture. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. 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 ...

  4. 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.

  5. 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.

  6. 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....

  7. 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.

  8. 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 ...

  9. 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 ...

  10. 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.

  11. [Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)]. (United States)

    Blum, Jochen; Hansen, Matthias; Rommens, Pol Maria


    Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. Unstabile two- and three-part fractures of the proximal humerus (AO classification: 11-A2, 11-A3, 11-B1, 11-B2, 11-B3). Subcapital nonunion of the humerus. Pathologic fractures. Pediatric fractures of the proximal humerus. Fractures of the proximal humerus types 11-C2 und 11-C3 according to the AO classification. Active local infection, e.g., after former operation. Closed reduction. Anterior acromial incision, splitting of the deltoid muscle and the rotator cuff. Opening of the medullary canal with the awl. Nail introduction. Spiral blade introduction in cannulated technique through stab incision. Distal interlocking through aiming device, angle-stable blocking of nail and blade through end cap. Postoperative fixation in Gilchrist sling until 2nd postoperative day; then physiotherapy respecting fracture type and stability, local swelling, patient's age and compliance, and concomitant injuries. 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.

  12. [A case of strangulated congenital diaphragmatic hernia with necrosis and rupture of the colon and herniation into a left hemithorax in an adult (author's transl)]. (United States)

    Sarris, M; Georgoulis, J; Gatos, M; Dariotis, A

    This is a case report of a successful repair of congenital diaphragmatic hernia in a 48 years old male that contained the transverse colon which was strangulated and ruptured in the left thoracic cavity. It was approached in two stages. First through a laparotomy the proximal part of the transverse colon was divided. The side going to the hernial sac was sutured and the proximal stump was anastomosed to the descending colon. In a second stage, two days later, through a felt thoracotomy the strangulated and ruptured colon was resected and the distal stump of the transverse colon was sutured and the hernia repaired.

  13. 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

  14. 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.

  15. Some Properties of Fuzzy Soft Proximity Spaces (United States)

    Demir, İzzettin; Özbakır, Oya Bedre


    We study the fuzzy soft proximity spaces in Katsaras's sense. First, we show how a fuzzy soft topology is derived from a fuzzy soft proximity. Also, we define the notion of fuzzy soft δ-neighborhood in the fuzzy soft proximity space which offers an alternative approach to the study of fuzzy soft proximity spaces. Later, we obtain the initial fuzzy soft proximity determined by a family of fuzzy soft proximities. Finally, we investigate relationship between fuzzy soft proximities and proximities. PMID:25793224

  16. Muscle atrophy (United States)

    Muscle wasting; Wasting; Atrophy of the muscles ... There are two types of muscle atrophy: disuse and neurogenic. Disuse atrophy is caused by not using the muscles enough . This type of atrophy can often be ...

  17. Muscle Disorders (United States)

    Your muscles help you move and help your body work. Different types of muscles have different jobs. There are many problems that can affect muscles. Muscle disorders can cause weakness, pain or even ...

  18. Muscle Cramps (United States)

    Muscle cramps are sudden, involuntary contractions or spasms in one or more of your muscles. They often occur after exercise or at night, ... to several minutes. It is a very common muscle problem. Muscle cramps can be caused by nerves ...


    Directory of Open Access Journals (Sweden)

    Ion Dorin BUMBENECI


    Full Text Available The purpose of this study is to evaluate the level of assimilation for the terms "Proximity Management" and "Proximity Manager", both in the specialized literature and in practice. The study has two parts: the theoretical research of the two terms, and an evaluation of the use of Proximity management in 32 companies in Gorj, Romania. The object of the evaluation resides in 27 companies with less than 50 employees and 5 companies with more than 50 employees.

  20. [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.

  1. 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.

  2. Morphometric Properties of the Thoracic Aorta of Warmblood and Friesian Horses with and without Aortic Rupture. (United States)

    Saey, V; Ploeg, M; Delesalle, C; van Loon, G; Gröne, A; Ducatelle, R; Duchateau, L; Chiers, K


    Rupture of the aorta is much more common in Friesians compared with other breeds of horse. Rupture always occurs adjacent to the scar of the ligamentum arteriosum. Previous histological examination of ruptured aortic walls suggested the presence of an underlying connective tissue disorder. Therefore, the aim of the present study was to compare the structural characteristics of the tunica media of the mid-thoracic aorta, distant to the lesion, in warmblood and Friesian horses with and without thoracic aortic rupture. In unaffected Friesian horses, the thickness of the tunica media, as well as the percentage area comprised of collagen type I, were significantly higher compared with the warmblood horses, supporting the hypothesis of a primary collagen disorder in the Friesian horse breed. However, in the tunica media of the affected Friesian horses there was no significant wall thickening. Moreover, the percentage area comprised of elastin was significantly lower, while the percentage area comprised of smooth muscle was higher, compared with unaffected Friesian and warmblood horses. These lesions are suggestive of an additional mild elastin deficiency with compensatory smooth muscle cell hypertrophy in affected Friesians. Copyright © 2016. Published by Elsevier Ltd.

  3. Thoracic aortic rupture and aortopulmonary fistulation in the Friesian horse: histomorphologic characterization. (United States)

    Ploeg, M; Saey, V; Delesalle, C; Gröne, A; Ducatelle, R; de Bruijn, M; Back, W; van Weeren, P R; van Loon, G; Chiers, K


    Aortic rupture in horses is a rare condition. Although it is relatively common in the Friesian breed, only limited histopathologic information is available. Twenty Friesian horses (1-10 years old) were diagnosed with aortic rupture by postmortem examination. Ruptured aortic walls were analyzed with histology and immunohistochemistry. Based on the histologic and immunohistochemical findings, these cases were divided into 3 groups: acute (n = 4, 20%), subacute (n = 8, 40%), and chronic (n = 8, 40%). Features common to samples from horses in all groups included accumulation of mucoid material; disorganization and fragmentation of the elastic laminae; aortic medial smooth muscle hypertrophy; and medial necrosis of varying degrees, ranging from mild and patchy in the acute cases to severe midzonal necrosis in the chronic cases. Inflammation, most likely secondary to medial necrosis, varied from predominantly neutrophilic infiltrates in the media and periadventitial tissue in the acute group to the presence of mainly hemosiderophages in the periadventitial tissue in the chronic group. Medial fibrosis with aberrant collagen morphology was seen in the subacute group and, more commonly, in the chronic group. Only minimal changes were seen in the aortic vasa vasorum. Smooth muscle hypertrophy and accumulation of mucoid material were not related to the age of the lesions. The findings of this study suggest that a connective tissue disorder affecting elastin or collagen in the aortic media is potentially the underlying cause of aortic rupture in Friesian horses. © The Author(s) 2014.

  4. 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

  5. Biomechanical and biochemical properties of the thoracic aorta in warmblood horses, Friesian horses, and Friesians with aortic rupture. (United States)

    Saey, Veronique; Famaey, Nele; Smoljkic, Marija; Claeys, Erik; van Loon, Gunther; Ducatelle, Richard; Ploeg, Margreet; Delesalle, Catherine; Gröne, Andrea; Duchateau, Luc; Chiers, Koen


    Thoracic aortic rupture and aortopulmonary fistulation are rare conditions in horses. It mainly affects Friesian horses. Intrinsic differences in biomechanical properties of the aortic wall might predispose this breed. The biomechanical and biochemical properties of the thoracic aorta were characterized in warmblood horses, unaffected Friesian horses and Friesians with aortic rupture in an attempt to unravel the underlying pathogenesis of aortic rupture in Friesian horses. Samples of the thoracic aorta at the ligamentum arteriosum (LA), mid thoracic aorta (T1) and distal thoracic aorta (T2) were obtained from Friesian horses with aortic rupture (A), nonaffected Friesian (NA) and warmblood horses (WB). The biomechanical properties of these samples were determined using uniaxial tensile and rupture assays. The percentages of collagen and elastin (mg/mg dry weight) were quantified. Data revealed no significant biomechanical nor biochemical differences among the different groups of horses. The distal thoracic aorta displayed an increased stiffness associated with a higher collagen percentage in this area and a higher load-bearing capacity compared to the more proximal segments. Our findings match reported findings in other animal species. Study results did not provide evidence that the predisposition of the Friesian horse breed for aortic rupture can be attributed to altered biomechanical properties of the aortic wall.

  6. Induction of atherosclerotic plaque rupture in apolipoprotein E-/- mice after adenovirus-mediated transfer of p53

    NARCIS (Netherlands)

    Thüsen, J.H. von der; Vlijmen, B.J.M. van; Hoeben, R.C.; Kockx, M.M.; Havekes, L.M.; Berkel, T.J.C. van; Biessen, E.A.L.


    Background - The presence of the tumor-suppressor gene p53 in advanced atherosclerotic plaques and the sensitivity to p53-induced cell death of smooth muscle cells isolated from these plaques have fueled speculation about the role of p53 in lesion destabilization and plaque rupture. In this study,

  7. 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...

  8. Spontaneous rupture of ovarian cystadenocarcinoma: pre- and post-rupture computed tomography evaluation

    Energy Technology Data Exchange (ETDEWEB)

    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)

  9. Right Diaphragm Spontaneous Rupture: A Surgical Approach

    Directory of Open Access Journals (Sweden)

    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.

  10. Ruptured Hydatid Cyst with an Unusual Presentation

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. 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…

  13. 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....

  14. Blunt cardiac rupture in a toddler

    Directory of Open Access Journals (Sweden)

    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.

  15. Bronchial and cardiac ruptures due to blunt trauma. (United States)

    Misao, Takahiko; Yoshikawa, Takeshi; Aoe, Motoi; Iga, Norichika; Furukawa, Masashi; Suezawa, Takanori; Tago, Mamoru


    Tracheobronchial and cardiac injuries following blunt thoracic trauma are uncommon but can be life-threatening. We report a case in which the patient with bronchial and right atrial ruptures due to blunt trauma survived after emergent repairs. An 18-year-old female driver was transported to our hospital after a traffic accident and was hemodynamically stable on arrival. Chest computed tomography revealed cervicomediastinal emphysema and hemopericardium, and fiberoptic bronchoscopy showed a tear in the right main bronchus. She was intubated with a double-lumen endotracheal tube guided by bronchoscopy. A median sternotomy was undertaken, and a laceration of the right atrium was oversewn without the use of cardiopulmonary bypass. After that, right-sided thoracotomy was performed. The tear in the membranous portion of the right main bronchus was repaired with interrupted sutures, and the suture lines were wrapped with a pedicled flap of intercostal muscle.

  16. 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.

  17. Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment. (United States)

    Cebral, J R; Mut, F; Raschi, M; Scrivano, E; Ceratto, R; Lylyk, P; Putman, C M


    Flow-diverting approaches to intracranial aneurysm treatment had many promising early results, but recent apparently successful treatments have been complicated by later aneurysm hemorrhage. We analyzed 7 cases of aneurysms treated with flow diversion to explore the possible rupture mechanisms. CFD analysis of pre- and posttreatment conditions was performed on 3 giant aneurysms that ruptured after treatment and 4 successfully treated aneurysms. Pre- and posttreatment hemodynamics were compared including WSS, relative blood flows, vascular resistances, and pressures, to identify the effects of flow-diverter placements. Expected reductions in aneurysm velocity and WSS were obtained, indicating effective flow diversion from the sac into the parent artery, consistent with periprocedural observations. In each case with postaneurysm rupture, the result of flow diversion led to an increase in pressure within the aneurysm. This pressure increase is related to larger effective resistance in the parent artery from placement of the devices and, in 2 cases, the reduction of a preaneurysm stenosis. Flow-diversion devices can cause intra-aneurysmal pressure increases, which can potentially lead to rupture, especially for giant aneurysms. This relates both to changes in the parent artery configuration, such as reduction of a proximal stenosis, and to the flow diversion into higher resistance parent artery pathways combined with cerebral autoregulation, leading to higher pressure gradients. These may be important effects that should be considered when planning interventions. Potentially dangerous cases could be identified with angiography and/or patient-specific CFD models.

  18. Proximal Limb Weakness Reverting After CSF Diversion In Intracranial Hypertension

    Directory of Open Access Journals (Sweden)

    Sinha S


    Full Text Available We report about two young girls who developed progressive visual failure secondary to increased intracranial pressure and had significant proximal muscle weakness of limbs. Patients with elevated intracranial pressure (ICP may present with "false localizing signs", besides having headache, vomiting and papilledema. Radicular pain as a manifestation of raised ICP is rare and motor weakness attributable to polyradiculopathy is exceptional. Two patients with increased intracranial pressure without lateralizing signs′ had singnificant muscle weakness. Clinical evaluation and laboratory tests did not disclose any other cause for weakness. Following theco-peritoneal shunt, in both patients, there was variable recovery of vision but the proximal weakness and symptoms of elevated ICP improved rapidly. Recognition of this uncommon manifestation of raised ICP may obviate the need for unnecessary investigation and reduce morbidity due to weakness by CSF diversion procedure.


    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

  20. Proximal femoral osteotomy in cerebral palsy. (United States)

    Tylkowski, C M; Rosenthal, R K; Simon, S R


    The purpose of this study was to examine the results of the proximal femoral osteotomy for the management of hip deformity in 32 children, aged 4 to 15 years. Twenty-two bilateral and ten unilateral procedures were performed. The indications for surgery were subluxation in 16, dislocation in two, and intoeing and femoral anteversion in 14. The average follow-up was two years and 11 months. CE angle of Wiberg, acetabular index and neck shaft angle were evaluated. The average time to regain preoperative ambulatory status was six months with intensive physical therapy. In osteotomies performed for subluxation, dislocation did not occur; roentgenographic indices showed variability in the degree of subluxation. Osteotomy performed in children older than 8 years of age produced no evidence of acetabular remodeling. THere was no recurrence with osteotomies for dislocation. In those patients with internal rotation gait, improvement resulted. Complications were few and minor. Hip dislocation in children with progressive subluxation, in spite of previous soft-tissue releases, is preventable by proximal femoral osteotomy. The inability of the roentgenographic indices to quantitate the increased stability indicates the procedure's major effect is to realign muscle forces about the hip. Treatment of the intoeing gait produced improvement of rotational deformity.

  1. A Prospective Study of Platelet-Rich Plasma as Biological Augmentation for Acute Achilles Tendon Rupture Repair

    Directory of Open Access Journals (Sweden)

    Jian Zou


    Full Text Available Acute Achilles tendon rupture is one of the most common tendon injuries in adults. We hypothesized that Platelet-Rich Plasma (PRP can be used as biological augmentation for surgical treatment of acute Achilles tendon rupture. Our study is a prospective randomized controlled trial. Patients with acute Achilles tendon rupture undergoing surgical repair were randomly assigned into either control group or PRP group. End-to-end modified Krackow suture was performed in both groups. In the PRP group, PRP was injected into the paratenon sheath and around the ruptured tissue after the tendon was repaired. Postoperatively we evaluated isokinetic muscle strength at 3, 6, 12, and 24 months. In addition, ankle ROM, calf circumference, Leppilahti score, and the SF-36 score were evaluated at 6, 12, and 24 months after operation. At 3 months, the PRP group had better isokinetic muscle. The PRP group also achieved higher SF-36 and Leppilahti scores at 6 and 12 months. At 24 months, the PRP group had an improved ankle range of motion compared to the control group. Our study results suggest that PRP can serve as a biological augmentation to acute Achilles tendon rupture repair and improves both short and midterm functional outcomes.

  2. Changes in geometry of actively shortening unipennate rat gastrocnemius muscle

    NARCIS (Netherlands)

    Zuurbier, C. J.; Huijing, P. A.


    Muscle geometry of the unipennate medial gastrocnemius (GM) muscle of the rat was examined with photographic techniques during isometric contractions at different muscle lengths. It was found that the length of fibers in different regions of GM differs significantly, and proximal aponeurosis length

  3. Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

    DEFF Research Database (Denmark)

    Kreiner, Frederik; Langberg, Henning; Galbo, Henrik


    Polymyalgia rheumatica (PMR) is characterized by aching of the proximal muscles and increased blood levels of markers of inflammation. Despite the muscle complaints, the current view is that symptoms are caused by inflammation in synovial structures. The purpose of this study was to elucidate the...... the disease mechanisms in symptomatic muscles by measuring interstitial levels of cytokines before and after prednisolone treatment....

  4. Muscle Deoxygenation Causes Muscle Fatigue (United States)

    Murthy, G.; Hargens, A. R.; Lehman, S.; Rempel, D.


    Muscle fatigue is a common musculoskeletal disorder in the work place, and may be a harbinger for more disabling cumulative trauma disorders. Although the cause of fatigue is multifactorial, reduced blood flow and muscle oxygenation may be the primary factor in causing muscle fatigue during low intensity muscle exertion. Muscle fatigue is defined as a reduction in muscle force production, and also occurs among astronauts who are subjected to postural constraints while performing lengthy, repetitive tasks. The objectives of this research are to: 1) develop an objective tool to study the role of decreased muscle oxygenation on muscle force production, and 2) to evaluate muscle fatigue during prolonged glovebox work.

  5. The roentgenographic findings of achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

    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.

  6. Muscle disorder (United States)

    Myopathic changes; Myopathy; Muscle problem ... Blood tests sometimes show abnormally high muscle enzymes. If a muscle disorder might also affect other family members, genetic testing may be done. When someone has symptoms and signs ...

  7. 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.

  8. 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.

  9. Bilateraly Diaphragmatic Traumatic Rupture with Delayed and Liver Herniation of Right Diaphragmatic Rupture

    Directory of Open Access Journals (Sweden)

    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.

  10. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig


    . The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis......Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate...

  11. The infrastructure of psychological proximity

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt


    ). The experience of psychological proximity between patient and nurse is provided through confidence, continuity and the practical set-up. This constitutes an important enactment of skillfulness, which may render telemedicine a convincing health service in the future. Methodology: The study draws on a pilot...... (Langstrup & Winthereik 2008). This study contributes by showing the infrastructure of psychological proximity, which is provided by way of device, confidence, continuity and accountability....

  12. [Biomechanical effect of anterior lower tibiofibular ligament rupture on tibiotalar articular surface]. (United States)

    Huang, Yun-Peng; Wang, Bin; Li, Jing-Nian; Ma, Yan; Li, Sheng


    To investigate the changes between pressure of trochlea of talus surface and distribution of area after anterior lower tibiofibular ligament rupture, and provide basis for treating anterior lower tibiofibular ligament rupture. Six fresh adult ankle joint specimens (4 males and 2 females, ranging age from 25 to 60 years, with an average of 44.6 years) were adopted. The specimens were removed from skin and muscles, remained ankle joint capsule, medial and lateral ligaments and anteroinferior tibiofibular ligament. The ankle joint was fixed with a special fixture in neutral position. Pressure sensitive film (700 N axial load ) was respectively used to measure mean pressure, peak pressure and stress distribution area of the upper articular facet of talar trochlea of the normal ankle joint and the ankle joint with anterioinferior tibiofibular ligament rupture. The stress distribution areas of the control group and the ruptured group were respectively (367.8 +/- 54.0) mm2 and (386.0 +/- 53.7) mm2; the mean pressures were respectively (1.40 +/- 0.12) MPa and (1.70 +/- 0.35) MPa; the peak pressures were respectively (2.60 +/- 0.33) MPa and (3.20 +/- 0.32) MPa. The experimental results showed that the change in stress distribution area after anterioinferior tibiofibular ligament rupture was not significant (t = 0.021, P = -0.983). When stress distribution changed, the region of stress concentration transferred to poster lateral,and mean pressure (t = 4.140, P = 0.020) and peak pressure (t = 3.169, P = 0.010) increased significantly. When anterior lower tibiofibular ligament rupture occurs, mean pressure,peak pressure and stress distribution of pressure of trochlea of talus surface is changed, which may cause traumatic arthritis, and surgical treatment is considerably used to restore normal anatomy.

  13. 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.

  14. Extramuscular myofascial force transmission within the rat anterior tibial compartment: Proximodistal differences in muscle force

    NARCIS (Netherlands)

    Huijing, P.A.J.B.M.; Baan, G.C.


    Intramuscular connective tissues are continuous to extramuscular connective tissues. If force is transmitted there, differences should be present between force at proximal and distal attachments of muscles. Extensor digitorum longus (EDL), tibialis anterior (TA), and extensor hallucis longus muscles

  15. Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Azarine, A.; Lions, C.; Beregi, J.P. [Dept. of Vascular Surgery, Hopital Cardiologique, CHRU de Lille (France); Koussa, M. [Dept. of Vascular Radiology, Hopital Cardiologique, CHRU de Lille (France)


    A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation. (orig.)

  16. Ruptured penetrating ulcer of the ascending aorta with pulmonary artery compression. (United States)

    Okiwelu, Ngozichukwuka; Finn, Chris; Vanden Driesen, Rohan; Sanders, Lucas; Joshi, Pragnesh


    Pulmonary artery involvement has been reported in various degrees of complicated dissection of the ascending aorta. The prognosis remains poor without high-risk surgical intervention, but conservative management can be considered in high-risk cases. We report a case of nonoperative management of an octogenarian who presented with a contained rupture of his proximal ascending aorta, likely from a penetrating atherosclerotic ulcer. It was complicated by extrinsic compression of the pulmonary trunk and transient pulmonary hypertension without features of acute right heart failure. He remained alive at the one-year follow-up. © The Author(s) 2014.

  17. 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.

  18. 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.

  19. 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.)

  20. 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.

  1. 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.

  2. 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


    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.

  4. 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.


    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.

  6. Development of digastric muscles in human fetuses: a review and findings in the flexor digitorum superficialis muscle. (United States)

    Rodríguez-Vázquez, José Francisco; Jin, Zhe Wu; Zhao, Peng; Murakami, Gen; Li, Xiang Wu; Jin, Yu


    The digastricus and omohyoideus muscles are digastric muscles with two muscle bellies. An insertion tendon of the posterior belly becomes an intermediate tendon in digastricus muscles, whereas a single band-like muscle in omohyoideus muscles may later be interrupted by an intermediate tendon, possibly due to muscle cell death caused by mechanical stress. In human fetuses, an intermediate tendon provides the temporal origins of the tensor veli palatini and tensor tympani muscles. Some reptiles, including snakes, carry multiple series of digastric-like axial muscles, in which each intersegmental septum is likely to become an intermediate tendon. These findings indicate that many pathways are involved in the development of digastric muscles. A review of these morphologies suggested that the flexor digitorum superficialis (FDS) muscle was a digastric muscle, although the intermediate tendon may not be visible in the surface view in adults. The present observations support the hypothesis that the proximal anlage at the elbow develops into a deep muscle slip to a limited finger, while the distal anlage at the wrist develops into the other slips. The findings suggest that, in the FDS muscle, the proximal and distal bellies of the embryonic digastric muscle fuse together to form a laminar structure, in which muscle slips accumulate from the palmar to the deep side of the forearm.

  7. Cubesat Proximity Operations Demonstration (CPOD) (United States)

    Villa, Marco; Martinez, Andres; Petro, Andrew


    The CubeSat Proximity Operations Demonstration (CPOD) project will demonstrate rendezvous, proximity operations and docking (RPOD) using two 3-unit (3U) CubeSats. Each CubeSat is a satellite with the dimensions 4 inches x 4 inches x 13 inches (10 centimeters x 10 centimeters x 33 centimeters) and weighing approximately 11 pounds (5 kilograms). This flight demonstration will validate and characterize many new miniature low-power proximity operations technologies applicable to future missions. This mission will advance the state of the art in nanosatellite attitude determination,navigation and control systems, in addition to demonstrating relative navigation capabilities.The two CPOD satellites are scheduled to be launched together to low-Earth orbit no earlier than Dec. 1, 2015.

  8. Morphology of peroneus tertius muscle. (United States)

    Joshi, S D; Joshi, S S; Athavale, S A


    Peroneus tertius (PT) muscle is peculiar to man, and man is the only member among the primates in whom this muscle occurs. The muscle is variable in its development and attachment. Because of functional demands of bipedal gait and plantigrade foot, part of extensor digitorum brevis (EDB) has migrated upwards into the leg from the dorsum of foot. PT is a muscle that evolution is rendering more important. In a total of 110 cadavers, extensor compartment of leg and dorsum of foot were dissected in both the lower limbs and extensor digitorum longus (EDL), and PT muscles were dissected and displayed. PT was found to be absent in 10.5% limbs, the incidence being greater on the right side. The remaining limbs in which the PT muscle was present had a very extensive origin from lower 3/4th of extensor surface of fibula (20% on right and in 17% on left), and the EDL was very much reduced in size. In approximately 12%, the tendon of PT was thick or even thicker than the tendon of EDL. In 4%, the tendon extended beyond fifth metatarsal up to metatarsophalangeal joint of fifth toe, and in 1.5%, it extended up to the proximal phalanx of little toe. In two cases (both on the right side), where PT was absent, it was replaced by a slip from lateral margin of EDL. We conclude that PT, which is preeminently human, is extending its purchase both proximally and distally. Copyright 2006 Wiley-Liss, Inc.

  9. Open splenectomy for Varicella zoster induced spontaneous splenic rupture

    Directory of Open Access Journals (Sweden)

    Mark Christopher Sykes


    Conclusion: Atraumatic splenic rupture should be considered as an important differential in those presenting with abdominal pain and peritonism without a history of preceding trauma. Haematological and infectious diagnoses should be sought to identify causation for the splenic rupture.

