Case Of Torsion Research Articles

Quantum Field Theory of Neutrino Mixing in Spacetimes with Torsion

In the framework of quantum field theory, we analyze the neutrino oscillations in the presence of a torsion background. We consider the Einstein–Cartan theory and we study the cases of constant torsion and of linearly time-dependent torsion. We derive new neutrino oscillation formulae which depend on the spin orientation. Indeed, the energy splitting induced by the torsion influences oscillation amplitudes and frequencies. This effect is maximal for values of torsion of the same order of the neutrino masses and for very low momenta, and disappears for large values of torsion. Moreover, neutrino oscillation is inhibited for intensities of torsion term much larger than neutrino masses and momentum. The modifications induced by torsion on the CP-asymmetry are also presented. Future experiments, such as PTOLEMY, which have as a goal the analysis of the cosmological background of neutrino (which have very low momenta), can provide insights into the effect shown here.

A sustained decrease in the systolic/diastolic ratio may be a sign of severe adverse events in the umbilical cord: a report of eight cases.

A high systolic/diastolic (S/D) ratio of umbilical cord blood is a manifestation of intrauterine hypoxia. However, the clinical significance of a persistently decreased S/D ratio of umbilical cord blood has not been reported. We report eight cases of a persistently decreased S/D ratio of umbilical cord blood, with two cases of umbilical thrombus, five cases of excessive torsion, and one case of a true cord knot. Fetuses with a persistently decreased S/D ratio of umbilical cord blood may be at risk, and it may be an important indication of umbilical cord lesions.

Left medial liver lobe torsion with secondary bicavitary effusion and septic peritonitis in a dog with an acute kidney injury following ovariohysterectomy

AbstractA 7‐month‐old, spayed, female, mixed breed dog was referred for a 3‐day duration of elevated liver enzymes, azotaemia, anorexia and lethargy following ovariohysterectomy. Bloodwork showed non‐regenerative anaemia, inflammatory leukogram, moderate thrombocytopenia, severe azotaemia, severe mixed hepatopathy, hyperbilirubinemia and hypoalbuminemia. Point‐of‐care ultrasound identified free fluid and a heterogeneous mass in the mid‐ventral abdomen. Septic peritonitis was confirmed on cytology, and abdominal exploratory with left medial liver lobectomy was performed. Histopathology identified submassive hepatic necrosis and bridging fibrosis with biliary reaction, confirming a liver lobe torsion. The dog recovered perioperatively, but remained hospitalised to receive dialysis for severe renal dysfunction. The dog was transitioned to outpatient dialysis for several treatments. Unfortunately, kidney function continued to decline after dialysis was discontinued, and humane euthanasia was performed approximately 2 months postoperatively. To the authors’ knowledge, this is the first reported case of liver lobe torsion following routine ovariohysterectomy in a dog.

The impact of ultrasound on testicular loss in cases of testicular torsion in children

PurposeUltrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss.MethodsPatients’ records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0–15 years admitted during 2015–2019 at Copenhagen University Hospital, Rigshospitalet were included.ResultsIn total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound.ConclusionIn a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.

A case of iatrogenic right middle lobe torsion after radiofrequency ablation with artificial pleural effusion for liver metastasis of colon cancer

A case of iatrogenic right middle lobe torsion after radiofrequency ablation with artificial pleural effusion for liver metastasis of colon cancer

CONVECTIVE HEAT TRANSFER INSIDE A ROTATING HELICAL PIPE FILLED WITH SATURATED POROUS MEDIA

In this paper, we study the hydrothermal characteristics of flow inside a rotating helical pipe filled with saturated homogeneous porous medium. The analysis is being carried out for the case of small curvature and torsion. Using the perturbation approach, velocity and temperature fields are solved for both uniform wall heat flux and uniform wall temperature boundary conditions. Perturbation expansion up to the third order is carried out to investigate the effect of rotation on the flow. The influence of rotation on velocity is noticed as early as the first order, and on temperature solution, it has an effect in the third order. The influence of rotation on the Nusselt number does not appear till third order, and it is discovered that the Nusselt number grows as dimensionless curvature increases. Moreover, the theoretical results have been verified against experimental data from existing literature for the special case of zero rotation and curvature of the pipe. The available experimental data align well with and support the theoretical results in this limiting case.