  10. Kinesio taping effect on biceps brachii muscle strength


    Králová Dagmar; Novotný Jan; Řezaninová Jana


    This work aimed at presenting the idea of inventor Dr. Kenzo Kase that kinesio tape application with proximal base leads to muscle contraction facilitation and application with distal base leads to muscle contraction inhibition. Twenty male volleyball players with the dominant shoulder girdle muscle imbalance between the ages of 25 and 30 participated in this study. There were compared two techniques which were placed on biceps brachii muscle in shoulder and elbow joint extension. Isokinetic ...

  11. Isolated gallbladder rupture following blunt abdominal injury

    African Journals Online (AJOL)


    May 26, 2015 ... A retrospective review consisting of. 1449 patients reported the incidence around 0.067%.[3]. Here, we presented a case of isolated gallbladder rupture following a blunt abdominal injury. Case Report. A 39‑year‑old man with history of cholelithiasis, alcoholism‑related liver cirrhosis, and chronic pancreatitis.

  12. Post Operative Miscarriage Following Ruptured Appendix in ...

    African Journals Online (AJOL)

    Intraoperative findings were purulent peritoneal exudates, ruptured appendix with flakes of necrotic tissues and fecolith. She subsequently had post operative miscarriage 48hours after the surgery which was completed by manual vacuum aspiration. She did remarkably well and was discharged on the 7th post operative ...


    Directory of Open Access Journals (Sweden)

    N. A. Koryshkov


    Full Text Available From 1998 to 2010 32 patients (14 men, 18 women, aged 15-65 years, underwent surgical treatment for old Achilles tendon rupture. In all cases correct diagnosis was made not earlier than 1 month after injury. The importance of clinical Thompson test and sonographic examination for diagnosis of Achilles tendon rupture is underlined. For the restoration of Achilles tendon V-Y plasty was used. Surgery was performed in a period of 1 to 13 months in patients with subcutaneous Achilles tendon ruptures. Follow-up results of patients in the postoperative period ranged from 6 months to 10 years (mean follow-up 1 year 7 months. Date of observation in the postoperative period ranged from 6 months to 19 years. Marginal necrosis wound occurred in 3 (10% patients, re-rupture of the Achilles tendon to tendon suture zone - in one patient, even in one patient on day 14 became infected. Violations of the foot innervation were no detected.

  14. Surgical management of spontaneous ruptured hepatocellular adenoma

    Directory of Open Access Journals (Sweden)

    Marcelo Augusto Fontenelle Ribeiro Junior


    Full Text Available AIMS: Spontaneous ruptured hepatocellular adenoma (SRHA is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS: We reviewed medical records and radiology files of 28 patients (from 1989 to 2006 with a proven diagnosis of hepatocellular adenoma (HA. Three (10.7% of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS: The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation, as well as intraperitoneal abscess (re-operation and pleural effusion. CONCLUSION: Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.

  15. Treatment Alternative for Irreparable Rotator Cuff Ruptures ...

    African Journals Online (AJOL)


    Sep 3, 2016 ... tendon to repair has decreased and patient has severe pain. Biodegradable balloon is one of the newest methods for the treatment of irreparable massive rotator cuff ruptures. Objective: The aim of this study was to assess shoulder function in the patients who underwent biodegradable balloon procedure ...

  16. Case report: Traumatic unilateral testicular rupture

    Directory of Open Access Journals (Sweden)

    Natasha J.G. Bauer


    Conclusion: Emergency assessment and diagnosis as well as scrotal exploration are important components of the management of acute testicular rupture. Analysis of the literature proves that timely surgical intervention is crucial; early intervention results in higher rates of preservation and avoids the need for an orchidectomy.

  17. Medial ankle pain after lateral ligament rupture

    NARCIS (Netherlands)

    van Dijk, C. N.; Bossuyt, P. M.; Marti, R. K.


    After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the

  18. 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

  19. The electrocardiogram in traumatic right atrial rupture

    NARCIS (Netherlands)

    van Veldhuisen, DJ; van den Berg, MP


    We:report the case of a previously healthy 20-year-old man who had a traumatic rupture of the right atrium. On admission an electrocardiogram (ECG) was recorded which is highly remarkable and, retrospectively, suggestive for the diagnosis. The patient died soon after the EGG, and the diagnosis was

  20. Bilateral synchronous rupture of the quadriceps tendon.

    LENUS (Irish Health Repository)

    Ellanti, P


    Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

  1. Delayed primary realignment of posterior urethral rupture

    African Journals Online (AJOL)

    Cerebral concussion. Rib fractures. Haemothorax. C/avicuIar fracture. Radial bone fracture. Knee fracture. Ankle fracture. ' Scrotal rupture. Scrotal haematoma. Perineal perforation ture. The age ranged between 17 and 55 years with the mean age of 31.58 years. The source of injury was usually violent and the mode.

  2. Diagnosis of foetal membrane ruptures: Placental alpha ...

    African Journals Online (AJOL)

    Context: Pre‑labour rupture of membranes (PROM) is a common obstetric complication which presents a diagnostic challenge, especially in equivocal cases. Standard methods of diagnosis are limited by high false positives and negatives. This study compared the accuracy of a biomarker placental alpha microglobulin‑1 ...

  3. Achilles tendon rupture as a result of oral steroid therapy. (United States)

    Hersh, Bryan L; Heath, Nicholas S


    Spontaneous Achilles tendon rupture associated with long-term oral steroid use is not uncommon, particularly in older patients who use these drugs daily to treat systemic diseases. Rupture often results in a large defect, which complicates surgical repair. The authors review Achilles tendon rupture associated with systemic and local steroid use and present a case of rupture due to chronic oral steroid use in a patient with Addison's disease.

  4. 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.

  5. Rupture of Baker's Cyst Producing Pseudothrombophlebitis in a Patient with Reiter's Syndrome

    Directory of Open Access Journals (Sweden)

    Salih Ozgocmen


    Full Text Available This is an unusual case of pseudothrombophlebitis resulting from rupture of Baker's cyst in a patient with Reiter's syndrome. The patient presented with a swollen, painful left calf and persistent itching on the skin of the calf. Ultrasonography showed a ruptured popliteal cyst with minimal hemorrhage and fluid collection within the fascial compartments and gastrocnemius muscle. Color Doppler ultrasound showed a patent popliteal vein and artery and duplex Doppler scans revealed a normal flow pattern. In conclusion, the clinical picture of deep vein thrombosis and that of pseudothrombophlebitis are difficult to distinguish by clinical examination and necessitate detailed examination by imaging techniques. Persistent pruritus on calf skin resulting from irritation of inflammatory synovial fluid may be an important clinical feature.

  6. Cigarette Smoke and Inflammation: Role in Cerebral Aneurysm Formation and Rupture

    Directory of Open Access Journals (Sweden)

    Nohra Chalouhi


    Full Text Available Smoking is an established risk factor for subarachnoid hemorrhage yet the underlying mechanisms are largely unknown. Recent data has implicated a role of inflammation in the development of cerebral aneurysms. Inflammation accompanying cigarette smoke exposure may thus be a critical pathway underlying the development, progression, and rupture of cerebral aneurysms. Various constituents of the inflammatory response appear to be involved including adhesion molecules, cytokines, reactive oxygen species, leukocytes, matrix metalloproteinases, and vascular smooth muscle cells. Characterization of the molecular basis of the inflammatory response accompanying cigarette smoke exposure will provide a rational approach for future targeted therapy. In this paper, we review the current body of knowledge implicating cigarette smoke-induced inflammation in cerebral aneurysm formation/rupture and attempt to highlight important avenues for future investigation.

  7. Case Report: Rupture of the Pregnant Uterus in an Unbooked ...

    African Journals Online (AJOL)

    Uterine rupture is a life threatening complication in pregnancy in developing countries. While multiparity is a commonly associated factor, primigravida are said to be immune to uterine rupture. We present a case of uterine rupture in an unbooked primigravida who had massive bolus doses of intravenous oxytocin in the ...

  8. Delivery of placenta before baby in ruptured uterus | Ameh | Annals ...

    African Journals Online (AJOL)

    An unusual case of ruptured uterus characterized by spontaneous delivery of the placenta while the foetus is retained in the abdomen is presented. The management and prevention of ruptured uterus in Sub- Saharan Africa is discussed. Key Words: Delivery of placenta, ruptured uterus. Annals of African Medicine Vol.3(3) ...

  9. Bilateral spontaneous rupture of flexor digitorum profundus tendons.

    LENUS (Irish Health Repository)

    O'Sullivan, S T


    Spontaneous tendon rupture is an unusual condition usually associated with underlying disease processes such as rheumatoid arthritis, chronic renal failure or bony abnormalities of the hand. We report a case of spontaneous, non-concurrent bilateral rupture of flexor profundus tendons in an otherwise healthy individual. Treatment was successful and consisted of a two-stage reconstruction of the ruptured tendon.

  10. An analysis of uterine rupture at the Nnamdi Azikiwe University ...

    African Journals Online (AJOL)


    Jul 31, 2011 ... Objective: Uterine rupture is a preventable condition which has persistently remained in our environment. The aim of this study therefore is to ascertain the incidence of uterine rupture, examine the predisposing factors and maternal and fetal outcome of patients managed of uterine rupture in a tertiary ...

  11. Radionuclide diagnosis of splenic rupture in infectious mononucleosis

    Energy Technology Data Exchange (ETDEWEB)

    Vezina, W.C.; Nicholson, R.L.; Cohen, P.; Chamberlain, M.J.


    Spontaneous splenic rupture is a rare but serious complication of infectious mononucleosis. Although radionuclide spleen imaging is a well accepted method for diagnosis of traumatic rupture, interpretation can be difficult in the setting of mononucleosis, as tears may be ill-defined and diagnosis hampered by inhomogeneous splenic uptake. Four proven cases of spontaneous rupture are presented, three of which illustrate these diagnostic problems.

  12. Challenging Friesian horse diseases : aortic rupture and megaesophagus

    NARCIS (Netherlands)

    Ploeg, M.


    Aortic rupture is quite rare in Warmblood horses and is best known as an acute and fatal rupture of the aortic root in older breeding stallions. It has now become clear that aortic rupture, which is diagnosed around an age of 4 years, is more frequent in the Friesian breed than in others. The high

  13. Isolated gallbladder rupture following blunt abdominal trauma | Gali ...

    African Journals Online (AJOL)

    The gallbladder is a relatively well‑protected organ; consequently its rupture following blunt abdominal injury is rare and usually associated with other visceral injuries. Isolated gallbladder rupture is extremely rare. We report a healthy Nigerian adult male who sustained isolated gallbladder rupture following blunt abdominal ...


    African Journals Online (AJOL)

    Preferred Customer

    SHORT COMMUNICATION. PROXIMATE COMPOSITION, MINERAL CONTENT AND ANTINUTRITIONAL. FACTORS OF SOME CAPSICUM (Capsicum annum) VARIETIES GROWN IN. ETHIOPIA. Esayas K.1, Shimelis A.2, Ashebir F.3, Negussie R.3, Tilahun B.4 and Gulelat D.4*. 1Hawassa University, Department of Food ...


    Guo, Jinhai; Huang, Fuguo


    To review the research progress of the biomechanics of proximal row carpal instability (IPRC). The related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. The muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. Some strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.

  16. Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking. (United States)

    Sarman, Hakan; Atmaca, Halil; Cakir, Ozgur; Muezzinoglu, Umit Sefa; Anik, Yonca; Memisoglu, Kaya; Baran, Tuncay; Isik, Cengiz


    Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques. Copyright © 2015 American College of Foot and Ankle

  17. Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report. (United States)

    Dacambra, Mark P; Walker, Richard Ea; Hildebrand, Kevin A


    The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a 'pop' on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single

  18. Revascularisation pattern of ruptured flexor tendon grafts in anterior cruciate ligament reconstruction: A histological study. (United States)

    Figueroa, D; Martínez, R; Calvo, R; Scheu, M; Gallegos, M; Vaisman, A; Martínez, C; González, A

    For successful anterior cruciate ligament (ACL) reconstruction, revascularisation and histological maturation are necessary, as their failure can cause graft rupture. The purpose of this study was to describe differences in the histological maturation of early failed plasty (less than 12 months after surgery) and late failed plasty (more than 12 months after surgery) in patients with re-rupture after ACL reconstruction with hamstring tendons. A descriptive observational study was conducted on a consecutive series of 20 patients whose ACL reconstruction had failed. Graft biopsy samples were obtained during the revision surgery from the proximal, medial, and distal graft remnants. The samples were evaluated by light microscopy, and the vascularity and maturation of the samples were established by histological scoring. The most common aetiology of reconstruction failure (86.6%) was a specific event with non-contact mechanism. The patients with re-rupture of their ACL plasty less than 12 months after surgery had substance vessels that were less deep. The distal segment of the graft in those patients showed a delay in histological maturation with fewer collagen fibres. In patients whose ACL grafts failed less than 12 months after surgery, a lower distribution of blood vessels and collagen fibres was found that were less ordered in the distal graft. These results indicate a delay in maturation, which leads to a higher risk of graft failure. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. [Diagnostic value of transesophageal echocardiography in traumatic rupture of the thoracic aorta]. (United States)

    Vignon, P; Guéret, P; Lagrange, P; Laskar, M


    Traumatic rupture of the aorta (TRA) usually occurs at the isthmus. It is rapidly lethal without early surgery and, therefore, diagnosis must not be delayed. The reference diagnostic investigation is aortography but it is invasive in a patient with multiple trauma whose haemodynamic status is often precarious. Transoesophageal echocardiography, a non-invasive investigation which can be undertaken rapidly at the bedside has been proposed recently for the diagnosis of this condition because it gives excellent views of the aortic isthmus. The authors report their experience of transoesophageal echocardiography in 3 victims of severe road traffic accidents with thoracic trauma and who were operated for traumatic rupture of the aorta. Echocardiographic diagnosis of TRA is based on the recording of the association of a thick and mobile intraluminal echo corresponding to the torn intima and media and localised dilatation of the aorta, the wall of which is reduced to the adventitia under tension. On Doppler colour flow mapping the velocities are similar on both sides of the tear but turbulence at the site of rupture may give rise to aliasing. It is important to recognise the echocardiographic features of TRA to differentiate it from dissection of the aorta. Transoesophageal echocardiography also allows diagnosis of any associated traumatic cardiovascular lesions. Its limitations are due to the inability to visualise the proximal portion of the transverse aorta and the supra aortic vessels. Aortography remains essential when a lesion of these vessels is suspected and when the echocardiographic features of the aorta are atypical.

  20. Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography. (United States)

    Inokuchi, Go; Makino, Yohsuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro


    Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.

  1. Fractures of the proximal humerus in children and adolescents

    Directory of Open Access Journals (Sweden)

    Ruban Raj Joshi, Dr


    Full Text Available Background: In most children proximal humeral fractures are treated non-operatively with generally good results. The aim of the study was to evaluate the clinical outcome of closed/open reduction in children with severely displaced proximal humeral fractures. Materials and Methods: The charts of 15 patients (8 girls and 7 boys; mean age: 9.4 years with proximal humeral fractures who were managed at our institution were reviewed from October 2011 to December 2013. Results: There were 7 metaphyseal fractures and 8 physeal injuries which were angulated according to Neer-Horowitz score as grade II (n=2, grade III(n=4 and grade IV(n=9. Associated lesions comprised open fracture with head trauma in a 2 year old female child which was operated on primarily and the 14 others by secondary intention. All patients were treated surgically with either closed (n = 5 or open (n=10 reduction and internal fixation with Kirschner wire or titanium elastic nails (TENs. They were assessed for clinical and radiological healing at a mean follow up of 1.25 years ranging from 0.5 to 2.0 years. Conclusion: Surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. In addition to the periosteum , long head of the biceps, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Key words: Proximal humerus fracture, Children, Open reduction, Operative.

  2. Muscle cramps (United States)

    ... spasm. Muscle cramps can occur while you play tennis or golf, bowl, swim, or do any other exercise. They can also be triggered by: Alcoholism Hypothyroidism (underactive thyroid) Kidney failure Medicines Menstruation Pregnancy Home Care If you have a muscle ...

  3. Uterine Rupture: Still a Harsh Reality! (United States)

    Singh, Abha; Shrivastava, Chandrashekhar


    To determine the, incidence, etiology, management, maternal, and fetal outcome and to evaluate trends in our area and recommend preventable measures. This prospective study is done between Jan 2012 and Aug 2013 in Pt. J.N.M. Medical College Raipur. All the women who had ruptured uterus were included. Relevant history was taken, women were assessed, adequate intervention done, and were followed up till 6 months after discharge. A total number of deliveries were 11,323. Out of 11,323 deliveries, 9,844 women were without prior LSCS, 1,479 women were with prior LSCS. A total of 40 cases of rupture uterus were there 25 in women with prior LSCS and 15 in women without LSCS. Thus, incidence among women with prior LSCS was 1.69 % and for women without LSCS was 0.152 %. Overall incidence of uterine rupture was 0.35 %. Major risk factors found were unbooked status (92.5 %), injudicious use of oxytocin (52.5 %), and unjustified VBAC trial (44 %). Bladder injury was found in 20 %. Extension to cervix was found commonly in uterus with no previous section (46.66 %). Blood transfusion was required in 92.5 %. Perinatal mortality was 85%. Only one maternal death was there (2.5%). Developed countries have incidence of uterine rupture 0.000 % in women without LSCS and 1 % in women with prior LSCS[1]. Thus, by directly comparing, our study of 20 month revealed that women stand 1,500 times higher risk for rupture even without previous cesarean section and 1.7 times in women with previous section in comparison to the developed countries. The overall burden of women with previous section being admitted for delivery is 12.28 %. 62.50 % women who had rupture uterus were those with previous section. Thus, careful selection of these women for trial of labor and a compulsory institutional delivery is recommended. We recommend use of oxytocin in titrated dose which clearly indicated by an obstetrician only, and it should be a prescription drug strictly.

  4. Use of B-mode ultrasonography for measuring femoral muscle thickness in dogs. (United States)

    Sakaeda, Kanako; Shimizu, Miki


    Assessment of muscle mass is important for evaluating muscle function and rehabilitation outcomes. Ultrasound has recently been successfully used to estimate muscle mass in humans by measuring muscle thickness. This study attempted to standardize procedures for measuring femoral muscle thickness ultrasonographically, as well as quantify the reliability and validity of ultrasound evaluations of muscle thickness compared to measurements made by magnetic resonance imaging (MRI) in dogs. We evaluated the quadriceps femoris (QF), biceps femoris (BF), semitendinosus (ST) and semimembranosus (SM) muscles of 10 clinically healthy Beagle dogs. Scans were taken in 5 different sections divided equally between the greater trochanter and proximal patella. MRI was performed, followed by T1-weighted and contrast-enhanced T1-weighted imaging. Muscle cross-sectional area (CSA) was measured with MRI, and muscle thickness was measured with MRI and ultrasonography. The thickness of the QF, BF and ST muscles as measured by ultrasound at slices 1-3 (from the proximal end to the middle of the femur), 2-4 (middle of the femur) and 2 (more proximal than the middle of the femur), respectively, was correlated with muscle thickness and CSA as measured by MRI. These sites showed a flat interface between muscle and transducer and were situated over belly muscle. No correlation between measurement types was seen in SM muscle. We must confirm this assessment method for various breeds, sizes, ages and muscle pathologies in dogs, thereby confirming that muscle thickness as measured ultrasonographically can reflect muscle function.

  5. Seismic constraints on the architecture of the Newport-Inglewood/Rose Canyon fault: Implications for the length and magnitude of future earthquake ruptures (United States)

    Sahakian, Valerie; Bormann, Jayne; Driscoll, Neal; Harding, Alistair; Kent, Graham; Wesnousky, Steve


    The Newport-Inglewood/Rose Canyon (NIRC) fault zone is an active strike-slip fault system within the Pacific-North American plate boundary in Southern California, located in close proximity to populated regions of San Diego, Orange, and Los Angeles counties. Prior to this study, the NIRC fault zone's continuity and geometry were not well constrained. Nested marine seismic reflection data with different vertical resolutions are employed to characterize the offshore fault architecture. Four main fault strands are identified offshore, separated by three main stepovers along strike, all of which are 2 km or less in width. Empirical studies of historical ruptures worldwide show that earthquakes have ruptured through stepovers with this offset. Models of Coulomb stress change along the fault zone are presented to examine the potential extent of future earthquake ruptures on the fault zone, which appear to be dependent on the location of rupture initiation and fault geometry at the stepovers. These modeling results show that the southernmost stepover between the La Jolla and Torrey Pines fault strands may act as an inhibitor to throughgoing rupture due to the stepover width and change in fault geometry across the stepover; however, these results still suggest that rupture along the entire fault zone is possible.

  6. Slip rate gradients along parallel strands of the eastern Altyn Tagh fault confirm modeled rupture behavior at a transpressional bend (United States)

    Elliott, A. J.; Oskin, M. E.; Liu-Zeng, J.; Shao, Y.; Liu, Z.; Duan, B.


    Characterized in sufficient spatial proximity, Holocene fault slip rates may be used to test numerical model predictions of recurrent rupture behavior, including whether fault geometry produces a persistent control on rupture length. We document slip rate gradients along two subparallel strands of the Altyn Tagh fault (ATF) in western China as they pass through the 50-km-long, 15-20° transpressional double-bend at Aksay (~93°E). In the middle of the bend the southern fault (SATF) attains a strike 20° clockwise from regional fault strike, a bend angle that prior model results predict will inhibit throughgoing propagation of rupture. The northern fault (NATF) reaches only 15° clockwise from regional strike, at which angle model results indicate rupture may continue unimpeded. The sum of NATF and SATF slip rates at a given longitude gives the full sinistral slip rate of the ATF. Our mapping, optically stimulated luminescence (OSL), Be-10, and C-14 geochronology, and paleoseismic results show that ruptures have not propagated through the bend on the SATF during at least the past 5-6 earthquake cycles, including the most recent surface rupture, which we have mapped and measured in detail. We map an abrupt west-to-east decline in mid-Holocene slip rate on the SATF from 5 ± 2 mm/yr west of the bend to 0 mm/yr in the middle of the bend. As the SATF straightens out again to the east, slip has largely been transferred to the NATF; a >10.7 ± 0.8 ka alluvial fan on the east side of the bend is offset merely 9.1 ± 1.2 m by the SATF, giving a Holocene slip rate of 0.9 ± 0.3 mm/yr and representing possibly only 2-3 Holocene earthquakes. On the NATF, we document a more gradual decline in slip rate through the bend, from 6.5 ± 2.5 mm/yr in the east to 2-3 mm/yr on the west. Fault morphology and the absence of an abrupt drop in slip rate on the NATF stand in stark contrast to the SATF and indicate that earthquakes on the NATF may span the bend. Our measured gradients in

  7. Roles of hypertension in the rupture of intracranial aneurysms. (United States)

    Tada, Yoshiteru; Wada, Kosuke; Shimada, Kenji; Makino, Hiroshi; Liang, Elena I; Murakami, Shoko; Kudo, Mari; Kitazato, Keiko T; Nagahiro, Shinji; Hashimoto, Tomoki


    Systemic hypertension has long been considered a risk factor of aneurysmal rupture. However, a causal link between systemic hypertension and the development of aneurysmal rupture has not been established. In this study, using a mouse model of intracranial aneurysm rupture, we examined the roles of systemic hypertension in the development of aneurysmal rupture. Aneurysms were induced by a combination of deoxycorticosterone acetate (DOCA)-salt and a single injection of elastase into the cerebrospinal fluid in mice. Antihypertensive treatment was started 6 days after aneurysm induction. Aneurysmal rupture was detected by neurological symptoms and confirmed by the presence of intracranial aneurysm with subarachnoid hemorrhage. Hydralazine (direct vasodilator) or discontinuation of DOCA-salt treatment was used to assess the roles of systemic hypertension. Captopril (angiotensin-converting enzyme inhibitor) or losartan (angiotensin II type 1 receptor antagonist) was used to assess the roles of the local renin-angiotensin system in the vascular wall. Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose-dependent relationship between reduction of blood pressure and prevention of aneurysmal rupture. Captopril and losartan were able to reduce rupture rate without affecting systemic hypertension induced by DOCA-salt treatment. Normalization of blood pressure after aneurysm formation prevented aneurysmal rupture in mice. In addition, we found that the inhibition of the local renin-angiotensin system independent from the reduction of blood pressure can prevent aneurysmal rupture.

  8. Modeling Muscles (United States)

    Goodwyn, Lauren; Salm, Sarah


    Teaching the anatomy of the muscle system to high school students can be challenging. Students often learn about muscle anatomy by memorizing information from textbooks or by observing plastic, inflexible models. Although these mediums help students learn about muscle placement, the mediums do not facilitate understanding regarding integration of…

  9. Muscle pain

    African Journals Online (AJOL)

    of muscle or tendons.4,14. Management of muscle pain. Non-Pharmacological Management. The non-pharmacological treatments for muscle pain are illustrated in Figure 1. Treatment modalities include the following. Transcutaneous electrical stimulation (TENS). TENS is a non-invasive procedure used in rehabilitation to.

  10. Muscle aches (United States)

    ... is most often related to tension, overuse, or muscle injury from exercise or hard physical work. The pain ... common causes of muscle aches and pains are: Injury or trauma, including sprains and strains Overuse including using a muscle too much, too soon before warming up, or ...

  11. Suture-Only Repair Versus Suture Anchor–Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump (United States)

    Boin, Michael A.; Dorweiler, Matthew A.; McMellen, Christopher J.; Gould, Gregory C.; Laughlin, Richard T.


    Background: Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Hypothesis: Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Study Design: Controlled laboratory study. Methods: Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor–augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. Results: The suture anchor–augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor–augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor–augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Clinical Relevance: Our results support the use of suture anchor–augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes. PMID:28203592

  12. An allometric analysis of the number of muscle spindles in mammalian skeletal muscles. (United States)

    Banks, R W


    An allometric analysis of the number of muscle spindles in relation to muscle mass in mammalian (mouse, rat, guinea-pig, cat, human) skeletal muscles is presented. It is shown that the trend to increasing number as muscle mass increases follows an isometric (length) relationship between species, whereas within a species, at least for the only essentially complete sample (human), the number of spindles scales, on average, with the square root rather than the cube root of muscle mass. An attempt is made to reconcile these apparently discrepant relationships. Use of the widely accepted spindle density (number of spindles g(-1) of muscle) as a measure of relative abundance of spindles in different muscles is shown to be grossly misleading. It is replaced with the residuals of the linear regression of ln spindle number against ln muscle mass. Significant differences in relative spindle abundance as measured by residuals were found between regional groups of muscles: the greatest abundance is in axial muscles, including those concerned with head position, whereas the least is in muscles of the shoulder girdle. No differences were found between large and small muscles operating in parallel, or between antigravity and non-antigravity muscles. For proximal vs. distal muscles, spindles were significantly less abundant in the hand than the arm, but there was no difference between the foot and the leg.

  13. Photoactivated In Vivo Proximity Labeling. (United States)

    Beck, David B; Bonasio, Roberto


    Identification of molecular interactions is paramount to understanding how cells function. Most available technologies rely on co-purification of a protein of interest and its binding partners. Therefore, they are limited in their ability to detect low-affinity interactions and cannot be applied to proteins that localize to difficult-to-solubilize cellular compartments. In vivo proximity labeling (IPL) overcomes these obstacles by covalently tagging proteins and RNAs based on their proximity in vivo to a protein of interest. In IPL, a heterobifunctional probe comprising a photoactivatable moiety and biotin is recruited by a monomeric streptavidin tag fused to a protein of interest. Following UV irradiation, candidate interacting proteins and RNAs are covalently biotinylated with tight spatial and temporal control and subsequently recovered using biotin as an affinity handle. Here, we describe experimental protocols to discover novel protein-protein and protein-RNA interactions using IPL. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

  14. 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...


    Directory of Open Access Journals (Sweden)

    Shergill Harbhajan K, Grover Suparna, Chhabra Ajay


    Full Text Available It is a rare occurrence for the rudimentary horn of uterus to harbour a pregnancy and the usual outcome is devastating leading to a spontaneous rupture in second trimester with the patient presenting in shock with massive intra-peritoneal haemorrhage and if appropriate management is not instituted in time it may lead to high rate of mortality. We report an unusual case of rupture rudimentary horn pregnancy who presented as a chronic ectopic with an adnexal mass and surprisingly with no sign of shock. Diagnosis is often difficult in such a situation which puts the treating gynaecologist in dilemma. High clinical suspicion supplemented with radiological findings helped clinch the diagnosis and laparotomy was performed followed by resection of the rudimentary horn to prevent future complications.

  16. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner


    to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute......BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains.......3 mm), inter-rater reliability (ICC 0.97, SEM 3.3 mm and MDC 9.3 mm) and validity (measurement error 2%). CONCLUSION: Treatment algorithms across Scandinavia showed considerable variation, though operative treatment and controlled early weight-bearing was the preferred treatment in Denmark, Norway...

  17. Liquid salt environment stress-rupture testing

    Energy Technology Data Exchange (ETDEWEB)

    Ren, Weiju; Holcomb, David E.; Muralidharan, Govindarajan; Wilson, Dane F.


    Disclosed herein are systems, devices and methods for stress-rupture testing selected materials within a high-temperature liquid salt environment. Exemplary testing systems include a load train for holding a test specimen within a heated inert gas vessel. A thermal break included in the load train can thermally insulate a load cell positioned along the load train within the inert gas vessel. The test specimen can include a cylindrical gage portion having an internal void filled with a molten salt during stress-rupture testing. The gage portion can have an inner surface area to volume ratio of greater than 20 to maximize the corrosive effect of the molten salt on the specimen material during testing. Also disclosed are methods of making a salt ingot for placement within the test specimen.

  18. Plaque rupture in humans and mice

    DEFF Research Database (Denmark)

    Schwartz, Stephen M; Galis, Zorina S; Rosenfeld, Michael E


    Despite the many studies of murine atherosclerosis, we do not yet know the relevance of the natural history of this model to the final events precipitated by plaque disruption of human atherosclerotic lesions. The literature has become particularly confused because of the common use of terms...... such as "instability", "vulnerable", "rupture", or even "thrombosis" for features of plaques in murine model systems not yet shown to rupture spontaneously and in an animal surprisingly resistant to formation of thrombi at sites of atherosclerosis. We suggest that use of conclusory terms like "vulnerable" and "stable...... that various forms of data have implicated in plaque progression. For example, formation of the fibrous cap, protease activation, and cell death in the necrotic core can be well described and have all been modeled in well-defined experiments. The relevance of such well-defined, objective, descriptive...

  19. Rupture directivity of moderate earthquakes in northern California (United States)

    Seekins, Linda C.; Boatwright, John


    We invert peak ground velocity and acceleration (PGV and PGA) to estimate rupture direction and rupture velocity for 47 moderate earthquakes (3.5≥M≥5.4) in northern California. We correct sets of PGAs and PGVs recorded at stations less than 55–125 km, depending on source depth, for site amplification and source–receiver distance, then fit the residual peak motions to the unilateral directivity function of Ben-Menahem (1961). We independently invert PGA and PGV. The rupture direction can be determined using as few as seven peak motions if the station distribution is sufficient. The rupture velocity is unstable, however, if there are no takeoff angles within 30° of the rupture direction. Rupture velocities are generally subsonic (0.5β–0.9β); for stability, we limit the rupture velocity at v=0.92β, the Rayleigh wave speed. For 73 of 94 inversions, the rupture direction clearly identifies one of the nodal planes as the fault plane. The 35 strike-slip earthquakes have rupture directions that range from nearly horizontal (6 events) to directly updip (5 events); the other 24 rupture partly along strike and partly updip. Two strike-slip earthquakes rupture updip in one inversion and downdip in the other. All but 1 of the 11 thrust earthquakes rupture predominantly updip. We compare the rupture directions for 10 M≥4.0 earthquakes to the relative location of the mainshock and the first two weeks of aftershocks. Spatial distributions of 8 of 10 aftershock sequences agree well with the rupture directivity calculated for the mainshock.

  20. Prox-1 Automated Proximity Operations (United States)


    on demonstrating the functionality required to meet minimum mission success criteria. The minimum mission includes on- orbit spacecraft checkout of...also includes deployment of LightSail-B from the P-POD, and imaging of LightSail-B for 20 minutes as it recedes from Prox-1. small satellite ; proximity...criteria. The minimum mission includes on- orbit spacecraft checkout of all spacecraft subsystems, including flight qualification of the following new

  1. Spontaneous bladder rupture in acute alcohol intoxication

    Directory of Open Access Journals (Sweden)

    Bahjat Barakat


    Full Text Available Spontaneous bladder rupture is a rare condition that can be followed by an acute alcohol intoxication and can be associated with significant morbidity and mortality. We report a case diagnosed in a alcoholic young male who was admitted to our emergency room for epigastric pain. The case demonstrates the difficulties with diagnosis and the need for physicians who work in an emergency room to be aware of this condition.

  2. Proximal spinal muscular atrophy: current orthopedic perspective

    Directory of Open Access Journals (Sweden)

    Haaker G


    Full Text Available Gerrit Haaker, Albert Fujak Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Abstract: Spinal muscular atrophy (SMA is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. Keywords: spinal muscular atrophy, scoliosis, contractures, fractures, lung function, treatment, rehabilitation, surgery, ventilation, nutrition, perioperative management



    Fernandes, Tiago Lazzaretti; Pedrinelli, Andr?; Hernandez, Arnaldo Jos?


    Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides such injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by: ultrasound, wh...

  4. Endovascular treatment for ruptured basilar apex aneurysm

    Directory of Open Access Journals (Sweden)

    Sheng LI


    Full Text Available Objective The present study aims to prove the effectiveness and safety of endovascular interventional therapy for ruptured basilar apex aneurysm.Methods The imaging data,methods of endovascular treatment,and clinical results of 12 patients suffering from ruptured basilar apex aneurysms from January 2001 to December 2009 were retrospectively analyzed.The 12 patients were composed of 5 males and 7 females,and their ages ranged from 21 years to 58 years.Results Nine patients suffered from narrow-necked aneurysms,which were directly embolized,and the other three suffered from wide-necked aneurysms,which were embolized using a microstent.Eight aneurysms were completely embolized,and the other four were partly embolized.No rebleeding occurred within the follow-up period of 12 months to 36 months,and all patients recovered well without neurological defects.Conclusions Therefore,endovascular treatment for ruptured basilar apex aneurysm is a semi-invasive,safe,and effective method.

  5. 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.

  6. Triceps tendon rupture: repair and rehabilitation. (United States)

    Kocialkowski, Cezary; Carter, Rebecca; Peach, Chris


    Triceps tendon ruptures are rare injuries and are frequently missed on initial presentation to the emergency department. In cases of complete rupture, surgical repair is recommended but no guidelines exist on the optimum reconstructive technique or rehabilitation. We present a surgical technique and rehabilitation programme for the management of these injuries. A midline posterior incision is performed, the ruptured triceps tendon is identified and mobilized, and the tendon footprint is prepared. The tendon is then repaired using bone suture anchors, with a parachute technique, and held in 40° of flexion. The rehabilitation programme is divided into five phases, over a period of 12 weeks. Range of movement is gradually increased in a brace for the first 6 weeks. Rehabilitation is gradually increase in intensity, progressing from isometric extension exercises to weight-resisted exercises, and finally plyometrics and throwing exercises. Our surgical technique provides a solid tendon repair without the need for further metalwork removal. The graduated rehabilitation programme also helps to protect the integrity of the repair at the same time as enabling patients to gradually increase the strength of the triceps tendon and ultimately return to sport activities.

  7. [Traumatic rupture of the thoracic aorta]. (United States)

    Glock, Y; Roux, D; Soula, P; Cerene, A; Fournial, G


    This is a retrospective analysis of 50 postraumatic aortic rupture (1968-1996, 39 males, mean age: 34.5). Group A is composed of 35 patients with an acute aortic rupture and a prompt diagnosis. Group B includes 13 patients with a chronic rupture. All patients from group A had a severe politraumatism with abdominal, cranial, extremities or hip fractures. Mediastinal thickening with or without hemothorax indicated an angiography or a transesophageal echocardiography lately. In group A, 36 patients have been operated on urgently (12-24 hours); cardiopulmonary bypass was performed on 20 patients; an aorto-aortical bypass was done in 27 cases and a direct suture in the remaining 9. In group B, cardiopulmonary bypass was performed on 9 patients; a aorto-aortical bypass was done in 11 cases and a direct suture in 2. Overall hospital mortality was 16%; 19% in group A and 7.6% in group B. Ischemic paraplejia appeared in 5 patients (10%), all from group A. No false aneurysm developed after 4.5 years of follow-up (3-135 months) in the 38 survivors. The usefulness of transesophageal echocardiography, the importance of medular protection and the utility of several interventionist radiologic techniques are discussed.

  8. Ruptured corpus luteal cyst: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyuck Jae; Kim, Seung Hyup; Kim, Sun Ho; Kim, Hyo Cheol; Park, Chang Min; Lee, Hak Jong; Moon, Min Hoan; Jeong, Jun Yong [Seoul National University Hospital, Seoul (Korea, Republic of)


    To evaluate the CT findings of ruptured corpus luteal cysts. Six patients with a surgically proven ruptured corpus luteal cyst were included in this series. The prospective CT findings were retrospectively analyzed in terms of the size and shape of the cyst, the thickness and enhancement pattern of its wall, the attenuation of its contents, and peritoneal fluid. The mean diameter of the cysts was 2.8 (range, 1.5-4.8) cm; three were round and three were oval. The mean thickness of the cyst wall was 4.7 (range, 1-10) mm; in all six cases it showed strong enhancement, and in three was discontinuous. In five of six cases, the cystic contents showed high attenuation. Peritoneal fluid was present in all cases, and its attenuation was higher, especially around the uterus and adnexa, than that of urine present in the bladder. In a woman in whom CT reveals the presence of an ovarian cyst with an enhancing rim and highly attenuated contents, as well as highly attenuated peritoneal fluid, a ruptured corpus luteal cyst should be suspected. Other possible evidence of this is focal interruption of the cyst wall and the presence of peritoneal fluid around the adnexa.

  9. [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.

  10. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. (United States)

    Lantto, Iikka; Heikkinen, Juuso; Flinkkila, Tapio; Ohtonen, Pasi; Siira, Pertti; Laine, Vesa; Leppilahti, Juhana


    The optimal treatment of acute Achilles tendon ruptures for active patients is under debate. To compare clinical outcomes and calf muscle strength recovery after the nonsurgical treatment and open surgical repair of acute Achilles tendon ruptures with identical accelerated rehabilitation programs. Randomized controlled trial; Level of evidence, 1. From 2009 to 2013, a total of 60 patients with an acute Achilles tendon rupture were randomized to surgery or nonsurgical treatment. Nonsurgical treatment included first a week of cast immobilization, followed by a functional orthosis for 6 weeks, allowing full weightbearing after week 1 and active plantar flexion after week 5. Surgery was simple end-to-end open repair, and postoperative treatment was identical to nonsurgical treatment. Outcome measures included the Leppilahti Achilles tendon performance score, isokinetic calf muscle strength, and RAND 36-Item Health Survey at 18-month follow-up. At 18-month follow-up, the mean Leppilahti score was 79.5 and 75.7 for the surgically and nonsurgically treated groups, respectively (mean difference, 3.8; 95% CI, -1.9 to 9.5; P = .19). Angle-specific peak torque results of affected legs showed that surgery resulted in faster and better recovery of calf muscle strength over the entire range of motion of the ankle joint: at 6 months, the difference varied from 16% to 24% (P = .016), favoring the surgically treated group, whereas at 18 months, surgically treated patients had 10% to 18% greater strength results (P = .037). At 18 months, a 14% difference in the peak torque of the affected leg favored the surgical group versus the nonsurgical group (mean peak torque, 110.3 vs 96.5 N·m, respectively; mean difference, 13.6 N·m; 95% CI, 2.0-25.1 N·m; P = .022). The RAND 36-Item Health Survey indicated better results in the domains of physical functioning (P = .006) and bodily pain (P = .037) for surgically treated patients. Surgical and nonsurgical treatments of acute Achilles tendon

  11. Management of diaphragmatic rupture from blunt trauma. (United States)

    Tan, K K; Yan, Z Y; Vijayan, A; Chiu, M T


    Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. We reviewed our institution's management of patients with diaphragmatic rupture after blunt trauma. All patients in this study were treated at Tan Tock Seng Hospital, Singapore, from March 2002 to October 2008. Patients with penetrating injuries were excluded. The parameters included age, mechanism of injury, haemodynamic status at admission, Glasgow coma scale (GCS) score, injury severity score (ISS), imaging studies, location of diaphragmatic injuries, associated injuries and outcome. 14 patients with a median age of 38 years formed the study group. Vehicular-related incidents accounted for 71.4 percent of the injuries. The median GCS score on admission was 14 (range 3-15), while the median systolic blood pressure and heart rate were 94 (range 50-164) mmHg and 110 (range 76-140) beats per minute, respectively. The median ISS was 41 (range 14-66). All had chest radiographs performed in the emergency department, six (42.9 percent) had computed tomography performed before surgery, while the remaining eight (57.1 percent) were sent straight to the operating theatre from the emergency department. There were five (35.7 percent) right-sided and nine (64.3 percent) left-sided diaphragmatic ruptures. The mortality rate was 35.7 percent. Some of the associated injuries included eight (57.1 percent) splenic lacerations, five (35.7 percent) haemothorax and lung injuries, four (28.6 percent) bone fractures and three (21.4 percent) liver lacerations. 12 (85.7 percent) patients underwent repair of the diaphragmatic rupture using interrupted polypropylene suture, while the remaining two (14.3 percent) were too haemodynamically unstable to undergo definitive treatment. Advanced age, haemodynamic instability and raised ISS were associated with mortality. An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult, and a thorough examination of both the


    Directory of Open Access Journals (Sweden)

    F. Nili AA. Shams Ansari


    Full Text Available Premature rupture of membranes (PROM is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91% cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86% of neonates was less than 37 completed weeks. Thirty five infants (21.47% had respiratory distress syndrome and 33 (20.245% had clinical sepsis. Pneumonia in 6 (3.7% and skeletal deformity in 7 (4.294% were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6% of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11% of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane

  13. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural artery flap. (United States)

    Abhyankar, Suhas V; Kulkarni, Ananta; Agarwal, Naveen Kumar


    Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting. The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

  14. Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes. (United States)

    Jallageas, R; Bordes, J; Daviet, J-C; Mabit, C; Coste, C


    In the past few decades, the incidence of Achilles tendon rupture has increased in parallel with increased sports participation. Although the optimal treatment remains controversial, there is a trend towards surgical treatment in athletes. Surgical repair of ruptured Achilles tendon in athlete results in good functional and objective recovery, irrespective of the type of surgery performed. Subsidiarily, are the results different between percutaneous surgery (PS) and standard open surgery (OS)? This was a cross-sectional study of 31 patients who presented with a ruptured Achilles tendon that occurred during sports participation. Percutaneous surgery was performed in 16 patients and open surgery in 15 patients between 2005 and 2009. The objective recovery status was evaluated by open chain goniometry, measurement of leg muscle atrophy and assessment of isokinetic strength. The functional analysis was based on the delay, level of sports upon return, AOFAS and VAS for pain. Our series of Achilles tendon rupture patients consisted of 88% men and 12% women, with an average age of 38 years. In 71% of cases, the rupture occurred during eccentric loading. After a follow-up of 15 months, the muscle atrophy was 13 mm after PS and 24 mm after OS (P=0.01). A strength deficit of 19% in the plantar flexors was found in the two groups. No patient experienced a rerupture. The return to sports occurred at 130 days after PS and 178 days after OS (P=0.005). The average AOFAS score was 94 and the VAS was 0.5. There were no differences in ankle range of motion between the two groups. The majority (77%) of patients had returned to their preinjury level of sports activity. The return to activities of daily living was slower in our study than in studies based in Anglo-Saxon countries; this can be explained by the different sick leave coverage systems. Percutaneous surgery resulted in a faster return to sports (about 130 days) and less muscle atrophy than open surgery. Our results for

  15. Rupture Velocities of Intermediate- and Deep-Focus Earthquakes (United States)

    Warren, L. M.


    The rupture velocities of intermediate- and deep-focus earthquakes --- how they vary between subduction zones, how they vary with depth, and what their maximum values are --- may help constrain the mechanism(s) of the earthquakes. As part of a global study of intermediate- and deep-focus earthquakes, I have used rupture directivity to estimate the rupture vector (speed and orientation) for 422 earthquakes >70 km depth with MW ≥5.7 since 1990. I estimate the rupture velocity relative to the local P-wave velocity (vr/α). Since the same method is used for all earthquakes, the results can be readily compared across study areas. The study areas --- Middle America, South America, Tonga-Kermadec, Izu-Bonin-Marianas, and Japan-Kurils-Kamchatka --- include some of the warmest and coldest subduction zones: subducting plate ages range from 9-150 Myr and descent rates range from 1-13 cm/yr. Across all subduction zones and depth ranges, for the 193 earthquakes with observable directivity and well-constrained rupture vectors, most earthquakes rupture on the more horizontal of the two possible nodal planes. However, the rupture vectors appear to be randomly-oriented relative to the slip vector, so the earthquakes span the continuum from Mode II (i.e., parallel slip and rupture vectors) to Mode III rupture (i.e., perpendicular slip and rupture vectors). For this earthquake population, the mean rupture velocity is 0.43 vr/α ± 0.14 vr/α. The mean earthquake rupture velocities are similar between all subduction zones. Since the local seismic wavespeed is faster in colder subduction zones, absolute rupture velocities are faster in colder subduction zones. Overall, the fastest rupture velocities exceed the local S-wave speed. The supershear ruptures are associated with earthquakes closer to Mode II than Mode III faulting. This is consistent with theoretical calculations, which limit the rupture velocity to the S-wave speed for Mode III rupture but the P-wave speed for Mode II

  16. Hip abductor moment arm - a mathematical analysis for proximal femoral replacement

    Directory of Open Access Journals (Sweden)

    Temple H Thomas


    Full Text Available Abstract Background Patients undergoing proximal femoral replacement for tumor resection often have compromised hip abductor muscles resulting in a Trendelenberg limp and hip instability. Commercially available proximal femoral prostheses offer several designs with varying sites of attachment for the abductor muscles, however, no analyses of these configurations have been performed to determine which design provides the longest moment arm for the hip abductor muscles during normal function. Methods This study analyzed hip abductor moment arm through hip adduction and abduction with a trigonometric mathematical model to evaluate the effects of alterations in anatomy and proximal femoral prosthesis design. Prosthesis dimensions were taken from technical schematics that were obtained from the prosthesis manufacturers. Manufacturers who contributed schematics for this investigation were Stryker Orthopaedics and Biomet. Results Superior and lateral displacement of the greater trochanter increased the hip abductor mechanical advantage for single-leg stance and adduction and preserved moment arm in the setting of Trendelenberg gait. Hip joint medialization resulted in less variance of the abductor moment arm through coronal motion. The Stryker GMRS endoprosthesis provided the longest moment arm in single-leg stance. Conclusions Hip abductor moment arm varies substantially throughout the hip's range of motion in the coronal plane. Selection of a proximal femur endoprosthesis with an abductor muscle insertion that is located superiorly and laterally will optimize hip abductor moment arm in single-leg stance compared to one located inferiorly or medially.


    African Journals Online (AJOL)


    PROXIMATE AND ELEMENTAL COMPOSITION OF WHITE GRUBS. 1 Alhassan, A. J. 1M .S. Sule, 1J. ... ABSTRACT. This study determined the proximate and mineral element composition of whole white grubs using standard methods of analysis. Proximate ... days, before pulverized to powder and kept in plastic container.

  18. Length-force characteristics of the aponeurosis in the passive and active muscle condition and in the isolated condition

    NARCIS (Netherlands)

    Zuurbier, C. J.; Everard, A. J.; van der Wees, P.; Huijing, P. A.


    Length behaviour of the entire and designated parts of the proximal aponeurosis of the unipennate gastrocnemius medialis (GM) muscle of the rat was examined at muscle lengths ranging form muscle slack length to 4 mm above muscle optimum length in the passive and active (isometric contractions)

  19. 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.

  20. The Energy Budget of Earthquake Rupture: a View From Spontaneous Rupture Modeling and Finite-Source Models (United States)

    Mai, P.; Guatteri, M.


    It is a common and frustrating experience of many dynamic modelers to initiate spontaneous rupture calculations that subsequently abort before rupturing to the desired earthquake size [Nielsen and Olsen, 2000; Oglesby and Day, 2002]. Source parameters in such dynamic source models are strongly correlated, but stress drop is the main factor affecting the distribution of the other dynamic rupture parameters. Additionally, the position of the hypocenter exerts a strong influence on the dynamic properties of the earthquake, and certain hypocenter positions are not plausible as those would not lead to spontaneous rupture propagation. To further investigate this last statement, we analyze the energy budget during earthquake rupture using spontaneous dynamic rupture calculations and finite-source rupture models. In describing the energy budget during earthquake rupture, we follow Favreau and Archuleta [2003]. Each point on the fault contributes to the radiated seismic energy Ers = Eel - Efr - Erx, where Eel denotes the elasto-static energy and Efr the fracture energy. In this study we neglect for simplicity the relaxation work Erx spent during the stopping of the earthquake. A rupture can be characterized by locally negative seismic energy density values, but its integral over the fault plane must be positive. The fundamental condition for rupture growth is therefore that the integral of Ers on the rupture area remains always positive during rupture propagation. Based on a simple energy budget calculation, we focus on identifying those target slip/stress distribution in dynamic rupture modeling that for a given hypocenter location fail to rupture spontaneously. Additionally, we study the energy budget of finite-source rupture models by analyzing the integrated seismic energy for the inferred slip maps using also hypocenter positions other than the network location. These results indicate how rupture was promoted for the true hypocenter while randomized hypocenters may not

  1. Physical and chemical properties of selected beef muscles infused ...

    African Journals Online (AJOL)

    The chemical composition of the treated muscles was not negatively affected by the infusion and the mineral content of the treated muscles was increased, accordingly. Keywords: Alkaline infusion, pH, water-binding capacity, instrumental tenderness, beef colour, proximate composition, mineral composition ...