A case of gallbladder torsion in which contrast-enhanced ultrasonography was useful

A case of gallbladder torsion in which contrast-enhanced ultrasonography was useful

儿童卵巢畸胎瘤蒂扭转1例并文献复习

儿童卵巢畸胎瘤蒂扭转1例并文献复习

Four cases of isolated fallopian tube torsion successfully treated with laparoscopic surgery:A case series.

We report four cases of isolated fallopian tube torsion (IFTT) successfully treated with laparoscopic surgery over the past 10 years. Two young women (each 19 years old) were IFTT with paraovarian cyst (POC) and tubal preservation was possible with detorsion and cystectomy. The other two patients (a 41-year-old woman with hydrosalpinx and a 50-year-old woman with hematosalpinx) underwent salpingectomy and adnexectomy, respectively, because there was no desire for tubal preservation. One patient had emergency surgery due to severe abdominal pain, one had semi-emergency surgery due to mild abdominal pain, and the other two were diagnosed during scheduled surgery without symptoms.Although IFTT was considered a very rare disease, our case series and recent reports suggest that it may have been underestimated, as it accounts for approximately 10% of adnexal torsion cases. Preoperative diagnosis of IFTT may be more difficult than for adnexal torsion because of its infrequency and nonspecific, vague clinical symptoms. Since the prevalent age for this disease is young, as in our first 2 patients, early surgical intervention to preserve the fallopian tubes should be chosen when necessary, and it seems to be important for gynecologists to be aware of this disease for earlier diagnosis and appropriate surgical intervention.

Wandering gallbladder wrapping hepatoduodenal ligament and mimicking gastrointestinal stromal tumor at imaging. Case report and literature review

Wandering or free-floating gallbladder is a rare anomaly of position of the gallbladder, characterized by an unusually long or absent mesentery. This condition may present clinically as an emergency case of gallbladder torsion or as part of a complex clinical picture, where patients may present symptoms that trace to gallbladder pathology, but show morphologic features that are distant from gallbladder disease. We present a case where a wandering gallbladder wrapping around the hepatoduodenal ligament adhered to the stomach mimicking features of a gastrointestinal stromal tumor at preoperative imaging.

The asynchronous torsion of the main and accessory wandering spleens in an infant

BACKGROUND: To diagnose the torsion of the wandering spleen in infants is a challenging task. Torsion of the wandering spleen in such population is an extremely rare case. Among children under one year of age, the wandering spleen is more common in boys (2.5:1). A total of 26 cases of torsion of an accessory spleen were described in the literature. Asymptomatic course of the disease before the first episode of spleen torsion occurs in 70% cases. No case of asynchronous torsion of the main and accessory wandering spleens are described in the literature.
 CLINICAL CASE DESCRIPTION: This article describes a very rare clinical case of asynchronous torsion of the main and accessory wandering spleens in an infant. In the described case, basic clinical manifestations of the spleen torsion in an 8-month-old girl were typical for acute enteric infection. The child had laparoscopic splenectomy.
 CONCLUSION: The present article describes challenges associated with the diagnostics of this pathology, important role of spiral computed tomography, efficacy of diagnostic laparoscopy and relaparoscopy as well as the efficacy of laparoscopic spleen resection in case of spleen necrosis in an infant.

Paediatric ovarian torsion–A painful twist

Ovarian torsion is a common gynecologic cause of acute abdomen in the reproductive females but it is not commonly encountered in paediatric age group. Safeguarding the ovary is especially important in young girls where the future fertility issue has to be considered. The main challenge in paediatric age group is a prompt diagnosis which aids in the salvagability of the ovary. Herein we are reporting a rare case of ovarian torsion in a 9 year old which was successfully managed by salvaging the ovary.