  2. Force feedback reinforces muscle synergies in insect legs. (United States)

    Zill, Sasha N; Chaudhry, Sumaiya; Büschges, Ansgar; Schmitz, Josef


    The nervous system solves complex biomechanical problems by activating muscles in modular, synergist groups. We have studied how force feedback in substrate grip is integrated with effects of sense organs that monitor support and propulsion in insects. Campaniform sensilla are mechanoreceptors that encode forces as cuticular strains. We tested the hypothesis that integration of force feedback from receptors of different leg segments during grip occurs through activation of specific muscle synergies. We characterized the effects of campaniform sensilla of the feet (tarsi) and proximal segments (trochanter and femur) on activities of leg muscles in stick insects and cockroaches. In both species, mechanical stimulation of tarsal sensilla activated the leg muscle that generates substrate grip (retractor unguis), as well as proximal leg muscles that produce inward pull (tibial flexor) and support/propulsion (trochanteral depressor). Stimulation of campaniform sensilla on proximal leg segments activated the same synergistic group of muscles. In stick insects, the effects of proximal receptors on distal leg muscles changed and were greatly enhanced when animals made active searching movements. In insects, the task-specific reinforcement of muscle synergies can ensure that substrate adhesion is rapidly established after substrate contact to provide a stable point for force generation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Finger Proximal Interphalangeal Joint Dislocation. (United States)

    Ramponi, Denise; Cerepani, Mary Jo


    Finger dislocations are common injuries that are often managed by emergency nurse practitioners. A systematic physical examination following these injuries is imperative to avoid complications. Radiographic views, including the anteroposterior, lateral, and oblique views, are imperative to evaluate these finger dislocations. A dorsal dislocation of the proximal interphalangeal (PIP) joint is the most common finger dislocation type often easily reduced. A volar PIP dislocation can often be difficult to reduce and may result in finger deformity. Finger dislocations should be reduced promptly. Referral to an orthopedic hand specialist is required if the dislocation is unable to be reduced or if the finger joint is unstable following reduction attempts.

  4. Equilibrium properties of proximity effect

    Energy Technology Data Exchange (ETDEWEB)

    Esteve, D.; Pothier, H.; Gueron, S.; Birge, N.O.; Devoret, M.


    The proximity effect in diffusive normal-superconducting (NS) nano-structures is described by the Usadel equations for the electron pair correlations. We show that these equations obey a variational principle with a potential which generalizes the Ginzburg-Landau energy functional. We discuss simple examples of NS circuits using this formalism. In order to test the theoretical predictions of the Usadel equations, we have measured the density of states as a function of energy on a long N wire in contact with a S wire at one end, at different distances from the NS interface. (authors). 12 refs.

  5. Induced seismicity provides insight into why earthquake ruptures stop

    KAUST Repository

    Galis, Martin


    Injection-induced earthquakes pose a serious seismic hazard but also offer an opportunity to gain insight into earthquake physics. Currently used models relating the maximum magnitude of injection-induced earthquakes to injection parameters do not incorporate rupture physics. We develop theoretical estimates, validated by simulations, of the size of ruptures induced by localized pore-pressure perturbations and propagating on prestressed faults. Our model accounts for ruptures growing beyond the perturbed area and distinguishes self-arrested from runaway ruptures. We develop a theoretical scaling relation between the largest magnitude of self-arrested earthquakes and the injected volume and find it consistent with observed maximum magnitudes of injection-induced earthquakes over a broad range of injected volumes, suggesting that, although runaway ruptures are possible, most injection-induced events so far have been self-arrested ruptures.

  6. Mechanisms causing effects of muscle position on proximo-distal muscle force differences in extra-muscular myofascial force transmission.

    NARCIS (Netherlands)

    Yucesoy, C.A.; Maas, J.H.; Maas, Huub; Koopman, Hubertus F.J.M.; Grootenboer, H.J.; Huijing, P.A.J.B.M.


    Certain recent studies showed that extra-muscular myofascial force transmission affects the length–force characteristics of rat extensor digitorium longus (EDL) muscle significantly after distal or proximal lengthening. This suggested that the relative position of a muscle with respect to its


    Directory of Open Access Journals (Sweden)

    Praveen Sivakumar K


    Full Text Available BACKGROUND Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, plant tan humerus fixator plates, Polaris nails and blade plates. Complications of these techniques include cutout or back out of the screws and plates, avascular necrosis, nonunion, malunion, nail migration, rotator cuff impairment and impingement syndromes. Insufficient anchorage from conventional implants may lead to early loosening and failure, especially in osteoporotic bones. In general, nonoperative treatment of displaced three and four-part fractures of the proximal humerus leads to poor outcome due to intraarticular nature of injury and inherent instability of the fragments. Comminuted fractures of the proximal humerus are at risk of fixation failure, screw loosening and fracture displacement. Open reduction and internal fixation with conventional plate and screws has been associated with unacceptably high incidence of screw pull out. PHILOS (the proximal humeral internal locking system plate is an internal fixation system that enables angled stabilisation with multiple interlocking screws for fractures of the proximal humerus. MATERIALS AND METHODS 30 patients with proximal humerus fractures who were admitted in the Department of Orthopaedics, Government General Hospital, Kakinada, during the period November 2014 - November 2016 were taken up for study according to inclusion criteria. All patients were treated with PHILOS plate. These proximal humerus fractures were classified according to Neer’s classification. Patients were followed up at 6 weeks, 12 weeks and 6 months’ interval. Functional outcomes for pain, range of motion and muscle power and function were assessed using the Constant-Murley scoring system. Collected data analysed with independent t-test and ANNOVA test. RESULTS The outcome of the study was 1

  8. Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-analysis. (United States)

    Zhang, Yi-Jun; Zhang, Chi; Wang, Quan; Lin, Xiang-Jin


    Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown. To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications. Meta-analysis. A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair. Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and

  9. Forecasting the Rupture Directivity of Large Earthquakes (United States)

    Donovan, J. R.; Jordan, T. H.


    Forecasting the rupture directivity of large earthquakes is an important problem in probabilistic seismic hazard analysis (PSHA), because directivity strongly influences ground motions. We cast this forecasting problem in terms of the conditional hypocenter distribution (CHD), defined to be the probability distribution of a hypocenter given the spatial distribution of fault slip (moment release). The simplest CHD is a uniform distribution for which the hypocenter probability density equals the moment-release probability density. We have compiled samples of CHDs from a global distribution of large earthquakes using three estimation methods: (a) location of hypocenters within the slip distribution from finite-fault inversions, (b) location of hypocenters within early aftershock distributions, and (c) direct inversion for the directivity parameter D, defined in terms of the degree-two polynomial moments of the source space-time function. The data from method (a) are statistically inconsistent with the uniform CHD suggested by McGuire et al. (2002) using method (c). Instead, the data indicate a 'centroid-biased' CHD, in which the expected distance between the hypocenter and the hypocentroid is less than that of a uniform CHD; i.e., the directivities inferred from finite-fault models appear to be closer to bilateral than predicted by the uniform CHD. One source of this discrepancy may be centroid bias in the second-order moments owing to poor localization of the slip in finite-fault inversions. We compare these observational results with CHDs computed from a large set of theoretical ruptures in the Southern California fault system produced by the Rate-State Quake simulator (RSQSim) of Dieterich and Richards-Dinger (2010) and discuss the implications for rupture dynamics and fault-zone heterogeneities.

  10. Misdiagnosed Uterine Rupture of an Advanced Cornual Pregnancy

    Directory of Open Access Journals (Sweden)

    Christian Linus Hastrup Sant


    Full Text Available Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.

  11. Intraoperative endobronchial rupture of pulmonary hydatid cyst: An airway catastrophe

    Directory of Open Access Journals (Sweden)

    Richa Gupta


    Full Text Available Hydatid cyst disease of lungs may not be symptomatic. It may present as spontaneous rupture in pleura or a bronchus. During spontaneous breathing, cyst content of endobronchially ruptured pulmonary hydatid cyst is mostly evacuated by coughing. However, during positive pressure ventilation such extruded fragments may lodge into smaller airway leading to an airway catastrophe. We present such accidental endobronchial rupture of pulmonary hydatid cyst during surgery, its prompt detection, and management by rigid bronchoscopy.

  12. Misdiagnosed uterine rupture of an advanced cornual pregnancy

    DEFF Research Database (Denmark)

    Sant, Christian Linus Hastrup; Andersen, Poul Erik


    Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination...... and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability....

  13. MRI in flexor tendon rupture after collagenase injection

    Energy Technology Data Exchange (ETDEWEB)

    Khurana, Shruti [Lady Hardinge Medical College, New Delhi (India); Wadhwa, Vibhor [University of Arkansas for Medical Sciences, Little Rock, AR (United States); Chhabra, Avneesh [UT Southwestern Medical Center, Dallas, TX (United States); Johns Hopkins University, Baltimore, MD (United States); Amirlak, Bardia [UT Southwestern Medical Center, Dallas, TX (United States)


    Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture. (orig.)

  14. Postinfarction heart rupture of posterior wall repaired by covering patch. (United States)

    Kimura, Naoyuki; Yamaguchi, Atsushi; Tanaka, Masashi; Okamura, Homare; Adachi, Hideo; Ino, Takashi


    A 46-year-old man underwent emergency surgery for heart rupture after acute infarction of the posterior wall. Echocardiography revealed limited myocardial thinning, so rather than sutureless repair, a covering patch was used in view of the risk of recurrent rupture. Postoperative echocardiography showed the myocardial thinning had progressed to a wide defect, and computed tomography demonstrated that the covering patch had prevented a repeat rupture.

  15. Uterine Rupture and Fetal Maceration in an Indian Mongrel Bitch

    Directory of Open Access Journals (Sweden)

    Deepti Bodh


    Full Text Available Uterine rupture and fetal maceration in an 11 year old mongrel bitch was diagnosed via lateral abdominal radiography and ventral midline laparotomy. The treatment of choice in cases of uterine rupture and fetal maceration is bilateral ovariohysterectomy along with plenty of intravenous fluid therapy and broad spectrum antibiotics. Incidences of uterine rupture and fetal maceration can be prevented by timely recognition of early signs of obstetrical-related complications and use of proper obstetrical techniques.

  16. Spontaneous rupture of infantile umbilical hernia: report of three cases. (United States)

    Ahmed, A; Ahmed, M; Nmadu, P T


    Three Nigerian infants with spontaneous rupture of an umbilical hernia are described. In two, hernias developed in the neonatal period following umbilical sepsis. Rupture occurred at the ages of 2 and 3 months, respectively, and was probably precipitated by raised intra-abdominal pressure resulting from excessive crying. The third child had a large, ulcerated umbilical hernia which ruptured at 10 months and was precipitated by damage to the overlying skin. The children were treated successfully.

  17. Rupture of the left atrial roof due to blunt trauma. (United States)

    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung


    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein-atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  18. Rupture of the left atrial roof due to blunt trauma


    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung


    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein–atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  19. Bladder rupture causing pseudo acute renal failure

    Directory of Open Access Journals (Sweden)

    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.


    African Journals Online (AJOL)

    Objectif L'analyse des aspects diagnostique, thérapeutique et évolutif de la rupture traumatique du corps caverneux (RTCC) à travers l'étude d'une série de 42 cas et d'une revue de la littérature. Patients et Méthodes L'âge moyen des patients est de 32 ans, le mécanisme le plus fréquent est la manipulation forcée de la ...

  1. Spontaneous diaphragmatic rupture: case report and literature review. (United States)

    Ghidirim, Gh; Mishin, I; Condratsky, E; Zastavnitsky, Gh


    Spontaneous diaphragm rupture is extremely rare. Usually a diaphragm rupture is trauma induced. We describe a case of an 18-year old patient admitted 2 hours after onset, presenting severe epigastric and left sided chest pain without any trauma history. Upright chest x-ray revealed displaced stomach and colon into the left pleural cavity with a collapsed left lung. Surgery for a left-sided diaphragm rupture with stomach, spleen and colon splenic flexure herniation was undertaken. We present a brief review regarding the aetiology, diagnostic and treatment policy of spontaneous diaphragmatic rupture. Celsius.

  2. 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.

  3. 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.

  4. Analysis of fault rupture potential resulting from large-scale groundwater withdrawal: application to Spring Valley, Nevada (United States)

    Anderson, B. J.; Schumer, R.; McCoy, S. W.; Hammond, W. C.


    Hydrospheric mass changes create subsurface stress perturbations on a scale that can trigger seismic events or accelerate frequency of seismicity on proximal faults. For example, groundwater pumping has been implicated in the 2011 Mw 5.1 earthquake in Lorca, Spain and the 2010 Mw 7.1 El-Mayor Cucapah earthquake in northern Baja California. Previous work on effects of pumping on seismicity is retrospective. We propose a method to assess changes in rupture potential on faults near areas of large-scale groundwater withdrawal ahead before pumping begins. Changes in potentiometric head due to pumping predicted by (MODFLOW) groundwater flow models can be used as the change in surface load input for analytical solutions from Boussinesq [1885] to resolve changes in the subsurface state of stress. Coulomb stress, which quantifies a fault's tendency toward failure, is then resolved on proximal faults. These stress changes can be compared with a 10 kPa stress threshold developed in previous work from statistical correlation of aftershock occurrence with spatial patterns of post-seismic Coulomb stress change on surrounding faults. Stress changes on critical to near-critically stressed faults above the threshold represent a higher likelihood of seismic rupture. The method is applied to a proposed groundwater development project in Spring Valley, Nevada. Proposed pumping in excess of 50 years will result in stress change on the proximal normal fault exceeding the 10 kPa threshold. This change in Coulomb stress is in the realm of earthquake-inducing pumping. However, the low seismic hazard in the region determined from geodetic and paleo-seismic analysis does not suggest imminent rupture.

  5. Changes of smooth muscle contractile filaments in small bowel atresia


    Gfrörer, Stefan; Fiegel, Henning; Ramachandran, Priya; Rolle, Udo; Metzger, Roman


    AIM: To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia patients. METHODS: Resected small bowel specimens from small bowel atresia patients (n = 12) were divided into three sections (proximal, atretic and distal). Standard histology hematoxylin-eosin staining and enzyme immunohistochemistry was performed to visualize smooth muscle contractile markers α-smooth muscle actin (SMA) and desmin using conventional paraffin sections of the proxi...

  6. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kuzmanović Ilija B.


    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

  7. Muscle histochemistry in chronic alcoholism

    Directory of Open Access Journals (Sweden)

    M. L. Ferraz


    Full Text Available Twenty-two chronic acoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3% better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%. Lack of the mosaic pattern (type grouping seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the. pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polineuropathy; the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.

  8. [Analysis of palpation laws of muscle meridian focus on knee osteoarthritis]. (United States)

    Zhang, Shu-Jian; Zhang, Xiao-Qing; Han, Yu; Li, Chun-Ri; Dong, Bao-Qiang


    To explore the distribution regulars of proximal and distal focus of muscle meridian regions in knee osteoarthritis patients. Seven hundred and sixty-five knees were selected in 516 cases of knee osteoarthritis. Under the guidance of muscle meridian theory, with the anatomical features of muscle meridian focus, the frequency and the location where the proximal and distal focus of muscle meridian regions appeared were calculated by palpation. Of all the points, 11 835 points of proximal focus of muscle meridian regions were found out by palpation, and 9455 points of distal focus of muscle meridian regions were found out. The percentages of the frequency that the focus of muscle meridian of Foot-Yangming, Foot-Taiyang, Foot-Shaoyang and three foot Yin meridians appeared at proximal points of knee were 37.1% (4388/11 835), 34.9% (4127/11 835), 9.5% (1129/11 835) and 18.5% (2191/11 835) respectively; and the percentage of the frequency that the focus of muscle meridian appeared at distal points of knee were 24.7% (2333/9455), 25.2% (2380/9455), 28.5% (2700/9455) and 21.6% (2042/9455). The proximal and distal focus of muscle meridian in knee osteoarthritis patients are closely related with anatomy structure and biomechanical characteristics; the distribution regulars of focus of muscle meridians study provides evidence for the selection of effective treatment points from different clinical acupuncture therapies.





    Diaphragmatic rupture is a tear of diaphragm. It results from blu nt or penetrating inj ury to trunk 1 . It occurs in 5% of cases of severe blunt trauma to trunk 2 . Mortality from traumatic rupture diaphragm is 14 - 5 0 % 3 . This increases to 77% when associated with shock & head injury 3 . Associated injury makes the outcome w orst. Here is a case with spleen tear associated with traumatic rupture of diaphragm . ...

  10. Physical therapy in the conservative treatment for anterior cruciate ligament rupture followed by contralateral rupture: case report


    Almeida, Gabriel Peixoto Leão; Arruda, Gilvan de Oliveira; Marques, Amélia Pasqual


    Although the surgical reconstruction be the obvious indication for the anterior cruciate ligament (ACL) lesion, there is no consensus on whether the results of surgery are superior to those obtained with nonsurgical management. The objective of this report was to describe a case of nonsurgical treatment for ACL rupture followed by a contralateral rupture. A 28-year-old female practitioner of muay-thai and handball suffered a non-contact ACL rupture in the left knee, and three months after the...

  11. Surface Rupture Characteristics and Rupture Mechanics of the Yushu Earthquake (Ms7.1), 14/04/2010 (United States)

    Pan, J.; Li, H.; Xu, Z.; Li, N.; Wu, F.; Guo, R.; Zhang, W.


    On April 14th 2010, a disastrous earthquake (Ms 7.1) struck Yushu County, Qinghai Province, China, killing thousands of people. This earthquake occurred as a result of sinistral strike-slip faulting on the western segment of the Xianshuihe Fault zone in eastern Tibetan Plateau. Our group conducted scientific investigation in the field on co-seismic surface rupture and active tectonics in the epicenter area immediately after the earthquake. Here, we introduce our preliminary results on the surface ruptures and rupture mechanics of the Yushu Earthquake. The surface rupture zone of Yushu earthquake, which is about 49 km-long, consists of 3 discontinuous left stepping rupture segments, which are 19 km, 22 km, and about 8 km, respectively, from west to east. Each segment consists of a series of right stepping en-echelon branch ruptures. The branch ruptures consist of interphase push-up and tension fissures or simply en-echelon tension fissures. The co-seismic displacements had been surveyed with a total station in detail on landmarks such as rivers, gullies, roads, farmlands, wire poles, and fences. The maximum offset measured is 2.3m, located near the Guoyangyansongduo Village. There are 3 offset peaks along the rupture zone corresponding to the 3 segments of the surface rupture zone. The maximum offsets in the west, central, and east segment rupture zones are 1.4m, 2.3m, and 1.6m respectively. The surface rupture zone of Yushu earthquake strikes in a 310°NW direction. The fault plane dips to the northeast and the dip angle is about 81°. The rupture zone is developed in transtension setting. Tension normal fault developed during the sinistral strike-slip process of the fault. The valley west of Yushu City and the Longbao Lake are both pull-apart basins formed during the transtension activity of the fault.

  12. Tendon rupture associated with excessive smartphone gaming. (United States)

    Gilman, Luke; Cage, Dori N; Horn, Adam; Bishop, Frank; Klam, Warren P; Doan, Andrew P


    Excessive use of smartphones has been associated with injuries. A 29-year-old, right hand-dominant man presented with chronic left thumb pain and loss of active motion from playing a Match-3 puzzle video game on his smartphone all day for 6 to 8 weeks. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints. The potential for video games to reduce pain perception raises clinical and social considerations about excessive use, abuse, and addiction. Future research should consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming.

  13. Creep rupture strength of microalloyed steels

    Energy Technology Data Exchange (ETDEWEB)

    Foldyna, V.; Kubon, Z.; Schellong, T.


    The superior creep resistance of the microalloyed steels compared to the carbon steels originates in the presence of very fine particles of minor phases based on vanadium or niobium. These steels are delivered either after controlled rolling or in the normalized state. The creep strength of these microalloyed steels reaches nearly that of low alloy 0.15C-0.3Mo steel type. The best creep properties are detected in steels after controlled rolling, while after normalizing creep rupture strength slightly decreases, especially in heats alloyed with niobium. This is the result of the microstructure of the steel when in steel with niobium originally fine particles of niobium carbonitride coarsen during normalizing with corresponding changes in their interparticle spacing. When compared the creep rupture strength attained experimentally with the data stated in the standard CSN 41 2025, it is clear that the data stated in the standard corresponds the creep properties of this steel after normalizing but do not take into account creep properties attained after controlled rolling (normalizing forming). (orig.)

  14. Management of extensor mechanism rupture after TKA. (United States)

    Rosenberg, A G


    Disruption of the extensor mechanism in total knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps tendon rupture, or patella fracture, and whether occurring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complications. This surgery is frequently performed in compromised tissues, and repairs must frequently be protected with cerclage wiring and/or augmentation with local tendon (semi-tendinosis, gracilis) which may also be used to treat soft-tissue loss in the face of chronic disruption. Quadriceps rupture may be treated with conservative therapy if the patient retains active extension. Component loosening or loss of active extension of 20° or greater are clear indications for surgical treatment of patellar fracture. Acute patellar tendon disruption may be treated by primary repair. Chronic extensor failure is often complicated by tissue loss and retraction can be treated with medial gastrocnemius flaps, achilles tendon allografts, and complete extensor mechanism allografts. Attention to fixing the graft in full extension is mandatory to prevent severe extensor lag as the graft stretches out over time.

  15. Ruptures of the distal biceps tendon. (United States)

    Ward, James P; Shreve, Mark C; Youm, Thomas; Strauss, Eric J


    Distal biceps ruptures occur most commonly in middle-aged males and result from eccentric contraction of the biceps tendon. The injury typically presents with pain and a tearing sensation in the antecubital fossa with resultant weakness in flexion and supination strength. Physical exam maneuvers and diagnostic imaging aid in determining the diagnosis. Nonoperative management is reserved for elderly, low demand patients, while operative intervention is generally pursued for younger patients and can consist of nonanatomic repair to the brachialis or anatomic repair to the radial tuberosity. Anatomic repair through a one-incision or two-incision approach is commonplace, while the nonanatomic repairs are rarely performed. No clear advantage exists in operative management with a one-incision versus two-incision techniques. Chronic ruptures present a more difficult situation, and allograft augmentation is often necessary. Common complications after repair include transient nerve palsy, which often resolves, and heterotopic ossification. Despite these possible complications, most studies suggest that better patient outcomes are obtained with operative, anatomic reattachment of the distal biceps tendon.

  16. Triceps Tendon Ruptures: A Systematic Review. (United States)

    Dunn, John C; Kusnezov, Nicholas; Fares, Austin; Rubin, Sydney; Orr, Justin; Friedman, Darren; Kilcoyne, Kelly


    Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR. A literature search collecting surgical treated cases of TTR was performed, identifying 175 articles, 40 of which met inclusion criteria, accounting for 262 patients. Data were pooled and analyzed focusing on medical comorbidities, presence of a fleck fracture on the preoperative lateral elbow x-ray film (Dunn-Kusnezov Sign [DKS]), outcomes, and rerupture rates. The average age of injury was 45.6 years. The average time from injury to day of surgery was 24 days while 10 patients had a delay in diagnosis of more than 1 month. Renal disease (10%) and anabolic steroid use (7%) were the 2 most common medical comorbidities. The DKS was present in 61% to 88% of cases on the lateral x-ray film. Postoperatively, 89% of patients returned to preinjury level of activity, and there was a 6% rerupture rate at an average follow-up of 34.6 months. The vast majority (81%) of the patients in this review underwent repair via suture fixation. TTR is an uncommon injury. Risks factors for rupture include renal disease and anabolic steroid use. Lateral elbow radiographs should be scrutinized for the DKS in patients with extension weakness. Outcomes are excellent following repair, and rates of rerupture are low.

  17. Closed traumatic rupture of the flexor pulleys of a long finger associated with avulsion of the flexor digitorum superficialis. (United States)

    Vandeputte, G; Dubert, T


    We report a closed rupture of the second, third and fourth annular pulleys associated with avulsion of the flexor digitorum superficialis tendon in the ring finger of a healthy, 48-year-old patient. It was caused by sudden and violent flexion of the finger and led to a serious impairment of the proximal interphalangeal joint motion, despite physiotherapy and dynamic splinting. The patient was treated surgically, 3 months after the injury, with reconstruction of the second (A2) and fourth (A4) annular pulleys and excision of the distal portion of the superficialis tendon. The final functional result was satisfactory. Copyright 2001 The British Society for Surgery of the Hand.