Cold-formed steel strength predictions for torsion and bending–torsion interaction

Locally slender cross-section members, such as cold-formed steel open sections, are susceptible to significant twisting and high warping torsion stresses. Torsion considerations are complicated by whether it is derived as a first-order effect from loading or a second-order effect from instability. Previous direct torsion experiments on lipped Cee sections have shown significant inelastic reserve. Furthermore, the current design for combined bending–torsion interaction has limitations, including only considering the first yield and ignoring the cross-section slenderness in torsion. Two parametric studies were conducted to predict both the torsion capacity and the combined bending–torsion interaction in locally slender cross-sections. Shell finite element analysis of lipped Cee and Zee sections for both the torsion only and the combined bending–torsion cases were created using a validated model. For the torsion-only study, various cross-section geometries, steel grades, and member lengths covering the range of practically expected torsional slenderness were investigated. A set of bimoment parameters, including yield, buckling, and plastic bimoments, were calculated and the ultimate bimoment was determined by shell finite element collapse analyses. A simple uniform equation predicting the bimoment capacity was adopted and two bimoment strength curves are proposed for local and distortional buckling-controlled cases respectively. For the combined bending–torsion case, various practical cross-sections and bracing conditions were investigated with various ratios of applied torsion and bending. Shell finite element buckling and collapse analyses were performed to determine the critical and ultimate moments and bimoments. It was found that the current AISI standard is conservative under most scenarios. Updated torsion–bending interaction equations incorporating bimoment and bending moments are proposed. The interaction equations are dependent on the cross-section, the direction of the applied torsion, and the bracing condition.

Case Report: Severe intermittent acute abdominal pain caused by extremely rare case of lienorenal accessory spleen torsion and detorsion: an accurate diagnostic and treatment strategy

Background: Accessory spleen (AS) is a rare condition that usually does not cause any symptoms. However recurrent torsion and detorsion of AS commonly happen in the case of AS with long pedicles. Thus diagnostic and treatment procedure is needed to prevent further complication in this case. Case presentation: An extreme case of an Austronesian 22-year-old college student who presented clinical symptoms of crampy abdominal pain in the left upper quadrant (LUQ) three days before being administered in a hospital. The pain was periodically worsened and relieved for the past year due to recurrent torsion and detorsion of the accessory spleen. Radiologic findings were accessory spleen located in the lienorenalis region with the size of 1.6 x 1.8 x 1.4 cm and the vascular accessory spleen extends from the splenic pedicle to the left splenorenal region. The intraoperative finding was a blackish-brown mass with spongy consistency with 0.5 cm of the pedicle. Conclusion: A combination of USG and CT scan with arterial and venous phase is preferred to diagnose the accessory spleen early. While the findings of the accessory spleen with long pedicle are highly suggested to be treated using modified anti-Trendelenburg 3-port laparoscopic excision of the accessory spleen (LEAS).

A rare case of ovarian torsion in premenarcheal age- Case report and review of literature

Ovarian torsion in childhood and adolescence is rare gynecological emergency. We report a case of ovarian torsion in eleven-year-old pre-menarcheal girl who presented with acute lower left abdominal pain and vomiting. On examination her vital signs were stable, secondary sexual characters were absent, abdomen was scaphoid with tenderness in left iliac fossa. Ultrasonography with doppler study showed a heterogenous mass measuring about 58x31mm in left adnexal region close to uterus with minimal vascularity. MRI findings were consistent with ovarian torsion. Patient underwent emergency laparoscopy and left ovary was found to be enlarged, blue-black with hemorrhagic cyst with two twists along Infundibulo-pelvic ligament. Ovarian Sparing Surgery involving de-torsion of torsed ovary with drainage of hemorrhagic cyst was performed. Right ovary was found to be normal in size with multicystic appearance. Bilateral oophoropexy using sandwich technique was done in order to prevent future recurrences. This case report emphasizes on importance of immediate diagnosis with ultrasound and MRI. Surgical management in form of laparoscopy with ovarian sparing surgery in young patients is important to preserve their fertility.