  18. Complications in proximal humeral fractures. (United States)

    Calori, Giorgio Maria; Colombo, Massimiliano; Bucci, Miguel Simon; Fadigati, Piero; Colombo, Alessandra Ines Maria; Mazzola, Simone; Cefalo, Vittorio; Mazza, Emilio


    Necrosis of the humeral head, infections and non-unions are among the most dangerous and difficult-to-treat complications of proximal humeral fractures. The aim of this work was to analyse in detail non-unions and post-traumatic bone defects and to suggest an algorithm of care. Treatment options are based not only on the radiological frame, but also according to a detailed analysis of the patient, who is classified using a risk factor analysis. This method enables the surgeon to choose the most suitable treatment for the patient, thereby facilitating return of function in the shortest possible time. The treatment of such serious complications requires the surgeon to be knowledgeable about the following possible solutions: increased mechanical stability; biological stimulation; and reconstructive techniques in two steps, with application of biotechnologies and prosthetic substitution. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Augmented Repair of an Achilles Tendon Rupture Using the Flexor Digitorum Lateralis Tendon in a Toy Poodle. (United States)

    Katayama, Masaaki


    To report appositional augmentation of Achilles tendon rupture in a toy breed dog with an intact flexor digitorum lateralis (FDL) muscle tendon. Clinical case report. Two-year-old spayed female Toy Poodle with Achilles tendon rupture. The Achilles tendon was accidentally ruptured by hair clippers during grooming. The dog demonstrated a plantigrade stance without digital flexion of the right hind limb. The ruptured gastrocnemius and superficial digital flexor tendons were sutured to their respective cut ends using a simple locking loop pattern under a surgical microscope. The repair site was appositionally augmented by the caudally retracted intact FDL. An aluminum splint was applied on the plantar aspect to immobilize the tarsal joint for the first 2 weeks, after which a soft bandage was applied for another 2 weeks. At the 7 month follow-up no lameness was detected during walking and no complications associated with decreased FDL function such as digital contracture were observed. The range of motion of the tarsal joint had improved and could be flexed to ∼60° and extended fully. Use of the FDL is feasible for augmenting Achilles tendon repair in toy breed dogs. © Copyright 2016 by The American College of Veterinary Surgeons.

  20. [Diagnostic value of a predictive model for complete ruptures of the rotator cuff associated to subacromial impingement]. (United States)

    Águila-Ledesma, I R; Córdova-Fonseca, J L; Medina-Pontaza, O; Núñez-Gómez, D A; Calvache-García, C; Pérez-Atanasio, J M; Torres-González, R


    Pathology related to the rotator cuff remains among the most prevalent musculoskeletal diseases. There is an increasing need for imaging studies (MRI, US, arthroscopy) to test the diagnostic performance of the medical history and physical examination. To prove the diagnostic value of a clinical-radiographic predictive model to find complete ruptures of the rotator cuff. Descriptive, observational, prospective, transversal and analytical study. Fifty-five patients with preoperative shoulder pain were evaluated with 13 predictive variables: age > 50 years, nocturnal pain, muscle weakness, clinical signs of Neer, Hawkins, Jobe, external rotation lag (ERLS), belly-press, bear hug, and lift-off, radiographic measurement of subacromial space, acromial index and critical shoulder angle. Sensitivity, specificity, and positive and negative predictive values were measured in each variable, comparing the results of each one against the postoperative findings. Of the 55 patients evaluated, 42 had a complete rupture of the rotator cuff in the postoperative period. The eight variables with a higher diagnostic value were selected and a ROC curve was performed, providing an area under the curve of 0.88. This predictive model uses eight variables (age > 50 years, nocturnal pain, muscle weakness, Jobe, Hawkins, ERLS, subacromial space ≤ 6 mm, and critical shoulder angle > 35°), which together add the predictive value of 0.88 (AUC) to diagnose complete ruptures of the supraspinatus tendon.

  1. Combined flexor hallucis longus tendon transfer and gastrocnemius recession for reconstruction of gapped chronic achilles tendon ruptures. (United States)

    Elgohary, Hatem Elsayed Ahmed; Elmoghazy, Nabil A; Abd Ellatif, Mohammed Serry


    The aim of this study was to assess the functional outcomes after a combined FHL transfer and a gastrocnemius recession for treatment of chronic ruptures of Achilles tendon with a gap and to investigate the patient's satisfaction about the great toe function after transfer. 19 patients with chronic rupture of the Achilles tendon with a gap were treated with a flexor halluces longus tendon transfer combined with a gastrocnemius recession, Clinical diagnosis depends on the presence of gap in the tendon on examination, inability of tip toe walking on the affected side and positive calf-squeeze test, MRI was used to confirm the clinical diagnosis. American Orthopedic Foot & Ankle Society hind foot score was used for assessment of the results. The AOFAS score improved significantly from a mean of 65 preoperatively to 94 at the last follow up (ptendon weaved through the stump of the Achilles tendon and those with trans osseous tunnels, the mean AOFAS score at the last follow up was 94.2, 93.8 respectively, no patient complained of big toe dysfunction. Management of chronic rupture of the Achilles tendon with a gap with flexor halluces longus tendon transfer combined with a gastrocnemius recession is a safe and reliable method with a significantly improved functional outcome, muscle advancement through gastrocnemius recession decreases the length of the gap without affecting the muscle function, flexor halluces longus tendon transfer doesn't harm the big toe function. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Proximity sensor technology for manipulator end effectors (United States)

    Johnston, A. R.


    Optical proximity sensing techniques which could be used to help control the critical grasping phase of a remote manipulation are described. The proximity sensors described use a triangulation geometry to detect a surface located in a pre-determined region. The design of the proximity sensors themselves is discussed, as well as their application to manipulator control with a local control loop, and possibilities for future development are discussed.

  3. Uterine Rupture due to Traumatic Assisted Fundal Pressure

    Directory of Open Access Journals (Sweden)

    Shen-Chuan Wei


    Conclusion: Assisted fundal pressure during painful delivery can be traumatic and results in uterine rupture. In this article, we suggest that uterine rupture should be considered whenever a pregnant woman experiences a sudden onset of abdominal pain during the course of assisted uterine fundal pressure.

  4. Associations in ruptured ectopic pregnancy in Nnamdi Azikiwe ...

    African Journals Online (AJOL)

    This study investigated other known factors associated with ruptured ectopic pregnancy. Retrospective analysis of the medical records of women who were operated on for ruptured ectopic pregnancy at Nnamdi Azikiwe University Teaching Hospital, Nnewi from 1991 to 2003 was carried out. No patient was excluded and all ...

  5. 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

  6. Field evidences of secondary surface ruptures occurred during the ...

    Indian Academy of Sciences (India)

    Keywords. Eskişehir fault zone; 1956 Eskişehir earthquake; morphotectonics; surface rupture; NW Anatolia. Abstract. Surface rupture and source fault of the 20 February 1956 Eskişehir earthquake have been a matter of debate that potentially contributes towards the understanding of the active deformation and seismic risk ...

  7. Urinary Bladder Rupture In An Elderly Man From Abdominal Massage

    African Journals Online (AJOL)

    Background: Bladder rupture is a serious urological injury. Because symptoms are often atypical among elderly patients, this condition is often undetected especially when there is little or no trauma. Aims and Objective: We report a rare case of bladder rupture, secondary to abdominal massage. Patient and Method: A case ...

  8. 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 ...

  9. Splenic rupture and intracranial haemorrhage in a haemophilic ...

    African Journals Online (AJOL)

    ... of haemophilia A, who was diagnosed with splenic rupture and bilateral subdural haematomas and underwent splenectomy, albeit with post-operative complications, in light of haemodynamic instability and high ongoing transfusion requirements. Key words: Hemophilia, intracranial hemorrhage, neonate, splenic rupture ...

  10. Cutaneous Silicone Granuloma Mimicking Breast Cancer after Ruptured Breast Implant

    Directory of Open Access Journals (Sweden)

    Waseem Asim Ghulam El-Charnoubi


    Full Text Available Cutaneous manifestations due to migration of silicone from ruptured implants are rare. Migrated silicone with cutaneous involvement has been found in the chest wall, abdominal wall, and lower extremities. We describe a case of cutaneous silicone granuloma in the breast exhibiting unusual growth mimicking breast cancer after a ruptured implant.

  11. Idiopathic Gastric Rupture in a Child: Critical Situation | Ourfali ...

    African Journals Online (AJOL)

    Idiopathic gastric rupture is extremely rare condition in children. We report herein a 4-years-old girl with Idiopathic GR who presented with shock. Resuscitation and early surgical intervention led to saving the child's life. Index Word: Gastric rupture, Pneumoperitoneum, Abdominal distension, Resuscitation.

  12. 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.


    African Journals Online (AJOL)


    RUPTURE OF SINUS OF VALSALVA ANEURYSM: CASE REPORT. A. G. B. AMOAH, K. FRIMPONG-BOATENG and H. BADDOO. SUMMARY. Sinus of Valsalva aneurysms are uncommon. Aortic sinus aneurysm may be complicated by endocarditis or rupture. A 26 year old native Ghanaian presented with dyspnoea, raised.

  14. 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

  15. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm

    DEFF Research Database (Denmark)

    Wernheden, Erika; Brenøe, Anne Sofie; Shahidi, Saeid


    Splenic artery aneurysms (SAAs) are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm) SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured...

  16. Intrapartum Rupture of the Uterus Diagnosed by Ultrasound ...

    African Journals Online (AJOL)

    Background: Spontaneous uterine rupture is a life threatening obstetrical emergency encountered infrequently in the emergency department. Its diagnosis is often missed or delayed, leading to maternal and fetal mortality. Method: We present a case of ruptured uterus diagnosed by ultrasound in a 33-year-old gravid female ...

  17. Closed rupture of the thumb flexor tendon pulleys. (United States)

    Wilson, S M; Roulot, E; Le Viet, D


    Closed flexor tendon pulley ruptures are relatively rare injuries. All previously reported cases have been in the long finger pulleys. To our knowledge, there has not been a case of closed thumb flexor tendon pulley rupture reported in the literature. This paper presents two cases of this pathology and discusses appropriate treatment of it.

  18. 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.

  19. 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 ...

  20. Use of ICD-10 codes to monitor uterine rupture

    DEFF Research Database (Denmark)

    Thisted, Dorthe L A; Mortensen, Laust Hvas; Hvidman, Lone


    OBJECTIVES: Uterine rupture is a rare but severe complication in pregnancies after a previous cesarean section. In Denmark, the monitoring of uterine rupture is based on reporting of relevant diagnostic codes to the Danish Medical Birth Registry (MBR). The aim of our study was to examine the vali...

  1. Spontaneous rupture of an incisional hernia | Eke | Highland ...

    African Journals Online (AJOL)

    She tested positive for HIV infection. The rupture was repaired under antibodies cover. She made an uneventful recovery but has since been lost to follow up. Lesson: The risk of spontaneous rupture is an indication for the elective repair of incisional hernias. Highland Medical Research Journal Vol. 4(1) 2006: 86-88 ...

  2. Posterior uterine rupture secondary to use of herbs leading to ...

    African Journals Online (AJOL)

    Uterine rupture is a potentially avoidable complication resulting in poor perinatal and maternal outcomes. This case had a number of unusual features including delivery of a healthy live baby; spontaneous posterior uterine rupture in a primigravida (and unscarred uterus); and delayed presentation with signs of peritonitis ...

  3. 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 ...

  4. Ruptured uterus in Azare, north eastern Nigeria | Dattijo | Jos ...

    African Journals Online (AJOL)

    Background:-Ruptured uterus is an obstetric emergency and results in significant maternal and perinatal morbidity and mortality in Nigeria. The objective of the review is to determine the incidence, predisposing factors, maternal and foetal outcome in cases of ruptured uterus. Methods:- A 4-year retrospective review of ...

  5. Spontaneous rupture: An uncommon complication of ventral hernia ...

    African Journals Online (AJOL)

    BACKGROUND: Literature is scarce about spontaneous rupture of hernia because spontaneous rupture of here is uncommon (1). Reported cases are complications of incisional hernias, recurrent inguinal hernia, and umbilical hernias. It is potentially life threatening (1) because the ensuing entrapment and tension on ...

  6. Proximate composition and antinutrient content of pumpkin ...

    African Journals Online (AJOL)

    Proximate composition and antinutrient content of pumpkin ( Cucurbita pepo ) and sorghum ( Sorghum bicolor ) flour blends fermented with Lactobacillus plantarum , Aspergillus niger and Bacillus subtilis.

  7. A standardized protocol for needle placement in suboccipital muscles. (United States)

    Hallgren, Richard C; Andary, Michael T; Wyman, Andrew J; Rowan, Jacob J


    The objective of this study was to assess the safety and accuracy of using common anatomic landmarks to guide the placement of needle electrodes into suboccipital muscles. Atrophic changes in suboccipital muscles have been reported in some patients who have tension-type headaches, and in some patients who have headaches resulting from whiplash-type injuries. These atrophic changes most likely result from disuse or denervation. Needle electromyography is a definitive technique for determining the cause of muscle atrophy, but requires that needle electrodes be inserted into the muscle. Suboccipital muscles present a challenge to the electromyographer in that they are physically small and are located in close proximity to one another. Atrophied muscles with fatty replacement and the presence of critical structures such as the vertebral artery further complicate the procedure. Using a standardized protocol, three investigators attempted blind needle insertions into each of the suboccipital muscles of eight embalmed cadavers. A dissector then assessed targeted muscle penetrations, final resting positions of the wires, and their proximity to critical structures. Eighty-one percent of 181 attempted insertions penetrated the targeted muscles: 83% for the rectus capitis posterior minor, 83% for the rectus capitis posterior major, 94% for the obliquus capitis superior, and 63% for the obliquus capitis inferior muscles, respectively. It was concluded that readily palpable external landmarks can be used to safely and reliably guide the insertion of needle electrodes into three of the four pairs of suboccipital muscles. (c) 2008 Wiley-Liss, Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. Characterization of proximal pulmonary arterial cells from chronic thromboembolic pulmonary hypertension patients

    Directory of Open Access Journals (Sweden)

    Quarck Rozenn


    Full Text Available Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH is associated with proximal pulmonary artery obstruction and vascular remodeling. We hypothesized that pulmonary arterial smooth muscle (PASMC and endothelial cells (PAEC may actively contribute to remodeling of the proximal pulmonary vascular wall in CTEPH. Our present objective was to characterize PASMC and PAEC from large arteries of CTEPH patients and investigate their potential involvement in vascular remodeling. Methods Primary cultures of proximal PAEC and PASMC from patients with CTEPH, with non-thromboembolic pulmonary hypertension (PH and lung donors have been established. PAEC and PASMC have been characterized by immunofluorescence using specific markers. Expression of smooth muscle specific markers within the pulmonary vascular wall has been studied by immunofluorescence and Western blotting. Mitogenic activity and migratory capacity of PASMC and PAEC have been investigated in vitro. Results PAEC express CD31 on their surface, von Willebrand factor in Weibel-Palade bodies and take up acetylated LDL. PASMC express various differentiation markers including α-smooth muscle actin (α-SMA, desmin and smooth muscle myosin heavy chain (SMMHC. In vascular tissue from CTEPH and non-thromboembolic PH patients, expression of α-SMA and desmin is down-regulated compared to lung donors; desmin expression is also down-regulated in vascular tissue from CTEPH compared to non-thromboembolic PH patients. A low proportion of α-SMA positive cells express desmin and SMMHC in the neointima of proximal pulmonary arteries from CTEPH patients. Serum-induced mitogenic activity of PAEC and PASMC, as well as migratory capacity of PASMC, were increased in CTEPH only. Conclusions Modified proliferative and/or migratory responses of PASMC and PAEC in vitro, associated to a proliferative phenotype of PASMC suggest that PASMC and PAEC could contribute to proximal vascular remodeling in CTEPH.

  10. Use of fluroquinolone and risk of Achilles tendon rupture

    DEFF Research Database (Denmark)

    Sode, Jacob; Obel, Niels; Hallas, Jesper


    OBJECTIVE: Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach. SETTING: Data on Achilles tendon ruptures and fluoroquinolone use were...... retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991-1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were...... identified. MAIN OUTCOME MEASURES: The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures. RESULTS: Between 1991 and 2002 the incidence...

  11. 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

  12. 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.


    Directory of Open Access Journals (Sweden)

    Mikako Sakamaki


    Full Text Available We examined the effect of walk training combined with blood flow restriction (BFR on the size of blood flow-restricted distal muscles, as well as, on the size of non-restricted muscles in the proximal limb and trunk. Nine men performed walk training with BFR and 8 men performed walk training alone. Training was conducted two times a day, 6 days/wk, for 3 wk using five sets of 2-min bouts (treadmill speed at 50 m/min, with a 1-min rest between bouts. After walk training with BFR, MRI-measured upper (3.8%, P < 0.05 and lower leg (3.2%, P < 0. 05 muscle volume increased significantly, whereas the muscle volume of the gluteus maximus (-0.6% and iliopsoas (1.8% and the muscle CSA of the lumber L4-L5 (-1.0 did not change. There was no significant change in muscle volume in the walk training alone. Our results suggest that the combination of leg muscle blood flow restriction with slow walk training elicits hypertrophy only in the distal blood flow restricted leg muscles. Exercise intensity may be too low during BFR walk training to increase muscle mass in the non- blood flow restricted muscles (gluteus maximus and other trunk muscles.

  14. Spontaneous bilateral rupture of the Achilles tendon in a patient with chronic obstructive pulmonary disease. (United States)

    Khurana, Rohit; Torzillo, Paul J; Horsley, Mark; Mahoney, John


    A 69-year-old man with chronic obstructive pulmonary disease (COPD) presented with an exacerbation of cough and breathlessness, as well as a 5 day history of sudden-onset bilateral calf tenderness. He had been commenced on inhaled steroids 41/2 years earlier and then received maintenance oral prednisone. Upon examination, there was a haematoma inferior to the medial malleolus with no Achilles tenderness on the left side. On the right side, there was focal tenderness over the mid-portion of the Achilles tendon with pain accentuated upon dorsi flexion. A venous duplex study confirmed superficial venous thrombosis involving the left gastrocnemius vein extending proximally to the popliteal vein junction. The major axial deep veins of the left lower leg were patent. Findings on the right side were normal. A subsequent diagnostic ultrasound demonstrated unequivocal bilateral Achilles tendon ruptures. The patient subsequently underwent corrective surgery. There have been several reports of bilateral Achilles tendon rupture associated with long-term corticosteroid use. It is likely that this entity is underdiagnosed because of a lack of awareness of this association by physicians. Recognition and surgical intervention are likely to reduce morbidity and improve outcome.

  15. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Yi-Pei Tai


    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  16. Emergency endovascular treatment of emergent or ruptured aortic aneurysms: A single centre experience

    Energy Technology Data Exchange (ETDEWEB)

    England, Andrew [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)]. E-mail:; Butterfield, John S. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Nasim, Akhtar [Department of Vascular Surgery, South Manchester University Hospitals, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Welch, Mark [Department of Vascular Surgery, South Manchester University Hospitals, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); McCollum, Charles N. [Department of Vascular Surgery, South Manchester University Hospitals, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Ashleigh, Raymond J. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)


    Objective: To report our experience with emergency endovascular repair (eEVAR) in patients with ruptured or acutely symptomatic AA. Methods: From August 1998 to June 2004, 22 high-risk patients (21 men, median age 74 years, range 15-84 years) with ruptured or acutely symptomatic aneurysms underwent eEVAR using Talent endoprostheses. All procedures were performed in the operating theatre by a surgical/radiology team. Indications for repair, co-morbidities and outcomes were recorded with follow-up by US and CT scanning. Results: Of 22 eEVARs, 13 patients had abdominal AA and nine patients had thoracic AA. Nineteen (86.4%) repairs were technically successful, there was one patient with a type I proximal endoleak treated conservatively and two patients died during their inpatient period (myocardial infarction and broncho-pneumonia). On follow-up of the 20 survivors (median 7 months, range 0-48 months), there were three further deaths, and two further endoleaks. The 1-year survival by life-table analysis is 75 {+-} 9.8% and 13 patients are free from reintervention at last follow-up. Conclusion: eEVAR had encouraging initial results in selected high-risk patients.

  17. Essentials of anterior cruciate ligament rupture management. (United States)

    Klinge, Stephen A; Sawyer, Gregory A; Hulstyn, Michael J


    Anterior cruciate ligament (ACL) rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. Accurate and prompt diagnosis requires an awareness of injury mechanisms and risk factors, common symptoms and physical/radiologic findings. Early mobilization and physical therapy improves outcomes regardless of treatment modality. Many older patients regain sufficient stability and function after non-operative rehabilitation. Early ACL reconstruction is appropriate for younger patients and those who engage in activities requiring frequent pivoting and rapid direction changes. ACL surgery involves reconstruction of the torn ligament tissue with various replacement graft options, each with advantages and disadvantages. The guidance of a knowledgeable and experienced therapist is required throughout an intensive and prolonged rehabilitation course. Generally excellent outcomes and low complication rates are expected, but treatment does not prevent late osteoarthritis.

  18. 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.

  19. Imaging of diaphragmatic rupture after trauma

    Energy Technology Data Exchange (ETDEWEB)

    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.

  20. Recanalization and rupture after intracranial aneurysm treatment. (United States)

    Costa, Emmanuel; Vaz, Geraldo R; Finet, Patrice; Goffette, Pierre; Docquier, Marie A; Raftopoulos, Christian


    Treatment of intra cranial aneurysm (ICA) can sometimes required several procedures. The aim of this study is to analyze the risk of recanalization and rupture recurrence after ICA treatment by endovascular coiling (EVC) or surgical clipping (SC) on a very long follow-up. Clinical data of 373 consecutive patients treated in our group between January 1996 and December 2006 as well by EVC as by SC for ruptured (RIA) or unruptured intracranial aneurysm (UIA), were reviewed. Patients were followed up at least to August 2009. First radiologic follow-up done six months after EVC and between three and five years after SC (median time: 5 years)). All patients underwent a clinical follow-up after treatment, at least by telephonic communication (median time: 6 years). Out of 197 patients with 198 RIAs, 82 (42 %) patients underwent an endovascular treatment and 115 (58%) were allocated to surgical treatment. From a total of 176 patients with 229 UIAs, 66 (37.5%) patients were treated by 74 EVC; and 110 (62.5%) patients were treated with 124 surgical procedures. Fifteen recanalizations of coiled RIAs were detected and only one in the surgical group (27% vs. 2%; p= 0.0008). Of the 15 recanalizations in the EVC group, 6 (40%) were initially completely occluded. We observed two rebleedings, one in each group (1.4% for EVC; 1% for SC; p=0.8). Our findings during the longest reported follow-up confirm a greater risk of recanalization for RIA treated by EVC without so far a significant difference in the rerupture risk.

  1. Soft, Brown Rupture: Clinical Signs and Symptoms Associated with Ruptured PIP Breast Implants

    Directory of Open Access Journals (Sweden)

    Yvette Godwin, FRCS


    Conclusions: Preoperative signs can be predictive of PIP implant failure. Brown-stained implants are more prone to rupture. The presence of iodine in the gel suggests unacceptable permeability of the shell early in the implant’s life span. A noninvasive screening test to detect brown implants in situ could help identify implants at risk of failure in those who elect to keep their implants.

  2. Ultrasound diagnostics of muscle and tendon injuries

    Directory of Open Access Journals (Sweden)

    Stević Ruža


    Full Text Available Introduction. Sonography is a useful technique for the investigation of a number of musculoskeletal disorders. The most common indication for ultrasonography of muscles and tendons is the diagnosis of traumatic lesions, distinguishing them from other disorders and follow-up of healing process. Objective. The purpose of this paper is to show the importance of ultrasound in the diagnosis of muscle and tendon injuries. Methods. The study included 170 patients (148 male and 22 female, mean age 29.6 years (range 14-60 years. All examinations were performed by linear transducer of 7.5-10 MHz, with longitudinal and transverse scanning. Ultrasound examination followed physical examination. Results. Traumatic lesions of muscles were diagnosed in 113 patients (66.7% and tendon injuries in 57 cases (33.2%. The muscle changes detected by ultrasonography were the following: 70 (61.9% partial and two (1.76% complete ruptures, 22 (19.46% haematoma, 9 (7.96% strains grade I, 4 fibroses and 4 ossifying myositis 4 (3.5%, respectively. Complications of muscle injuries were diagnosed in two cases, a muscular hernia and an arteriovenous fistula. Among tendon injuries, 21 (33.8% ruptures and 36 (66.1% tendinitis were diagnosed. Accompanying effusion in the bursa of patients with tendon injuries was found in 9 cases. Conclusion. Ultrasonography allowed visualization and objective assessment of the type and the extent of traumatic pathomorphological changes of muscles and tendons. Such diagnostic possibilities of ultrasonography are especially important in the choice of appropriate therapy.

  3. Creep and rupture of an ODS alloy with high stress rupture ductility. [Oxide Dispersion Strengthened (United States)

    Mcalarney, M. E.; Arsons, R. M.; Howson, T. E.; Tien, J. K.; Baranow, S.


    The creep and stress rupture properties of an oxide (Y2O3) dispersion strengthened nickel-base alloy, which also is strengthened by gamma-prime precipitates, was studied at 760 and 1093 C. At both temperatures, the alloy YDNiCrAl exhibits unusually high stress rupture ductility as measured by both elongation and reduction in area. Failure was transgranular, and different modes of failure were observed including crystallographic fracture at intermediate temperatures and tearing or necking almost to a chisel point at higher temperatures. While the rupture ductility was high, the creep strength of the alloy was low relative to conventional gamma prime strengthened superalloys in the intermediate temperature range and to ODS alloys in the higher temperature range. These findings are discussed with respect to the alloy composition; the strengthening oxide phases, which are inhomogeneously dispersed; the grain morphology, which is coarse and elongated and exhibits many included grains; and the second phase inclusion particles occurring at grain boundaries and in the matrix. The creep properties, in particular the high stress dependencies and high creep activation energies measured, are discussed with respect to the resisting stress model of creep in particle strengthened alloys.