Clinico Pathological Profile of Adnexal Torsion Cases- A Retrospective Analysis from A Tertiary Care Teaching Hospital in Southern India

Introduction: Adnexal torsion is a significant source of morbidity, and nonspecific signs can make diagnosis difficult. Early identification is crucial to avoid ovarian infarction and the likelihood of related infertility. Our study aims to assess the clinicopathological profile of adnexal torsion cases through retrospective analysis from a tertiary care teaching hospital in southern India. Methods: This retrospective study was carried out in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital in Tamil Nadu, India. Data was collected on women with surgically proven adnexal torsion from January 2019 to December 2022. Proper ethics permission was obtained, and informed consent was taken from all the patients prior to the commencement of the study. The subjects' confidentiality was maintained. The data was represented using detailed descriptive analyses, medians, and percentages. Statistical analysis was carried out using Microsoft Excel 2007 and IBM SPSS version 21. Conclusion: Adnexal torsion is an uncommon condition. Acute stomach discomfort, nausea, and vomiting are the most common symptoms. Adnexal torsion’s clinical and radiographic diagnosis is challenging for both doctors and radiologists. As a result, extensive clinical experience and radiological abilities are necessary. Early identification and surgical treatment save the ovary while maintaining its function.

Implementation of a health system intervention to reduce time from presentation to surgical intervention for pediatric testicular torsion

Testicular salvage rates for torsion are time-dependent1. Door to detorsion time has been identified as an independent testicular survival factor2. We describe an initiative to reduce door to incision (DTI) time for pediatric testicular torsion. An institutional multidisciplinary quality improvement initiative with a primary outcome of reducing DTI time for pediatric testicular torsion was developed with multidisciplinary stakeholders. Several process and balancing measures were used as secondary outcomes to help interpret and verify the observed change in DTI time. Interventions were implemented in cycles. Initial interventions standardized assessment of suspected torsion by Emergency Medicine utilizing a validated scoring system. A threshold Testicular Workup for Ischemia and Suspected Torsion (TWIST) score led to parallel notification of essential services for rapid assessment and case prioritization3. Subsequently, bedside ultrasound in the Emergency Department was implemented. Progress was tracked in a live dashboard and analyzed with X-mR process control charts and Nelson rules. These tools are used in quality improvement and process control to demonstrate the significance of changes as they are being implemented, prior to when traditional hypothesis testing would be able to do so. We aimed to increase the proportion of cases with DTI times under 4h from 64% to >90% within one year. We observed 22 torsion cases prior to and 62 following initial implementation. The percentage of cases with DTI times under 4h improved from 64% to 95%. At week 29, a shift identified a significant change on the X chart, with reduction in mean DTI time from 221 to 147min. At the same time, a shift on the mR chart identified reduction in patient-to-patient variation. Mean time from arrival to Urology evaluation decreased from 140 to 56min, mean time from arrival to scrotal ultrasound decreased from 70 to 36min, and mean time from scrotal ultrasound to surgical incision decreased from 128 to 80min. These improvements highlight the two key successes of our project: application of the TWIST score and bedside ultrasound for rapid assessment of suspected testicular torsions, and parallel processing of the evaluation and management. Implementation of a protocol for pediatric testicular torsion increased the proportion of cases with DTI time <4h to 95%, decreased mean DTI time, and decreased variation. Our protocol provides a model to improve timeliness of care in treating pediatric testicular torsion.