  4. Penile fracture: A rare case of simultaneous rupture of the one corpus cavernosum and complete urethral rupture

    Directory of Open Access Journals (Sweden)

    Nale Đorđe


    Full Text Available Introduction. Penile fracture is a traumatic rupture of tunica albuginea and the tumescent corpora cavernosa due to the nonphysiological bending of the penile shaft, presenting with or without rupture of corpus spongiosum and urethra. The incidence of concomitant injury of the urethra is 0-38%. Complete urethral rupture is rare, but it is almost always associated with bilateral corporeal injury. Case report. We presented a patient with complete urethral rupture, and rupture of the right cavernous body. According to the available literature, this case is extremely rare. Conclusion. Fracture of the penis is relatively uncommon and is considered a urologic emergency. Prompt surgical exploration and repair can preserve erectile and voiding function.

  5. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures


    Thyagarajan David; Haridas Samarth; Jones Denise; Dent Colin; Evans Richard; Williams Rhys


    Aim: To assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures. Patients and Methods: We reviewed 30 consecutive patients treated surgically with the proximal humeral locking plate for a displaced proximal humeral fracture. Functional outcome was determined using the American Shoulder and Elbow Society (ASES) score and Constant Murley score. Results: Average age of the patients was 58 years...

  6. Best Proximity Points for a New Class of Generalized Proximal Mappings

    Directory of Open Access Journals (Sweden)

    Tayyab Kamran


    Full Text Available The best proximity points are usually used to find the optimal approximate solution of the operator equation Tx = x, when T has no fixed point. In this paper, we prove some best proximity point theorems for nonself multivalued operators, following the foot steps of Basha and Shahzad [Best proximity point theorems for generalized proximal contractions, Fixed Point Theory Appl., 2012, 2012:42].

  7. [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

  8. Preliminary phytochemical screening, proximate and elemental ...

    African Journals Online (AJOL)

    The seed powder of Moringa oleifera was analysed for its phytochemical, proximate and elemental composition using Folin-Denis spectrophotometric method, gravimetric method and energy dispersing X-ray fluorescence (EDXRF) transmission emission technique respectively. The seed powder had the following proximate ...

  9. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.


    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  10. Grouping by Proximity in Haptic Contour Detection (United States)

    Overvliet, Krista E.; Krampe, Ralf Th.; Wagemans, Johan


    We investigated the applicability of the Gestalt principle of perceptual grouping by proximity in the haptic modality. To do so, we investigated the influence of element proximity on haptic contour detection. In the course of four sessions ten participants performed a haptic contour detection task in which they freely explored a haptic random dot display that contained a contour in 50% of the trials. A contour was defined by a higher density of elements (raised dots), relative to the background surface. Proximity of the contour elements as well as the average proximity of background elements was systematically varied. We hypothesized that if proximity of contour elements influences haptic contour detection, detection will be more likely when contour elements are in closer proximity. This should be irrespective of the ratio with the proximity of the background elements. Results showed indeed that the closer the contour elements were, the higher the detection rates. Moreover, this was the case independent of the contour/background ratio. We conclude that the Gestalt law of proximity applies to haptic contour detection. PMID:23762364

  11. Proximate analysis on four edible mushrooms ADEDAYO ...

    African Journals Online (AJOL)

    Michael Horsfall

    Vol. 15 (1) 9 - 11. Full-text Available Online at Proximate analysis on four edible mushrooms. ADEDAYO, MAJEKODUNMI RACHEL. Nigerian Stored Product Research Institute, P.M.B.3032, Kano. ABSTRACT: Proximate study was conducted on four edible mushrooms commonly found in farmlands in.

  12. Proximate Sources of Collective Teacher Efficacy (United States)

    Adams, Curt M.; Forsyth, Patrick B.


    Purpose: Recent scholarship has augmented Bandura's theory underlying efficacy formation by pointing to more proximate sources of efficacy information involved in forming collective teacher efficacy. These proximate sources of efficacy information theoretically shape a teacher's perception of the teaching context, operationalizing the difficulty…

  13. Phytochemical screening, proximate analysis and anticonvulsant ...

    African Journals Online (AJOL)

    Spigelia anthelmia is used traditionally in Southern Nigeria for the treatment of infant convulsion and epilepsy. This study investigated the phytochemical constituents, proximate analysis and anticonvulsant effect of the methanolic extract of Spigelia anthelmia. Phytochemical evaluation and proximate analysis was carried ...

  14. Intramedullary compression device for proximal ulna fracture. (United States)

    Hong, Choon Chiet; Han, Fucai; Decruz, Joshua; Pannirselvam, Vinodhkumar; Murphy, Diarmuid


    Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).

  15. Daughter bubble cascades produced by folding of ruptured thin films. (United States)

    Bird, James C; de Ruiter, Riëlle; Courbin, Laurent; Stone, Howard A


    Thin liquid films, such as soap bubbles, have been studied extensively for over a century because they are easily formed and mediate a wide range of transport processes in physics, chemistry and engineering. When a bubble on a liquid-gas or solid-gas interface (referred to herein as an interfacial bubble) ruptures, the general expectation is that the bubble vanishes. More precisely, the ruptured thin film is expected to retract rapidly until it becomes part of the interface, an event that typically occurs within milliseconds. The assumption that ruptured bubbles vanish is central to theories on foam evolution and relevant to health and climate because bubble rupture is a source for aerosol droplets. Here we show that for a large range of fluid parameters, interfacial bubbles can create numerous small bubbles when they rupture, rather than vanishing. We demonstrate, both experimentally and numerically, that the curved film of the ruptured bubble can fold and entrap air as it retracts. The resulting toroidal geometry of the trapped air is unstable, leading to the creation of a ring of smaller bubbles. The higher pressure associated with the higher curvature of the smaller bubbles increases the absorption of gas into the liquid, and increases the efficiency of rupture-induced aerosol dispersal.

  16. Pectoralis major ruptures in professional American football players. (United States)

    Tarity, T David; Garrigues, Grant E; Ciccotti, Michael G; Zooker, Chad C; Cohen, Steven B; Frederick, Robert W; Williams, Gerald R; DeLuca, Peter F; Dodson, Christopher C


    Pectoralis major injuries are an infrequent shoulder injury that can result in pain, weakness, and deformity. These injuries may occur during the course of an athletic competition, including football. The purpose of this study was to determine the incidence of pectoralis major ruptures in professional football players and time lost from the sport following injury. We hypothesized that ruptures most frequently occur during bench-press strength training. The National Football League Injury Surveillance System was reviewed for all pectoralis major injuries in all players from 2000 to 2010. Details regarding injury setting, player demographics, method of treatment, and time lost were recorded. A total of 10 injuries-complete ruptures-were identified during this period. Five of the 10 were sustained in defensive players, generally while tackling. Nine occurred during game situations, and 1 occurred during practice. Specific data pertinent to the practice injury was not available. No rupture occurred during weight lifting. Eight ruptures were treated operatively, and 2 cases did not report the method of definitive treatment. The average days lost was 111 days (range, 42-189). The incidence was 0.004 pectoralis major ruptures during the 11-year study period. Pectoralis major injuries are uncommon while playing football. In the National Football League, these injuries primarily occur not during practice or while bench pressing but rather during games. When pectoralis major ruptures do occur, they are successfully treated operatively. Surgery may allow for return to full sports participation. IV, case series.

  17. Shigella subverts the host recycling compartment to rupture its vacuole. (United States)

    Mellouk, Nora; Weiner, Allon; Aulner, Nathalie; Schmitt, Christine; Elbaum, Michael; Shorte, Spencer L; Danckaert, Anne; Enninga, Jost


    Shigella enters epithlial cells via internalization into a vacuole. Subsequent vacuolar membrane rupture allows bacterial escape into the cytosol for replication and cell-to-cell spread. Bacterial effectors such as IpgD, a PI(4,5)P2 phosphatase that generates PI(5)P and alters host actin, facilitate this internalization. Here, we identify host proteins involved in Shigella uptake and vacuolar membrane rupture by high-content siRNA screening and subsequently focus on Rab11, a constituent of the recycling compartment. Rab11-positive vesicles are recruited to the invasion site before vacuolar rupture, and Rab11 knockdown dramatically decreases vacuolar membrane rupture. Additionally, Rab11 recruitment is absent and vacuolar rupture is delayed in the ipgD mutant that does not dephosphorylate PI(4,5)P₂ into PI(5)P. Ultrastructural analyses of Rab11-positive vesicles further reveal that ipgD mutant-containing vacuoles become confined in actin structures that likely contribute to delayed vacular rupture. These findings provide insight into the underlying molecular mechanism of vacuole progression and rupture during Shigella invasion. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Observations of the rupture development process from source time functions (United States)

    Renou, Julien; Vallée, Martin


    The mechanisms governing the seismic rupture expansion and leading to earthquakes of very different magnitudes are still under debate. In the cascade model, the rupture starts from a very small patch, which size is undetectable by seismological investigation. Then rupture grows in a self-similar way, implying that no clues about the earthquake magnitude can be found before rupture starts declining. However dependencies between early phases of the rupture process and final magnitude have also been proposed, which can be explained if an earthquake is more likely to be a big one when its start and early development occur in rupture-prone areas. Here, the analysis of the early phases of the seismic rupture is achieved from an observational point of view using the SCARDEC database, a global catalog containing more than 3000 Source Time Functions (STFs) of earthquakes with magnitude larger than 5.7. This dataset is theoretically very suitable to investigate the initial phase, because STFs directly describe the seismic moment rate released over time, giving access to the rupture growth behavior. As several studies already showed that deep earthquakes tend to have a specific signature of short duration with respect to magnitude (implying a quicker rupture growth than superficial events), only shallow events (depths approach does not use any rupture time information, which is interesting as (1) the exact hypocentral time can be uncertain and (2) the real rupture expansion can be delayed compared to origin time. If any magnitude-dependent signal exists, the average or median value of the slope should vary with the magnitude of the events, despite the intrinsic variability of the STFs. The preliminary results from the SCARDEC dataset seem to only exhibit a weak dependence of the slope with magnitude, in the magnitude domain where the chosen moment rate value crosses most of the STFs onsets. In addition, our results point out that slope values gradually increase with the

  19. 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

  20. Blunt traumatic rupture of the diaphragm: sonographic diagnosis. (United States)

    Kim, H H; Shin, Y R; Kim, K J; Hwang, S S; Ha, H K; Byun, J Y; Choi, K H; Shinn, K S


    Ultrasonographic features of seven patients with diaphragmatic rupture due to blunt trauma were analyzed. The ruptures occurred at the left hemidiaphragm in four patients and at the right in three. Direct ultrasonographic findings were as follows: disrupted diaphragm in four patients; nonvisualized diaphragm in three patients; floating diaphragm in two patients; and herniation of the liver or bowel loops through the diaphragmatic defect in three patients. Indirect sonographic findings included pleural effusion or subphrenic fluid collection in five patients and splenic laceration in one. Although the number of patients was limited, ultrasonography was very useful for the diagnosis of diaphragmatic rupture.

  1. Creep rupture behavior of welded Grade 91 steel

    Energy Technology Data Exchange (ETDEWEB)

    Shrestha, Triratna [Department of Chemical and Materials Engineering, University of Idaho, Moscow, ID 83844 (United States); Basirat, Mehdi [Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844 (United States); Alsagabi, Sultan; Sittiho, Anumat [Department of Chemical and Materials Engineering, University of Idaho, Moscow, ID 83844 (United States); Charit, Indrajit, E-mail: [Department of Chemical and Materials Engineering, University of Idaho, Moscow, ID 83844 (United States); Potirniche, Gabriel P. [Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844 (United States)


    Creep rupture behavior of fusion welded Grade 91 steel was studied in the temperature range of 600 – 700 °C and at stresses of 50–200 MPa. The creep data were analyzed in terms of the Monkman-Grant relation and Larson-Miller parameter. The creep damage tolerance factor was used to identify the origin of creep damage. The creep damage was identified as the void growth in combination with microstructural degradation. The fracture surface morphology of the ruptured specimens was studied by scanning electron microscopy and deformed microstructure examined by transmission electron microscopy, to further elucidate the rupture mechanisms.

  2. Laparoscopic splenectomy for spontaneous rupture of the spleen

    Directory of Open Access Journals (Sweden)

    Pinky M Thapar


    Full Text Available Laparoscopic splenectomy is a gold standard for management of planned benign splenic pathologies. Spontaneous rupture of the spleen (SRS leading to acute abdomen occurs in only 1% of all splenic ruptures. Laparoscopic splenectomy in traumatic and atraumatic rupture due to intra-splenic pathology is reported. We present the first reported case of laparoscopic splenectomy in a 23-year-old male who presented with hemoperitoneum due to idiopathic or SRS. The procedure was safely accomplished with slight modified technique and minimum usage of advanced gadgets.

  3. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm

    Directory of Open Access Journals (Sweden)

    Erika Wernheden, MD


    Full Text Available Splenic artery aneurysms (SAAs are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured 15-cm giant SAA in an 84-year-old woman treated successfully with emergency endovascular coiling. To our knowledge, this is one of the few reports of emergency endovascular treatment for ruptured giant SAA.

  4. Left atrial rupture due to blunt thoracic trauma. (United States)

    Akar, İlker; İnce, İlker; Aslan, Cemal; Çeber, Mehmet; Kaya, İlker


    Blunt traumatic cardiac rupture is rare and associated with high mortality. The most popular theory of cardiac rupture after blunt thoracic trauma is rapid deceleration with disruption of the atria from their connections to the vena cava and pulmonary veins. In cases with both massive hemothorax and hemopericardium, injury can usually originate from the heart and/or major vessels. Surgical approach through the median sternotomy can provide convenience to repair the defect. In this article, successful treatment with median sternotomy of a 33-year-old male case with a rupture of the left atrium after blunt thoracic trauma was reported.

  5. Protein turnover and cellular stress in mildly and severely affected muscles from patients with limb girdle muscular dystrophy type 2I. (United States)

    Hauerslev, Simon; Sveen, Marie L; Vissing, John; Krag, Thomas O


    Patients with Limb girdle muscular dystrophy type 2I (LGMD2I) are characterized by progressive muscle weakness and wasting primarily in the proximal muscles, while distal muscles often are spared. Our aim was to investigate if wasting could be caused by impaired regeneration in the proximal compared to distal muscles. Biopsies were simultaneously obtained from proximal and distal muscles of the same patients with LGMD2I (n = 4) and healthy subjects (n = 4). The level of past muscle regeneration was evaluated by counting internally nucleated fibers and determining actively regenerating fibers by using the developmental markers embryonic myosin heavy chain (eMHC) and neural cell adhesion molecule (NCAM) and also assessing satellite cell activation status by myogenin positivity. Severe muscle histopathology was occasionally observed in the proximal muscles of patients with LGMD2I whereas distal muscles were always relatively spared. No difference was found in the regeneration markers internally nucleated fibers, actively regenerating fibers or activation status of satellite cells between proximal and distal muscles. Protein turnover, both synthesis and breakdown, as well as cellular stress were highly increased in severely affected muscles compared to mildly affected muscles. Our results indicate that alterations in the protein turnover and myostatin levels could progressively impair the muscle mass maintenance and/or regeneration resulting in gradual muscular atrophy.

  6. Proximal Alternating Direction Method with Relaxed Proximal Parameters for the Least Squares Covariance Adjustment Problem

    Directory of Open Access Journals (Sweden)

    Minghua Xu


    Full Text Available We consider the problem of seeking a symmetric positive semidefinite matrix in a closed convex set to approximate a given matrix. This problem may arise in several areas of numerical linear algebra or come from finance industry or statistics and thus has many applications. For solving this class of matrix optimization problems, many methods have been proposed in the literature. The proximal alternating direction method is one of those methods which can be easily applied to solve these matrix optimization problems. Generally, the proximal parameters of the proximal alternating direction method are greater than zero. In this paper, we conclude that the restriction on the proximal parameters can be relaxed for solving this kind of matrix optimization problems. Numerical experiments also show that the proximal alternating direction method with the relaxed proximal parameters is convergent and generally has a better performance than the classical proximal alternating direction method.

  7. Antibiotics for preterm rupture of membranes. (United States)

    Kenyon, Sara; Boulvain, Michel; Neilson, James P


    Premature birth carries substantial neonatal morbidity and mortality. Subclinical infection is associated with preterm rupture of membranes (PROM). Prophylactic maternal antibiotic therapy might lessen infectious morbidity and delay labour, but could suppress labour without treating underlying infection. To evaluate the immediate and long-term effects of administering antibiotics to women with PROM before 37 weeks, on maternal infectious morbidity, neonatal morbidity and mortality, and longer-term childhood development. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013). Randomised controlled trials comparing antibiotic administration with placebo that reported clinically relevant outcomes were included as were trials of different antibiotics. Trials in which no placebo was used were included for the outcome of perinatal death alone. We extracted data from each report without blinding of either the results or the treatments that women received. We sought unpublished data from a number of authors. We included 22 trials, involving 6872 women and babies.The use of antibiotics following PROM is associated with statistically significant reductions in chorioamnionitis (average risk ratio (RR) 0.66, 95% confidence interval (CI) 0.46 to 0.96, and a reduction in the numbers of babies born within 48 hours (average RR 0.71, 95% CI 0.58 to 0.87) and seven days of randomisation (average RR 0.79, 95% CI 0.71 to 0.89). The following markers of neonatal morbidity were reduced: neonatal infection (RR 0.67, 95% CI 0.52 to 0.85), use of surfactant (RR 0.83, 95% CI 0.72 to 0.96), oxygen therapy (RR 0.88, 95% CI 0.81 to 0.96), and abnormal cerebral ultrasound scan prior to discharge from hospital (RR 0.81, 95% CI 0.68 to 0.98). Co-amoxiclav was associated with an increased risk of neonatal necrotising enterocolitis (RR 4.72, 95% CI 1.57 to 14.23).One study evaluated the children's health at seven years of age (ORACLE Children Study) and found

  8. Passive Muscle-Tendon Unit Gearing is Joint Dependent in Human Medial Gastrocnemius

    Directory of Open Access Journals (Sweden)

    Emma F Hodson-Tole


    Full Text Available Skeletal muscles change length and develop force both passively and actively. Gearing allows muscle fibre length changes to be uncoupled from those of the whole muscle-tendon unit. During active contractions this process allows muscles to operate at mechanically favorable conditions for power or economical force production. Here we ask whether gearing is constant in passive muscle; determining the relationship between fascicle and muscle-tendon unit length change in the bi-articular medial gastrocnemius and investigating the influence of whether motion occurs at the knee or ankle joint. Specifically, the same muscle-tendon unit length changes were elicited by rotating either the ankle or knee joint whilst simultaneously measuring fascicle lengths in proximal and distal muscle regions using B-mode ultrasound. In both the proximal and distal muscle region, passive gearing values differed depending on whether ankle or knee motion occurred. Fascicle length changes were greater with ankle motion, likely reflecting anatomical differences in proximal and distal passive tendinous tissues, as well as shape changes of the adjacent mono-articular soleus. This suggests that there is joint-dependent dissociation between the mechanical behaviour of muscle fibres and the muscle-tendon unit during passive joint motions that may be important to consider when developing accurate models of bi-articular muscles.

  9. Earthquake Triggering Inferred from Rupture Histories, DInSAR Ground Deformation and Stress-Transfer Modelling: The Case of Central Italy During August 2016-January 2017 (United States)

    Papadopoulos, G. A.; Ganas, A.; Agalos, A.; Papageorgiou, A.; Triantafyllou, I.; Kontoes, Ch.; Papoutsis, I.; Diakogianni, G.


    On August 24, October 26 and 30, 2016, Central Apennines (Italy) were hit by three shallow, normal faulting very strong earthquakes rupturing in an NW-SE striking zone. Event 3 (Norcia) occurred between event 1 (Amatrice) at the SE and event 2 (Visso) at the NW of the entire rupture zone. The rupture histories of the three events, as revealed by teleseismic P-wave inversion, showed that all were characterized by bilateral rupture process with stronger rupture directivity towards NW for events 1 and 3 and towards SSE for event 2. Maximum seismic slip of 1.2, 0.8, and 1.4 m in the hypocenter and magnitude of M w 6.2, 6.1, and 6.5 were calculated for the three events, respectively. DInSaR measurements based on Sentinel-1 and 2 satellite images showed ground deformation directivity from events 1 and 2 towards event 3, which is consistent with the rupture process directivity. For events 1, 2, and 3, the maximum ground subsidence was found equal to 0.2, 0.15, and 0.35 m. Based on rupture directivity and ground deformation pattern, we put forward the hypothesis that the area of the second event was stress loaded by the first one and that both the first and second earthquake events caused stress loading in the area, where the third event ruptured. Coulomb stress-transfer modelling yields strong evidence in favor of our hypothesis. The stress in the fault plane of event 2 was increased by 0.19 bars due to loading from event 1. Event 3 fault plane was loaded by an amount of 2 bars, due to the combined stress transfer from the two previous events, despite its proximity to the negative/positive lobe boundary. The three events produced combined stress loading of more than +0.5 bar along the Apennines to the NW and SE of the entire rupture zone. In the SE stress lobe, a series of strong earthquakes of M w 5.3, 5.6, and 5.7 occurred on January 18, 2017, but likely, seismic potential remains in the area. We consider that in the NW and more extensive stress lobe, the seismic

  10. Induction and modulation of referred muscle pain in humans

    DEFF Research Database (Denmark)

    Laursen, René Johannes

    Muscle pain is a major factor in many disorders such as injuries, degenerative diseases, and cancer. The mechanisms underlying muscle pain are not fully understood. A particular problem in muscle pain is the relationship between local and referred muscle pain. Experimental pain models are useful...... in basic pain research, because they allow a standardized activation of the nociceptive system and measurements of evoked responses. An electrical muscle pain model was constructed and applied on healthy subjects. The model was found suitable for inducing local (LP) and referred muscle pain (RF......). It was demonstrated that LP was elicited around the stimulation needles (proximal part of the tibial anterior muscle) and RP appeared at a distal site (the ventral part of the ankle). RP required significantly higher stimulus intensity compared with LP, and RP appeared later than LP. The sizes of LP and RP areas were...

  11. Complex Polysaccharide Inclusions in Skeletal Muscle Adjacent to Sarcomas in Two Dogs

    National Research Council Canada - National Science Library

    Valentine, B. A; Bildfell, R. J; Cooper, B. J; Giger, U; Fischer, K. A


    Inclusions of periodic acid-Schiff-positive, amylase resistant material were found within skeletal muscle fibers adjacent to an osteosarcoma in the proximal femur of an 8-year-old intact female Cocker Spaniel dog (dog No. 1...


    Directory of Open Access Journals (Sweden)

    Elenice Souza dos Reis Goes


    Full Text Available The aim of this study was evaluate the effect of slaughter weight and sex on processing yield and on the proximate composition of Rhamdia voulezi. We calculated the percentage yield of the whole fish (carcass, clean trunk, abdominal muscle, fillet, edible parts, head, skin, gonads and visceral fat yield. There was no statistical difference in yields among weight classes (P>0.05. However, when assessing the income between sexes we observed significant difference (P0.05 among the classes, however, moisture, lipids and calories had significant difference (P<0.05 among the classes, and humidity decreased with increasing size of the fish, and lipid content and calorific value were higher for fish weighing 301-400 g. We oncluded R. voulezi with mass between 100 and 400 g presents equal yield processing, and fish weighing 301-400 g have higher lipid content in the fillet.

  13. [Tangent sign - a reliable predictor of risk for tendon re-rupture in rotator cuff repair]. (United States)

    Smíd, P; Hart, R; Puskeiler, M


    Repair techniques for rotator cuff injury are currently well advanced. However, the risk of re-rupture, particularly when severe damage to the tendons has been repaired, is still high. The causes of failure can be due to the extent of injury, a repair done on a highly degenerated tendon with diminished viability or ischaemic damage to the tendon tissue resulting from suture material. The aim of the study was to ascertain the reliability of the tangent sign, a commonly used indicator of the degree of suprasupinatus muscle atrophy, in the prediction of risk for tendon re-rupture in the post-operative period. In 2011 the rotator cuff torn tendons were repaired by the method of double-row suture in 37 patients. The surgery was done by an open technique using the deltoid-splitting approach. A pre-operative magnetic resonance image (MRI) of the shoulder was obtained in all patients and each was assessed by a competent independent radiology specialist with a focus on the extent of a tendon lesion and the tangent sign. At 2-year follow-up, the results of repeated MRI were evaluated in view of the state of repaired tendons and, if a re-tear was found, its relation to the original suture and its extent in the sagittal plane were determined. The pre- and post-operative MRI findings were compared to find out how the presence or absence of a tangent sign before surgery relates to the incidence of supraspinatus tendon re-rupture at 2 years after surgery. The results were statistically analysed using Student's t-test and the Chi-square test. Of the 37 shoulders, in the pre-operative period, a tangent sign was identified in 21 (56.8%). The average size of a rotator cuff tear was 29.3 mm for the whole group. For the shoulders with no tangent sign, the average value was 21.8 mm, for those with a tangent sign present, it was 39.6 mm. At 2-year follow-up, no tear was found in the patients in whom preoperative MRI showed no tangent sign while re-tears were recorded in 18 of 21

  14. Suture-Only Repair Versus Suture Anchor-Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump: A Biomechanical Comparison. (United States)

    Boin, Michael A; Dorweiler, Matthew A; McMellen, Christopher J; Gould, Gregory C; Laughlin, Richard T


    Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Controlled laboratory study. Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor-augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. The suture anchor-augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor-augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor-augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Our results support the use of suture anchor-augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.

  15. [Gait analysis after rotationplasty hip surgery for malignant tumor of the proximal femur]. (United States)

    Donati, D; Benedetti, M G; Catani, F; Berti, L; Capanna, R


    Rotationplasty of the hip joint is a special surgical technique used for the treatment of malignant tumors of the proximal part of the femur. We report a clinical case and gait analysis results before and after rehabilitation training. Evaluation of joint motion, kinetic moments, and the electromyographic findings enabled us to document progressive adaptation of muscle and joint function to their new role in the motor pattern, demonstrating the exceptional strength of rotationplasty. Active control of two fulcrums in the lower limb, the pseudo hip proximally and the pseudo knee intermedially, makes this type of operation extremely advantageous compared to the alternative of hip disarticulation or hemipelvectomy. Total absence of pain together with the preservation of articular and cutaneous proprioception are important advantages. Rotationplasty is an attractive alternative for treatment of malignant tumors of the proximal part of the femur.

  16. The Life Saving Effects of Hospital Proximity

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from......) increases the fatality rate by 13.84% on the sample average. This is equal to a 0.92 additional death per every 100 accidents. We show that OLS estimates provide a downward biased measure of the real effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity matters...

  17. Medical image of the week: stomach rupture

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. A 61-year-old man was transferred from another hospital for further care. He had a history of oxygen-dependent chronic obstructive pulmonary disease in addition to congestive heart failure, hypertension and diabetes mellitus. He had been seen earlier in the day at his primary care physician’s office for a routine visit. Although he was asymptomatic, emergency medical services (EMS were called because of significant hypoxemia detected by pulse oximetry. EMS noted that the patient said he “feels OK”. However, a decision was made to intubate the patient. Multiple failed intubation attempts failed and he suffered a cardiopulmonary arrest. He was successfully resuscitated and underwent a cricotracheotomy with an uncuffed endotracheal tube. When transferred his mouth was taped shut and his nose clamped. His abdomen was markedly distended and tympanic (Figure 1. A supine chest x-ray showed air under the diaphragm. Abdominal exploration showed a ruptured stomach which was repaired. He made an …

  18. Sex-related penile fracture with complete urethral rupture: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Marco Garofalo


    Full Text Available Objective: To present the management of a patient with partial disruption of both cavernosal bodies and complete urethral rupture and to propose a non-systematic review of literature about complete urethral rupture. Material and method - Case report: A 46 years old man presented to our emergency department after a blunt injury of the penis during sexual intercourse. On physical examination there was subcutaneous hematoma extending over the proximal penile shaft with a dorsal-left sided deviation of the penis and urethral bleeding. Ultrasound investigation showed an hematoma in the ventral shaft of the penis with a discontinuity of the tunica albuginea of the right cavernosal corporum. The patient underwent immediate emergency surgery consisted on evacuation of the hematoma, reparation the partial defect of both two cavernosal bodies and end to end suture of the urethra that resulted completely disrupted. Results: The urethral catheter was removed at the 12-th postoperative day without voiding symptoms after a retrograde urethrography. 6 months postoperatively the patients was evaluated with uroflowmetry demonstrating a max flow rate of 22 ml/s and optimal functional outcomes evaluated with validated questionnaires. 8 months after surgery the patients was evaluated by dynamic magnetic resonance (MRI of the penis showing only a little curvature on the left side of the penile shaft. Conclusion: Penile fracture is an extremely uncommon urologic injury with approximately 1331 reported cases in the literature till the years 2001. To best of our knowledge from 2001 up today, 1839 more cases have been reported, only in 159 of them anterior urethral rupture was associated and in only 22 cases a complete urethral rupture was described. In our opinion, in order to prevent long term complications, in case of clinical suspicion of penile fracture, especially if it is associated to urethral disruption, emergency surgery should be the first choice of treatment.

  19. [Clinical analysis of prosthesis replacement for proximal humerus tumors]. (United States)

    Weng, Xiaojun; Liao, Qiande; Li, Xiaosheng; Wang, Jing


    To explore surgical strategies, functions and prognosis of artificial prosthesis replacement and soft tissue reconstruction for patients with invasive benign or primary malignant proximal humerus tumor.
 A total of 17 patients with invasive benign or primary malignant proximal humerus tumor underwent prosthetic replacement after segment bone tumor resection and soft tissues reconstruction from April 2007 to April 2014 were enrolled. Based on histological types, tumor stages and surgical procedures, the effects of artificial prosthesis replacement and soft tissue reconstruction on prognosis and shoulder joint function were evaluated.
 All patients were followed up for 8 to 96 months (average time: 58.9 months). Among 11 patients with primary malignant tumor, 5 died of tumor recurrence or metastasis, and 6 showed tumor-free survival for 24 to 91 months (average time: 54.83 months). The 6 patients with aggressive benign tumors survived for 39 to 96 months, with an average of 72.33 months. The shoulder joint function of 17 patients recovered to 64.88% of normal. There were significant differences in the shoulder joint function between the patients who underwent half shoulder replacement and those who underwent total shoulder replacement (56.25% vs 72.56%, Pshoulder joint function between the patients who underwent Type I A excision (retention of abductor muscles and rotator cuff) and those who underwent Type I B excision (68.75% vs 61.44%, Pshoulder joint function is associated with the methods of prosthesis replacement and soft tissue resection.

  20. Protein Turnover and Cellular Stress in Mildly and Severely Affected Muscles from Patients with Limb Girdle Muscular Dystrophy Type 2I

    DEFF Research Database (Denmark)

    Hauerslev, Simon; Sveen, Marie-Louise; Vissing, John


    Patients with Limb girdle muscular dystrophy type 2I (LGMD2I) are characterized by progressive muscle weakness and wasting primarily in the proximal muscles, while distal muscles often are spared. Our aim was to investigate if wasting could be caused by impaired regeneration in the proximal...... highly increased in severely affected muscles compared to mildly affected muscles. Our results indicate that alterations in the protein turnover and myostatin levels could progressively impair the muscle mass maintenance and/or regeneration resulting in gradual muscular atrophy....

  1. Sex Differences in Outcome After an Acute Achilles Tendon Rupture

    National Research Council Canada - National Science Library

    Grävare Silbernagel, Karin; Brorsson, Annelie; Olsson, Nicklas; Eriksson, Bengt I; Karlsson, Jon; Nilsson-Helander, Katarina


    Background: Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women. Purpose...

  2. Ruptured renal artery aneurysm during pregnancy, a clinical dilemma

    Directory of Open Access Journals (Sweden)

    Ammary Mohamed


    Full Text Available Abstract Background Rupture of a renal artery aneurysm (RAA during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. Case presentation We present here a case report of total avulsion of solitary kidney secondary to rupture of RAA in a pregnant patient with congenital absence of the contralateral kidney. The main indication for nephrectomy was severely damaged kidney. Diagnosis was made during operation and both mother and fetus were saved. There are no previous reports of an intact renal artery aneurysm diagnosed either antepartum or postpartum. Conclusion The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. This case was unusual because it occurred in a solitary kidney, during the third trimester of pregnancy.

  3. A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

    Directory of Open Access Journals (Sweden)

    Engin Cetinkaya


    Conclusion: We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy.

  4. Multiple Tophaceous Gout of Hand with Extensor Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Haruki Tobimatsu


    Full Text Available A 45-year-old man presented with painless subcutaneous masses bilaterally on his hands and loss of motion or contracture of the fingers. Initially, drug therapy to reduce the serum uric acid was administered and was expected to reduce the tophi. However, during observation at the clinic, spontaneous rupture of an extensor tendon occurred, and surgical repair of the tendon and resection of the masses were performed. Surgical exploration of the right hand showed hypertrophic white-colored crystal deposits that both surrounded and invaded the extensor digitorum communis of the index finger, which was ruptured. Histopathologic examination of the specimen demonstrated findings consistent with gouty tophi. Tophaceous gout can induce a rupture of tendons during clinical observation, and surgical resection of the tophi might be needed to prevent ruptures.

  5. 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.

  6. Staged Management of a Ruptured Internal Mammary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    O Young Kwon


    Full Text Available The rupture of an internal mammary artery (IMA aneurysm in a patient with type 1 neurofibromatosis (NF-1 is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS. The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.

  7. 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%)

  8. 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.

  9. Impairment of the proximal to distal tonic gradient in the human diabetic stomach. (United States)

    Min, Y W; Hong, Y S; Ko, E-J; Lee, J Y; Min, B-H; Sohn, T S; Kim, J J; Rhee, P-L


    Little has been known about the contractile characteristics of diabetic stomach. We investigated spontaneous contractions and responses to acetylcholine in the gastric muscle in diabetic patients and non-diabetic control subjects according to the region of stomach. Gastric specimens were obtained from 26 diabetics and 55 controls who underwent gastrectomy at Samsung Medical Center between February 2008 and November 2011. Isometric force measurements were performed using circular muscle strips from the different regions of stomach under basal condition and in response to acetylcholine. Basal tone of control was higher in the proximal stomach than in the distal (0.63 g vs 0.46 g, p = 0.027). However, in diabetics, basal tone was not significantly different between the proximal and distal stomach (0.75 g vs 0.62 g, p = 0.32). The distal stomach of diabetics had higher basal tone and lower frequency than that of control (0.62 g vs 0.46 g, p = 0.049 and 4.0/min vs 4.9/min, p = 0.049, respectively). After exposure to acetylcholine, dose-dependent increases of basal tone, peak, and area under the curve (AUC) were noticed in both proximal and distal stomach of the two groups. In the proximal stomach, however, the dose-dependent increase of basal tone and AUC was less prominent in diabetics than in control. On the contrary to control, the proximal to distal tonic gradient was not observed in diabetic stomach. Diabetic stomach also had lower frequency of spontaneous contraction in the distal stomach and less acetylcholine-induced positive inotropic effect in the proximal stomach than control. © 2013 John Wiley & Sons Ltd.

  10. Case Report - Rupture diaphragmatique droite avec passage total et ...

    African Journals Online (AJOL)

    Case Report - Rupture diaphragmatique droite avec passage total et isolé du foie en intrathoracique. M Turki, MH Barhoumi, H Hajji, H Chemchik, B M'barek. Abstract. La rupture traumatique de la coupole diaphragmatique droite avec hernie du foie dans le thorax est une lésion rare. Elle est souvent intégrée dans le cadre ...

  11. 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.

  12. 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...

  13. Neonatal outcome in pregnancies that presented premature rupture of membranes


    Marcela Lima Silveira; Náira de Oliveira Caminha; Rosiléa Alves de Sousa; Sarah Maria Fraxe Pessoa; Eloah de Paula Pessoa Gurgel; Dylmara Maria Prudêncio Cavalcante


    This study aimed to describe the neonatal outcomes of infants whose mothers had premature rupture of membranes during pregnancy. This is a retrospective, descriptive, quantitative study performed in a public maternity in Fortaleza-CE, Brazil, with 166 neonates of mothers with premature rupture of membranes, in 2010. Data were collected through research in medical records using a pre-structured form. There was a predominance of newborns at term with good birth weight and adequate vitality. Sta...

  14. Successful treatment of annular rupture during transcatheter aortic valve implantation. (United States)

    Unic, Daniel; Sutlic, Zeljko; Starcevic, Boris; Bradic, Nikola; Baric, Davor; Rudez, Igor


    Annular rupture presents a rare but potentially fatal complication of transcatheter aortic valve implantation (TAVI). Although it can be subtle and subclinical in presentation, most severe forms present with hemodynamic instability and represent true emergencies requiring a more invasive treatment, even conventional surgery. We present a case of successful treatment of annular rupture by left ventricular outflow tract patch and surgical aortic valve replacement.

  15. Spontaneous Rupture of Umbilical Hernia in Pregnancy: A Case Report


    Yahaya Ukwenya; Garba Stephen; Adamu Ahmed


     A 28 year old woman presented with a spontaneous rupture of an umbilical hernia in her seventh month of pregnancy. She had four previous unsupervised normal deliveries. There was no history of trauma or application of herbal medicine on the hernia. The hernia sac ruptured at the inferior surface where it was attached to the ulcerated and damaged overlying skin. There was a gangrenous eviscerated small bowel. The patient was resuscitated and the gangrenous small bowel was resected and end to ...

  16. Emergency endovascular repair of ruptured visceral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Tang Tjun


    Full Text Available Abstract Background Visceral artery aneurysms although rare, have very high mortality if they rupture. Case presentation An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented with hypovolemic shock while being treated in the hospital after undergoing total knee replacement. Endovascular embolization was successfully employed to treat this patient, with early hospital discharge. Conclusion Prompt diagnosis and endovascular management of ruptured visceral aneuryms can decrease the associated mortality and morbidity.

  17. Proximity and Collaboration in European Nanotechnology

    NARCIS (Netherlands)

    Cunningham, S.W.; Werker, C.


    Collaborations are particularly important for the development and deployment of technology. We analyze the influence of organizational, technological and geographical proximity on European nanotechnology collaborations with the help of a publication dataset and additional geographical information.

  18. Promoting proximal formative assessment with relational discourse (United States)

    Scherr, Rachel E.; Close, Hunter G.; McKagan, Sarah B.


    The practice of proximal formative assessment - the continual, responsive attention to students' developing understanding as it is expressed in real time - depends on students' sharing their ideas with instructors and on teachers' attending to them. Rogerian psychology presents an account of the conditions under which proximal formative assessment may be promoted or inhibited: (1) Normal classroom conditions, characterized by evaluation and attention to learning targets, may present threats to students' sense of their own competence and value, causing them to conceal their ideas and reducing the potential for proximal formative assessment. (2) In contrast, discourse patterns characterized by positive anticipation and attention to learner ideas increase the potential for proximal formative assessment and promote self-directed learning. We present an analysis methodology based on these principles and demonstrate its utility for understanding episodes of university physics instruction.

  19. Ammonia transport in the proximal tubule. (United States)

    Hamm, L L; Simon, E E


    The transport of ammonia in the proximal tubule is a complex interaction of a number of processes. Ammonia transport in the proximal tubule is clearly bidirectional; ammonia is secreted into the early proximal tubule lumen, but later in the proximal tubule, efflux out of the lumen may result in net ammonia reabsorption. Two mechanisms of ammonia transport have clearly been established: NH3 diffusion and NH4+ transport on the Na(+)-H+ exchanger. The relative contribution of these pathways to ammonia transport is still unsettled. Other pathways for ammonia transport, particularly NH4+ efflux out of the lumen, may be important as well. A variety of factors may modulate ammonia transport: plasma, cell and luminal pH, luminal flow rate, luminal potassium, and angiotensin II. Each of these factors also alters ammonia production rates and in most circumstances, ammonia transport appears to follow ammonia production rates.

  20. Proximate composition and cholesterol concentrations of ...

    African Journals Online (AJOL)



    DWB) for raw and fried samples, respectively, but decreased to 295.20 ... Key words: Rhynchophorus phoenicis, Oryctes monoceros, proximate composition, cholesterol, heat treatment. INTRODUCTION. Insects have played ...


    African Journals Online (AJOL)

    Babatunde Emmanuel


    Oct 6, 2011 ... Fish allows for protein improved nutrition in that it has a high biological value in terms of high ... marine algae upon which the fish feed [11]. ... Proximate composition of catfish Clarias gariepinus and Tarpon atlanticus were.

  2. Acute Compartment Syndrome After Gastrocnemius Rupture (Tennis Leg) in a Nonathlete Without Trauma. (United States)

    Tao, Li; Jun, Huang; Muliang, Ding; Deye, Song; Jiangdong, Ni


    Acute compartment syndrome is a serious emergency that warrants urgent decompression, and tennis leg (i.e., rupture of the medial head of the gastrocnemius) is a known clinical condition that is usually treated symptomatically, with good results overall. In rare cases, acute compartment syndrome is associated with tennis leg after severe direct muscle trauma or severe exercise in athletes or physically active individuals. We present an unusual case of acute compartment syndrome secondary to tennis leg after the patient, a nonathlete, had disembarked from a truck without any trauma. Clinicians should have a high index of suspicion for atraumatic compartment syndrome, and timely surgical fasciotomy must be undertaken to avoid complications resulting from delayed diagnosis and treatment. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Muscle lengthening surgery causes differential acute mechanical effects in both targeted and non-targeted synergistic muscles. (United States)

    Ateş, Filiz; Özdeşlik, Rana N; Huijing, Peter A; Yucesoy, Can A


    Epimuscular myofascial force transmission (EMFT) is a major determinant of muscle force exerted, as well as length range of force exertion. Therefore, EMFT is of importance in remedial surgery performed, e.g., in spastic paresis. We aimed to test the following hypotheses: (1) muscle lengthening surgery (involving preparatory dissection (PD) and subsequent proximal aponeurotomy (AT)) affects the target muscle force exerted at its distal and proximal tendons differentially, (2) forces of non-operated synergistic muscles are affected as well, (3) PD causes some of these effects. In three conditions (control, post-PD, and post-AT exclusively on m. extensor digitorum longus (EDL)), forces exerted by rat anterior crural muscles were measured simultaneously. Our results confirm hypotheses (1-2), and hypothesis (3) in part: Reduction of EDL maximal force differed by location (i.e. 26.3% when tested distally and 44.5% when tested proximally). EDL length range of active force exertion increased only distally. Force reductions were shown also for non-operated tibialis anterior (by 11.9%), as well as for extensor hallucis longus (by 8.4%) muscles. In tibialis anterior only, part of the force reduction (4.9%) is attributable to PD. Due to EMFT, remedial surgery should be considered to have differential effects for targeted and non-targeted synergistic muscles. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Stochastic Earthquake Rupture Modeling Using Nonparametric Co-Regionalization (United States)

    Lee, Kyungbook; Song, Seok Goo


    Accurate predictions of the intensity and variability of ground motions are essential in simulation-based seismic hazard assessment. Advanced simulation-based ground motion prediction methods have been proposed to complement the empirical approach, which suffers from the lack of observed ground motion data, especially in the near-source region for large events. It is important to quantify the variability of the earthquake rupture process for future events and to produce a number of rupture scenario models to capture the variability in simulation-based ground motion predictions. In this study, we improved the previously developed stochastic earthquake rupture modeling method by applying the nonparametric co-regionalization, which was proposed in geostatistics, to the correlation models estimated from dynamically derived earthquake rupture models. The nonparametric approach adopted in this study is computationally efficient and, therefore, enables us to simulate numerous rupture scenarios, including large events ( M > 7.0). It also gives us an opportunity to check the shape of true input correlation models in stochastic modeling after being deformed for permissibility. We expect that this type of modeling will improve our ability to simulate a wide range of rupture scenario models and thereby predict ground motions and perform seismic hazard assessment more accurately.

  5. Pancreatic Pseudocyst Ruptured due to Acute Intracystic Hemorrhage

    Directory of Open Access Journals (Sweden)

    Kunishige Okamura


    Full Text Available Rupture of pancreatic pseudocyst is one of the rare complications and usually results in high mortality. The present case was a rupture of pancreatic pseudocyst that could be treated by surgical intervention. A 74-year-old man developed abdominal pain, vomiting, and diarrhea, and he was diagnosed with cholecystitis and pneumonia. Three days later, acute pancreatitis occurred and computed tomography (CT showed slight hemorrhage in the cyst of the pancreatic tail. After another 10 days, CT showed pancreatic cyst ruptured due to intracystic hemorrhage. Endoscopic retrograde cholangiopancreatography revealed leakage of contrast agent from pancreatic tail cyst to enclosed abdominal cavity. His left hypochondrial pain was increasing, and CT showed rupture of the cyst of the pancreatic tail into the peritoneal cavity was increased in 10 days. CT showed also two left renal tumors. Therefore we performed distal pancreatectomy with concomitant resection of transverse colon and left kidney. We histopathologically diagnosed pancreatic pseudocyst ruptured due to intracystic hemorrhage and renal cell carcinoma. Despite postoperative paralytic ileus and fluid collection at pancreatic stump, they improved by conservative management and he could be discharged on postoperative day 29. He has achieved relapse-free survival for 6 months postoperatively. The mortality of pancreatic pseudocyst rupture is very high if some effective medical interventions cannot be performed. It should be necessary to plan appropriate treatment strategy depending on each patient.

  6. Location of Ruptured Bullae in Secondary Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Jinseok Choi


    Full Text Available Background: The surgical treatment of secondary spontaneous pneumothorax (SSP can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung in-jury during manipulation of the lung. Common sites of bulla development and ruptured bullae were inves-tigated based on computed tomography (CT and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS. We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%, followed by the azygoesophageal recess (27.4%. Of the 75 cases on the left side, the most com-mon rupture site was the apical segment (24.0%, followed by the anterior basal segment (17.3%. Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bul-la development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

  7. Muscle strain (image) (United States)

    A muscle strain is the stretching or tearing of muscle fibers. A muscle strain can be caused by sports, exercise, a ... something that is too heavy. Symptoms of a muscle strain include pain, tightness, swelling, tenderness, and the ...

  8. Phytochemical screening, proximate analysis and acute toxicity ...

    African Journals Online (AJOL)

    Phytochemical screening, proximate analysis and acute toxicity studies were carried out on the leaf extract of Cola lepidota, in accordance with established standard procedures. The proximate analysis reveals a moisture content of 27.43 ± 3.11 % w/w, total ash value 9.32 ± 0.27 % w/w, acid insoluble ash 3.12 ± 1.05 % w/w ...

  9. Proximate, Mineral and Phytochemical Composition of Dioscorea ...

    African Journals Online (AJOL)


    ABSTRACT: Proximate, mineral and phytochemical composition of Dioscorea dumetorum tubers was investigated using standard procedures. Proximate analysis included in g% dry weight: crude protein (6.44 ± 0.32), crude fat (0.75 ± 0.04), crude fibre (15.00 ± 0.56), total ash. (3.45 ± 0.20) and a moisture content of 70.04 ...

  10. Painful Spastic Hip Dislocation: Proximal Femoral Resection


    Albiñana, Javier; Gonzalez-Moran, Gaspar


    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despit...

  11. Relationship between muscle volume and muscle torque of the hamstrings after anterior cruciate ligament lesion. (United States)

    Konishi, Yu; Kinugasa, Ryuta; Oda, Toshiaki; Tsukazaki, Satoshi; Fukubayashi, Toru


    This study was conducted to identify factors other than morphological muscle strength factors that affect injured and uninjured sides of knee flexors with anterior cruciate ligament (ACL) lesions. The study population consisted of 22 patients with ACL lesions. Their hamstring muscle volume was measured on MRI, and muscle torque per muscle volume was calculated as the peak torque of knee flexion divided by hamstring muscle volume. The mean muscle torque per unit volume of hamstrings in patients with ACL rupture was 0.09 ± 0.02 Nm/cm(3) at 60°/s and 0.08 ± 0.01 Nm/cm(3) at 180°/s on the injured side, and 0.11 ± 0.02 Nm/cm(3) at 60°/s and 0.08 ± 0.01 Nm/cm(3) at 180°/s on the uninjured side. The mean muscle torque per unit volume of hamstrings in control subjects was 0.11 ± 0.02 Nm/cm(3) at 60°/s and 0.08 ± 0.03 Nm/cm(3) at 180°/s. One-factor ANOVA analysis found no significant differences between the three groups at either flexion velocity. Neurological dysfunction does not appear to exist in knee flexor muscles after ACL injury, unlike the quadriceps. Since the mechanism of muscle weakness will differ depending on the muscle, it is important for clinicians to take this discrepancy into consideration. II.

  12. Intraprocedural left ventricular free wall rupture diagnosed by left ventriculogram in a patient with infero-posterior myocardial infarction and severe aortic stenosis. (United States)

    Konishi, Takao; Funayama, Naohiro; Yamamoto, Tadashi; Nishihara, Hiroshi; Hotta, Daisuke; Kikuchi, Kenjiro; Yokoyama, Hideo; Ohori, Katsumi


    Left ventricular wall rupture remains a major lethal complication of acute myocardial infarction and hypertension is a well-known predisposing factor of cardiac rupture after myocardial infarction. An 87-year-old man was admitted to our hospital, diagnosed as acute myocardial infarction (AMI). The echocardiogram showed 0.67-cm(2) aortic valve, consistent with severe aortic stenosis (AS). A coronary angiography showed a chronic occlusion of the proximal left circumflex artery and a 99 % stenosis and thrombus in the mid right coronary artery. During percutaneous angioplasty of the latter, transient hypotension and bradycardia developed at the time of balloon inflation, and low doses of noradrenaline and etilefrine were intravenously administered as needed. The patient suddenly lost consciousness and developed electro-mechanical dissociation. Cardio-pulmonary resuscitation followed by insertion of an intra-aortic balloon pump (IABP) and percutaneous cardiopulmonary support were initiated. The echocardiogram revealed moderate pericardial effusion, though the site of free wall rupture was not distinctly visible. A left ventriculogram clearly showed an infero-posterior apical wall rupture. Surgical treatment was withheld because of the interim development of brain death. In this patient, who presented with severe AS, the administration of catecholamine to stabilize the blood pressure probably increased the intraventricular pressures considerably despite apparently normal measurements of the central aortic pressure. IABP, temporary pacemaker, or both are recommended instead of intravenous catecholamines for patients with AMI complicated with significant AS to stabilize hemodynamic function during angioplasty.