Laparoscopic Ovarian-Sparing Surgery for the Management of Benign Ovarian Lesions in Pediatric Patients: A Retrospective Analysis

IntroductionLaparoscopic ovarian-sparing surgery (OSS) is safe and effective management approach for benign ovarian lesions in pediatric patients. This study evaluates the outcomes of females younger than 18 years who underwent the OSS procedure between December 2013 and November 2022 at a single institution. Material and methodsWe conducted a retrospective analysis of records from 82 females who underwent OSS for ovarian lesions. OSS was performed based on diagnostic imaging that suggested the benign nature of the lesion. ResultsOf the 82 patients studied, 78 had unilateral lesions and 4 had bilateral synchronous lesions. The mean age was 14 years. The majority (62 cases) of the surgeries were laparoscopic, with 20 requiring conversion to open surgery due to factors such as indistinguishable edges and large size of the lesion. We identified 8 cases of ovarian torsion. The surgical specimens revealed that 46 were ovarian teratomas, 2 were granulosa cell tumors, 15 were cystadenomas, and 23 were functional cysts. There were no intraoperative complications. Two recurrences were observed in patients who were initially treated for bilateral ovarian teratomas. One patient developed a pelvic abscess. Additionally, three patients had metachronous ovarian tumors during the follow-up period. In patients followed with ultrasound imaging, the viable ovary was visualized in 83.6% of the cases (61 out of 73). ConclusionOur findings demonstrate the effectiveness of laparoscopic OSS in preserving ovarian function and providing clinical benefits in patients with benign ovarian lesions. We recommend regular follow-up with ultrasound to exclude metachronous lesions or recurrence. Level of evidenceIII.

A Case of Torsion in an Otherwise-Normal Ovary in a 22-years old nulliparous women: Utilization of Diagnostic Laparoscopy for the Accurate Diagnosis

Ovarian torsion can be seen in the otherwise-normal ovary and is a challenging issue in the emergency department. Definitive diagnosis is sometimes difficult to establish because of clinical symptoms similar to other abdominal diseases. We report a 22-year-old woman, nullipara, with acute lower right abdominal pain for 14 hours before coming to an emergency room. On examination, the abdomen was soft but tender over the right iliac fossa and rebound tenderness were present.Ultrasound radiological examination showed that the right ovary is grossly enlarged (volume- 98.4cc) with hyperechoic central stoma. On colour, doppler twisted pedicel was noted. Mild collection is also seen in the pouch of Doglus. During laparoscopy, we found a blackish-red cystic mass of about 12 × 11 cm experiencing torsion. Then salpingooophorectomy was done. This is an interesting case of torsion in an otherwise-normal ovary with a huge hematosalpinx. J Bangladesh Coll Phys Surg 2023; 41(4): 342-347

A medical and literature undescribed case of acute abdomen - Consequences of bilateral torsion of the adnexa: Case report

ntroduction: Torsion is the turning of the adnexa around its axis. It accounts for 3% of all gynecological emergencies. It also happens during pregnancy, as much as 20-25% of all torsions. It most often occurs in pathologically altered ovaries, 60-80% of cases. Causes in pregnancy are more often benign than in nonpregnant women. The diagnosis is established by clinical picture, physical and ultrasound examination. Due to the specificity of pregnancy, it is more difficult to diagnose, especially in the third trimester. Torsion is treated surgically by laparoscopy or laparotomy. Options are detorquation or removal of the necrotic adnexa. Case report: We report the first case of bilateral adnexal torsion in the third trimester of pregnancy. A 32-year-old pregnant woman came to our institution in the 28th week of a spontaneous twin pregnancy with pain in the right hemiabdomen and an episode of vomiting. After clinical, laboratory and ultrasound evaluation, as well as artificial maturation of fetal lungs, cesarean section and bilateral adnexectomy were successfully performed. Pathohistological findings showed infarction and necrosis of the adnexa. Conclusion: Torsion of the adnexa is not uncommon in pregnancy, with 20-25% of all torsions occurring in pregnant women. Torsion of the adnexa should be considered in the differential diagnosis of pain in pregnancy, especially if it is accompanied by nausea, vomiting and fever.