  13. Botulinum Toxin Type A Injections in the Psoas Muscle of Children with Cerebral Palsy: Muscle Atrophy after Motor End Plate-Targeted Injections (United States)

    Van Campenhout, Anja; Verhaegen, Ann; Pans, Steven; Molenaers, Guy


    MEP targeting during BoNT-A injections has been demonstrated to improve outcome. Two injection techniques of the psoas muscle--proximal MEP targeting versus a widely used more distal injection technique--are compared using muscle volume assessment by digital MRI segmentation as outcome measure. Method: 7 spastic diplegic children received…

  14. Change in muscle thickness under contracting conditions following return to sports after a hamstring muscle strain injury—A pilot study

    Directory of Open Access Journals (Sweden)

    Yasuharu Nagano


    Full Text Available The purpose of this study was to measure the change in hamstring muscle thickness between contracting and relaxing conditions following a return to sports after a hamstring muscle strain and thereby evaluate muscle function. Six male track and field sprinters participated in this study. All had experienced a prior hamstring strain injury that required a minimum of 2 weeks away from sport participation. Transverse plane scans were performed at the following four points on the affected and unaffected sides under contracting and relaxing conditions: proximal biceps femoris long head, proximal semitendinosus, middle biceps femoris long head, and middle semitendinosus. The results demonstrated an increase in the thickness of the middle biceps femoris long head and middle semitendinosus regions on the unaffected side with contraction, whereas the affected side did not show a significant increase. The proximal semitendinosus muscle thickness was increased with contraction on both the unaffected and the affected sides. By contrast, the proximal biceps femoris muscle thickness did not show a significant increase on both sides. The results of this study show that evaluation of muscle thickness during contraction may be useful for assessing the change in muscle function after a hamstring muscle strain injury.

  15. Proximity sensor system development. CRADA final report

    Energy Technology Data Exchange (ETDEWEB)

    Haley, D.C. [Oak Ridge National Lab., TN (United States); Pigoski, T.M. [Merrit Systems, Inc. (United States)


    Lockheed Martin Energy Research Corporation (LMERC) and Merritt Systems, Inc. (MSI) entered into a Cooperative Research and Development Agreement (CRADA) for the development and demonstration of a compact, modular proximity sensing system suitable for application to a wide class of manipulator systems operated in support of environmental restoration and waste management activities. In teleoperated modes, proximity sensing provides the manipulator operator continuous information regarding the proximity of the manipulator to objects in the workspace. In teleoperated and robotic modes, proximity sensing provides added safety through the implementation of active whole arm collision avoidance capabilities. Oak Ridge National Laboratory (ORNL), managed by LMERC for the United States Department of Energy (DOE), has developed an application specific integrated circuit (ASIC) design for the electronics required to support a modular whole arm proximity sensing system based on the use of capacitive sensors developed at Sandia National Laboratories. The use of ASIC technology greatly reduces the size of the electronics required to support the selected sensor types allowing deployment of many small sensor nodes over a large area of the manipulator surface to provide maximum sensor coverage. The ASIC design also provides a communication interface to support sensor commands from and sensor data transmission to a distributed processing system which allows modular implementation and operation of the sensor system. MSI is a commercial small business specializing in proximity sensing systems based upon infrared and acoustic sensors.

  16. Transformations through Proximity Flying: A Phenomenological Investigation (United States)

    Holmbom, Maria; Brymer, Eric; Schweitzer, Robert D.


    Participation in extreme sports has been linked to personal transformations in everyday life. Descriptions of lived experience resulting from transformative experiences are limited. Proximity flying, a relatively new discipline involving BASE jumping with a wingsuit where participants fly close to solid structures, is arguably one of the most extreme of extreme sports. The aim of this paper, part of a larger phenomenological study on the lived experience of proximity flying, is to explicate the ways in which participating in proximity flying influences the everyday lives of participants. Interpretative phenomenological analysis was used to explicate the lived experience of six proximity pilots. An analysis of interview transcripts revealed three significant themes describing the lived experience of participants. First, experiences of change were described as positive and skills developed through proximity flying were transferable into everyday life. Second, transformative experiences were considered fundamental to participants’ perspectives on life. Third, experience of transformation influenced their sense of personal identity and facilitated flourishing in other aspects of everyday life. Participants were clear that their experiences in proximity flying facilitated a profound process of transformation which manifest as changes in everyday capabilities and behaviors, values and sense of identity. PMID:29104552

  17. Long-term functional outcome of bilateral spontaneous and simultaneous Achilles tendon ruptures.

    LENUS (Irish Health Repository)

    Ellanti, Prasad


    Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome.

  18. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate. (United States)

    Sun, Jing-Cheng; Li, Yu-Lin; Ning, Guang-Zhi; Wu, Qiang; Feng, Shi-Qing


    The purpose of this study was to evaluate the effectiveness and complications of the locking proximal humerus plate to treat proximal humerus fractures. A retrospective clinical trial. Department of Orthopaedics, Tianjin Medical University General Hospital. Sixty-eight consecutive patients with three- or four-part fractures of the proximal humerus were treated with locking proximal humerus plates. The deltopectoral anterolateral acromial approach was used to the proximal humerus; open reduction and locking proximal humerus plate were applied. Constant Score was used to measure the shoulder functional recovery, and Visual Analog Scale (VAS) was used to measure subjective evaluation of pain. The radiology was observed. After average 26.7 months, the average Constant Score was 72.6 ± 13.2 points and the average VAS was 1.2 ± 0.8 points. All the complications such as screw perforation into the glenohumeral joint, screws loosening, soft tissue infections, avascular necrosis and delayed union occurred in eight cases (11.8 %). The effectiveness of the locking proximal humerus plate was similar to other published literatures on treating fractures of the proximal humerus; however, a lower complications rate in short follow-up time was observed in this study. It may potentially provide a favorable option for treating three- or four-part fractures of the proximal humerus. Dealing with each particular fracture pattern, surgeons should have a decision of appropriate way to internal fixation.

  19. 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

  20. 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.

  1. Composite Overwrap Pressure Vessels: Mechanics and Stress Rupture Lifting Philosophy (United States)

    Thesken, John C.; Murthy, Pappu L. N.; Phoenix, S. L.


    The NASA Engineering and Safety Center (NESC) has been conducting an independent technical assessment to address safety concerns related to the known stress rupture failure mode of filament wound pressure vessels in use on Shuttle and the International Space Station. The Shuttle s Kevlar-49 (DuPont) fiber overwrapped tanks are of particular concern due to their long usage and the poorly understood stress rupture process in Kevlar-49 filaments. Existing long term data show that the rupture process is a function of stress, temperature and time. However due to the presence of load sharing liners and the complex manufacturing procedures, the state of actual fiber stress in flight hardware and test articles is not clearly known. Indeed nonconservative life predictions have been made where stress rupture data and lifing procedures have ignored the contribution of the liner in favor of applied pressure as the controlling load parameter. With the aid of analytical and finite element results, this paper examines the fundamental mechanical response of composite overwrapped pressure vessels including the influence of elastic plastic liners and degraded/creeping overwrap properties. Graphical methods are presented describing the non-linear relationship of applied pressure to Kevlar-49 fiber stress/strain during manufacturing, operations and burst loadings. These are applied to experimental measurements made on a variety of vessel systems to demonstrate the correct calibration of fiber stress as a function of pressure. Applying this analysis to the actual qualification burst data for Shuttle flight hardware revealed that the nominal fiber stress at burst was in some cases 23 percent lower than what had previously been used to predict stress rupture life. These results motivate a detailed discussion of the appropriate stress rupture lifing philosophy for COPVs including the correct transference of stress rupture life data between dissimilar vessels and test articles.

  2. Acute Associations between Outdoor Temperature and Premature Rupture of Membranes. (United States)

    Ha, Sandie; Liu, Danping; Zhu, Yeyi; Sherman, Seth; Mendola, Pauline


    Extreme ambient temperatures have been linked to preterm birth. Preterm premature rupture of membranes is a common precursor to preterm birth but is rarely studied in relation to temperature. We linked 15 381 singleton pregnancies with premature rupture of membranes from a nationwide US obstetrics cohort (2002-2008) to local temperature. Case-crossover analyses compared daily temperature during the week preceding delivery and the day of delivery to two control periods, before and after the case period. Conditional logistic regression models calculated the odds ratio (OR) and 95% confidence intervals (CI) of preterm and term premature rupture of membranes for a 1˚C increase in temperature during the warm (May-September) and cold (October-April) season separately after adjusting for humidity, barometric pressure, ozone and particulate matter. During the warm season, 1˚C increase during the week before delivery was associated with a 5% (95% CI: 3-6%) increased preterm premature rupture of membranes risk, and a 4% (95% CI: 3-5%) increased term premature rupture of membranes risk. During the cold season, 1˚C increase was associated with a 2% decreased risk for both preterm (95% CI: 1-3%) and term premature rupture of membranes (95% CI: 1-3%). The day-specific associations for the week before delivery were similar, but somewhat stronger for days closer to delivery. Relatively small ambient temperature changes were associated with the risk of both preterm and term premature of membranes. Given the adverse consequences of premature rupture of membranes and concerns over global climate change, these findings merit further investigation.

  3. Composite Overwrap Pressure Vessels: Mechanics and Stress Rupture Lifing Philosophy (United States)

    Thesken, John C.; Murthy, Pappu L. N.; Phoenix, Leigh


    The NASA Engineering and Safety Center (NESC) has been conducting an independent technical assessment to address safety concerns related to the known stress rupture failure mode of filament wound pressure vessels in use on Shuttle and the International Space Station. The Shuttle's Kevlar-49 fiber overwrapped tanks are of particular concern due to their long usage and the poorly understood stress rupture process in Kevlar-49 filaments. Existing long term data show that the rupture process is a function of stress, temperature and time. However due to the presence of load sharing liners and the complex manufacturing procedures, the state of actual fiber stress in flight hardware and test articles is not clearly known. Indeed non-conservative life predictions have been made where stress rupture data and lifing procedures have ignored the contribution of the liner in favor of applied pressure as the controlling load parameter. With the aid of analytical and finite element results, this paper examines the fundamental mechanical response of composite overwrapped pressure vessels including the influence of elastic-plastic liners and degraded/creeping overwrap properties. Graphical methods are presented describing the non-linear relationship of applied pressure to Kevlar-49 fiber stress/strain during manufacturing, operations and burst loadings. These are applied to experimental measurements made on a variety of vessel systems to demonstrate the correct calibration of fiber stress as a function of pressure. Applying this analysis to the actual qualification burst data for Shuttle flight hardware revealed that the nominal fiber stress at burst was in some cases 23% lower than what had previously been used to predict stress rupture life. These results motivate a detailed discussion of the appropriate stress rupture lifing philosophy for COPVs including the correct transference of stress rupture life data between dissimilar vessels and test articles.

  4. Three cases of hemiplegia after cervical paraspinal muscle needling. (United States)

    Ji, Gyu Yeul; Oh, Chang Hyun; Choi, Won-Seok; Lee, Jang-Bo


    Muscle needling therapy is common for chronic pain management, but the development of unusual complications such as hemiplegia is not well understood. We report on three cases with hemiplegia after cervical paraspinal muscle needling and propose possible explanations for these unusual complications. Case report. The authors retrospectively reviewed the medical charts from a decade (2002-2013) at Korea University Hospital. The records were systematically searched, and the cases with hemiplegia (gradehemiplegia by cervical subdural or epidural hematoma after cervical posterior paraspinal muscle needling without direct invasion (intramuscular stimulation, acupuncture, or intramuscular lidocaine) were observed. All patients were taken for emergent decompressive laminectomy, and their postoperative motor function improved substantially. Spinal hematoma after muscle needling is unusual but was thought to result after a rupture of the epidural or subarachnoid veins by a sharp increase in blood pressure delivered in the intraabdominal or intrathoracic areas after needling therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Exercise, GLUT4, and Skeletal Muscle Glucose Uptake

    DEFF Research Database (Denmark)

    Richter, Erik; Hargreaves, Mark


    Glucose is an important fuel for contracting muscle, and normal glucose metabolism is vital for health. Glucose enters the muscle cell via facilitated diffusion through the GLUT4 glucose transporter which translocates from intracellular storage depots to the plasma membrane and T-tubules upon...... muscle contraction. Here we discuss the current understanding of how exercise-induced muscle glucose uptake is regulated. We briefly discuss the role of glucose supply and metabolism and concentrate on GLUT4 translocation and the molecular signaling that sets this in motion during muscle contractions....... Contraction-induced molecular signaling is complex and involves a variety of signaling molecules including AMPK, Ca(2+), and NOS in the proximal part of the signaling cascade as well as GTPases, Rab, and SNARE proteins and cytoskeletal components in the distal part. While acute regulation of muscle glucose...

  6. Characteristics of acute groin injuries in the adductor muscles

    DEFF Research Database (Denmark)

    Serner, A.; Weir, A.; Tol, J. L.


    using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin...... pain of which 71 athletes were included, median age 27 years (range 18-37). There were 46 isolated muscle injuries and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4....... At the proximal insertion, 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic...

  7. Locking plate fixation for proximal humerus fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G


    Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

  8. 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.

  9. Spontaneous splenic rupture in Waldenstrom's macroglobulinemia: a case report

    Directory of Open Access Journals (Sweden)

    Charakidis Michail


    Full Text Available Abstract Introduction We report the case of a patient with Waldenstrom's macroglobulinemia complicated by spontaneous splenic rupture. Case presentation A 49-year-old Caucasian woman was referred to our emergency department by her general practitioner following a three-week history of malaise, night sweats, six kilograms of weight loss, intermittent nausea and vomiting, progressive upper abdominal pain and easy bruising. On the fourth day following her admission, she had a rapid clinical deterioration, with subsequent radiological investigations revealing a splenic rupture. Her morphology, biochemistry, flow cytometry and histology were strongly suggestive of Waldenstrom's macroglobulinemia. Conclusions Spontaneous splenic rupture is not an expected complication of low-grade lymphoplasmacytic lymphomas, such as Waldenstrom's macroglobulinemia. To the best of our knowledge, this is the only reported case of early spontaneous splenic rupture due to Waldenstrom's macroglobulinemia. Our case highlights that despite the typical disease course of low-grade hematological malignancies, signs and symptoms of imminent splenic rupture should be considered when formulating a clinical assessment.

  10. Steam generator tube rupture simulation using extended finite element method

    Energy Technology Data Exchange (ETDEWEB)

    Mohanty, Subhasish, E-mail:; Majumdar, Saurin; Natesan, Ken


    Highlights: • Extended finite element method used for modeling the steam generator tube rupture. • Crack propagation is modeled in an arbitrary solution dependent path. • The FE model is used for estimating the rupture pressure of steam generator tubes. • Crack coalescence modeling is also demonstrated. • The method can be used for crack modeling of tubes under severe accident condition. - Abstract: A steam generator (SG) is an important component of any pressurized water reactor. Steam generator tubes represent a primary pressure boundary whose integrity is vital to the safe operation of the reactor. SG tubes may rupture due to propagation of a crack created by mechanisms such as stress corrosion cracking, fatigue, etc. It is thus important to estimate the rupture pressures of cracked tubes for structural integrity evaluation of SGs. The objective of the present paper is to demonstrate the use of extended finite element method capability of commercially available ABAQUS software, to model SG tubes with preexisting flaws and to estimate their rupture pressures. For the purpose, elastic–plastic finite element models were developed for different SG tubes made from Alloy 600 material. The simulation results were compared with experimental results available from the steam generator tube integrity program (SGTIP) sponsored by the United States Nuclear Regulatory Commission (NRC) and conducted at Argonne National Laboratory (ANL). A reasonable correlation was found between extended finite element model results and experimental results.

  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. [Analysis on clinical palpation laws of muscle meridian focus in scapulohumeral periarthritis]. (United States)

    You, Zhu; Yu, Ben-Xing; Deng, Tian-Tian; Dong, Bao-Qiang


    To explore the distribution rules of proximal and distal focus of muscle meridian region in scapulohumeral periarthritis. Three hundred and six shoulder joints of affected side were selected in 216 patients of scapulohumeral periarthritis. Under the guidance of muscle meridian theory, with the anatomical characteristics of muscle meridian focuses, the frequency and location where proximal and distal focus appeared were calculated by palpation. The percentages of the frequency that the focus of muscle meridian of Hand-Yangming, Hand-Shaoyang, Hand-Taiyang, and three yin meridians of hand appeared at proximal points of shoulder joint were 25.6% (1 146/5 657), 30.9% (1 749/5 657), 19.0% (1 075/5 657), and 24.5% (1 387/5 657), respectively, the focuses of muscle meridian region were Jianyuci, Juguci, Xiaoshuoci, Naohuici, etc. The percentages of the frequency that the focus of muscle meridian region appeared at distal points of shoulder joint were 31.77% (287/905), 23.2% (210/905), 10.9% (99/905), and 34.1% (304/905), the focuses of muscle meridian were Yangxici, Shousanlici, Yangchici, etc. The location and frequency of proximal and distal focus of muscle meridian in scapulohumeral periarthritis are closely related with the anatomical structure and biomechanical characteristics of the shoulder joints, thus new therapy for scapulohumeral periarthritis is implied.

  13. Quantitative assessment of fatty infiltration and muscle volume of the rotator cuff muscles using 3-dimensional 2-point Dixon magnetic resonance imaging. (United States)

    Matsumura, Noboru; Oguro, Sota; Okuda, Shigeo; Jinzaki, Masahiro; Matsumoto, Morio; Nakamura, Masaya; Nagura, Takeo


    In patients with rotator cuff tears, muscle degeneration is known to be a predictor of irreparable tears and poor outcomes after surgical repair. Fatty infiltration and volume of the whole muscles constituting the rotator cuff were quantitatively assessed using 3-dimensional 2-point Dixon magnetic resonance imaging. Ten shoulders with a partial-thickness tear, 10 shoulders with an isolated supraspinatus tear, and 10 shoulders with a massive tear involving supraspinatus and infraspinatus were compared with 10 control shoulders after matching age and sex. With segmentation of muscle boundaries, the fat fraction value and the volume of the whole rotator cuff muscles were computed. After reliabilities were determined, differences in fat fraction, muscle volume, and fat-free muscle volume were evaluated. Intra-rater and inter-rater reliabilities were regarded as excellent for fat fraction and muscle volume. Tendon rupture adversely increased the fat fraction value of the respective rotator cuff muscle (P muscle volume was significantly decreased in the infraspinatus (P = .035) and increased in the teres minor (P = .039). With subtraction of fat volume, a significant decrease of fat-free volume of the supraspinatus muscle became apparent with a massive tear (P = .003). Three-dimensional measurement could evaluate fatty infiltration and muscular volume with excellent reliabilities. The present study showed that chronic rupture of the tendon adversely increases the fat fraction of the respective muscle and indicates that the residual capacity of the rotator cuff muscles might be overestimated in patients with severe fatty infiltration. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Industrial Computed Tomography using Proximal Algorithm

    KAUST Repository

    Zang, Guangming


    In this thesis, we present ProxiSART, a flexible proximal framework for robust 3D cone beam tomographic reconstruction based on the Simultaneous Algebraic Reconstruction Technique (SART). We derive the proximal operator for the SART algorithm and use it for minimizing the data term in a proximal algorithm. We show the flexibility of the framework by plugging in different powerful regularizers, and show its robustness in achieving better reconstruction results in the presence of noise and using fewer projections. We compare our framework to state-of-the-art methods and existing popular software tomography reconstruction packages, on both synthetic and real datasets, and show superior reconstruction quality, especially from noisy data and a small number of projections.

  15. Correlation between social proximity and mobility similarity. (United States)

    Fan, Chao; Liu, Yiding; Huang, Junming; Rong, Zhihai; Zhou, Tao


    Human behaviors exhibit ubiquitous correlations in many aspects, such as individual and collective levels, temporal and spatial dimensions, content, social and geographical layers. With rich Internet data of online behaviors becoming available, it attracts academic interests to explore human mobility similarity from the perspective of social network proximity. Existent analysis shows a strong correlation between online social proximity and offline mobility similarity, namely, mobile records between friends are significantly more similar than between strangers, and those between friends with common neighbors are even more similar. We argue the importance of the number and diversity of common friends, with a counter intuitive finding that the number of common friends has no positive impact on mobility similarity while the diversity plays a key role, disagreeing with previous studies. Our analysis provides a novel view for better understanding the coupling between human online and offline behaviors, and will help model and predict human behaviors based on social proximity.

  16. [Disorders of sex development and proximal hypospadias]. (United States)

    Oswald, J


    Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy. This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented. The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented. Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.

  17. Infiltrating/sealing proximal caries lesions

    DEFF Research Database (Denmark)

    Martignon, S; Ekstrand, K R; Gomez, J


    This randomized split-mouth controlled clinical trial aimed at assessing the therapeutic effects of infiltration vs. sealing for controlling caries progression on proximal surfaces. Out of 90 adult students/patients assessed at university clinics and agreeing to participate, 39, each with 3...... differences in lesion progression between infiltration and placebo (P = 0.0012) and between sealing and placebo (P = 0.0269). The study showed that infiltration and sealing are significantly better than placebo treatment for controlling caries progression on proximal lesions. No significant difference...... proximal lesions identified radiographically around the enamel-dentin junction to the outer third of the dentin, were included. Lesions were randomly allocated for treatment to test-A (Infiltration: ICON-pre-product; DMG), test-B (Sealing: Prime-Bond-NT; Dentsply), or control-C (Placebo). Primary outcome...

  18. Sport-Specific Training Targeting the Proximal Segments and Throwing Velocity in Collegiate Throwing Athletes. (United States)

    Palmer, Thomas; Uhl, Timothy L; Howell, Dana; Hewett, Timothy E; Viele, Kert; Mattacola, Carl G


    The ability to generate, absorb, and transmit forces through the proximal segments of the pelvis, spine, and trunk has been proposed to influence sport performance, yet traditional training techniques targeting the proximal segments have had limited success improving sport-specific performance. To investigate the effects of a traditional endurance-training program and a sport-specific power-training program targeting the muscles that support the proximal segments and throwing velocity. Randomized controlled clinical trial. University research laboratory and gymnasium. A total of 46 (age = 20 ± 1.3 years, height = 175.7 ± 8.7 cm) healthy National Collegiate Athletic Association Division III female softball (n = 17) and male baseball (n = 29) players. Blocked stratification for sex and position was used to randomly assign participants to 1 of 2 training groups for 7 weeks: a traditional endurance-training group (ET group; n = 21) or a power-stability-training group (PS group; n = 25). Mean Outcome Measure(s) : The change score in peak throwing velocity (km/h) normalized for body weight (BW; kilograms) and change score in tests that challenge the muscles of the proximal segments normalized for BW (kilograms). We used 2-tailed independent-samples t tests to compare differences between the change scores. The peak throwing velocity (ET group = 0.01 ± 0.1 km/h/kg of BW, PS group = 0.08 ± 0.03 km/h/kg of BW; P sport-specific training regimen targeting the proximal segments.

  19. Functional significance of muscarinic receptor expression within the proximal and distal rat vagina. (United States)

    Basha, Maureen; Labelle, Edward F; Northington, Gina M; Wang, Tanchun; Wein, Alan J; Chacko, Samuel


    Information regarding the role of cholinergic nerves in mediating vaginal smooth muscle contraction is sparse, and in vitro studies of the effects of muscarinic agonists on vaginal smooth muscle are discrepant. The goal of this study was to determine the expression of muscarinic receptors in the vaginal wall of the rat. In addition, we sought to determine the effect of the muscarinic receptor agonist carbachol on contractility and inositol phosphate production of the proximal and distal rat vaginal muscularis. RT-PCR analysis indicated that both M(2) and M(3) receptor transcripts were expressed within the proximal and distal rat vagina. Carbachol dose-dependently (10(-7)-10(-4) M) contracted the rat vaginal muscularis with a greater maximal contractile response in the proximal vagina (P vagina. The contractile responses of the rat vaginal muscularis to carbachol were dose dependently inhibited by the M(3) antagonist para-fluoro-hexahydrosiladefenidol, and a pK(B) of 7.78 and 7.95 was calculated for the proximal and distal vagina, respectively. Inositol phosphate production was significantly increased in both regions of the vagina following 20-min exposure to 50 muM carbachol with higher levels detected in the proximal vagina compared with the distal (P < 0.05). Preliminary experiments indicated the presence of M(2) and M(3) receptors in the human vaginal muscularis as well as contraction of human vaginal muscularis to carbachol, indicating that our animal studies are relevant to human tissue. Our results provide strong evidence for the functional significance of M(3) receptor expression in the vaginal muscularis.

  20. Knowledge networks in the Dutch aviation industry: The proximity paradox

    NARCIS (Netherlands)

    Broekel, T.; Boschma, R.A.


    The importance of geographical proximity for interaction and knowledge sharing has been discussed extensively in recent years. There is increasing consensus that geographical proximity is just one out of many types of proximities that might be relevant. We argue that proximity may be a crucial