Cause Of Rupture Research Articles

Explant analysis of AneuRx stent grafts: relationship between structural findings and clinical outcome

Objective We reviewed the structural findings of explanted AneuRx stent grafts used to treat abdominal aortic aneurysms, and relate the findings to clinical outcome measures. Methods We reviewed data for all bifurcated AneuRx stent grafts explanted at surgery or autopsy and returned to the manufacturer from the US clinical trial and worldwide experience of more than 33,000 implants from 1996 to 2003. Devices implanted for more than 1 month with structural analysis are included in this article. Explant results were analyzed in relation to cause of explantation and pre-explant evidence of endoleak, enlargement, or device migration. Results One hundred twenty explanted stent grafts, including 37 from the US clinical trial, were analyzed. Mean implant duration was 22 ± 13 months (range, 1-61 months). Structural abnormalities included stent fatigue fractures, fabric abrasion holes, and suture breaks. The mean number of nitinol stent strut fractures per explanted device was 3 ± 4, which represents less than 0.2% of the total number of stent struts in each device. The mean number of fabric holes per explanted device was 2 ± 3, with a median hole size of 0.5 mm 2. Suture breaks were seen in most explanted devices, but composed less than 1.5% of the total number of sutures per device. “For cause” explants (n = 104) had a 10-month longer implant duration ( P = .007) compared with “incidental” explants (n = 16). “For cause” explants had more fractures (3 ± 5; P = .005) and fabric holes (2 ± 3; P = .008) per device compared with “incidental” explants, but these differences were not significant ( P = .3) when adjusted for duration of device implantation. Among clinical trial explants the number of fabric holes in grafts in patients with endoleak (2 ± 3 per device) was no different from those without endoleak (3 ± 4 per device; P = NS). The number of fatigue fractures or fabric holes was no different in grafts in clinical trial patients with pre-explant aneurysm enlargement compared with those without enlargement. Pre-explant stent-graft migration was associated with a greater number of stent strut fractures (5 ± 7 per device; P = .04) and fabric holes (3 ± 3 per bifurcation; P = .03) compared with explants without migration. Serial imaging studies revealed inadequate proximal, distal, or junctional device fixation as the probable cause of rupture or need for conversion to open surgery in 86% of “for cause” explants. Structural device abnormalities were usually remote from fixation sites, and no causal relationship between device findings and clinical outcome could be established. Conclusions Nitinol stent fatigue fractures, fabric holes, and suture breaks found in explanted AneuRx stent grafts do not appear to be related to clinical outcome measures. Longer term studies are needed to confirm these observations.

Pressure measurements in arterial feeders of brain arteriovenous malformations before and after endovascular embolization.

Arteriovenous malformations (AVMs) are composed of abnormal arterial and venous vessels in the brain causing arteriovenous shunts of arterialized blood directly from pial arteries to draining veins. The hemodynamics of these lesions is not well-understood. Changes in blood flow and pressure are probably related to the natural history of AVMs and may also play a major role in AVM treatment. In this study intra-arterial pressure was measured in feeding arteries of AVMs using a microcatheter that had been placed for subsequent embolization treatment (201 measurements were performed in 95 patients before and after the embolization procedure). Results show a direct relationship between pressure changes and degree of embolization. Since pressure changes during the embolization procedure are relatively small, it seems unlikely that these changes are the direct cause of rupture and periprocedural bleedings.

Uterine rupture: UCH, Ibadan experience.

To determine the incidence, predisposing factors, maternal and fetal outcome of uterine rupture patients at the University College Hospital (U. C. H.), Ibadan. A 5-year retropective study of patients with uterine rupture in U. C. H., Ibadan between January 1996 - December, 2000 was done. Thirty five cases of uterine rupture out of a total delivery of 4531 were recorded over the 5-year period. An incidence of 7.75/1000 deliveries or 0.72% was obtained and the yearly trend showss it's on the increase. 85.7% of the patients were unbooked. Common modes of presentation were bleeding per vaginam and abdominal pain. Spontaneous cause of rupture predominates. The interval between diagnosis and surgery was greater than 7 hours in 75% of cases. Uterine repair with or without tubal ligation was commonly employed. Case fatality rate was high at 17.9%. Perinatal mortality was 92.5%. Other maternal morbidities include anaemia, puerperal and wound sepsis, vesico-vaginal fistula and prolonged hospital stay. All the indice at the present time are higher than they were 10 years ago. The incidence is still high and is on the increase. Attributable reasons include type I, II, III delays in health care service utilization associated with poor socioeconomic status of patients and lack of essential drugs and compatible blood in the hospitals.

Successful salvage of inferior vena cava rupture during reoperative repair for ascending aortic aneurysm

A 44-year-old man underwent reoperative repair for ascending aortic aneurysm at our hospital. He had received aortic valve replacement due to severe aortic regurgitation 4 years previously. The cardiopulmonary bypass was set up through the femoral arterial and venous cannula. An unusual experience of rupture of the abdominal inferior vena cava was encountered after total-body retrograde perfusion. The tragic situation was successfully salvaged by recannulation into the intrapericardial inferior vena cava and repair of the several perforations on abdominal inferior vena cava. The patient recovered smoothly except for mild pancreatitis. The causes of rupture of the inferior vena cava are discussed here.

Rupture of the extensor pollicis longus tendon: a study of aetiological factors.

Although rupture of the extensor pollicis longus (EPL) tendon is a well-known complication of distal radial fractures, a number of patients rupture the EPL because of other conditions. We have retrospectively studied the aetiology of 27 ruptures of the EPL in 26 consecutive patients. Of 19 patients with injured wrists 12 had distal radial fractures, five had blunt trauma, and two had stab wounds that resulted in rupture. In the radial fractures operated on, the EPL rupture was caused by chafing against a dorsal plate (n = 2) or wear against the pins of an external fixator (n = 2). Six patients were taking steroids for systemic diseases and in two cases a local steroid injection was given just before the rupture. We conclude that previous injury is the most common cause of rupture of the EPL. but that rheumatoid arthritis or local or systemic steroids, or both, are also important aetiological factors. Seven patients had an iatrogenic cause for their rupture.

Late renal allograft rupture in a patient with small vessel vasculitis following discontinuation of immunosuppression

We report the case of a 21-year-old man with antineutrophil cytoplasmic antibody (ANCA)--associated vasculitis who experienced spontaneous renal allograft rupture 21 months after engraftment. Because of chronic allograft nephropathy, the patient's immunosuppressive regimen had been discontinued approximately 3 weeks prior to his presentation with abdominal pain and evidence of internal hemorrhage. He was emergently taken to the operating room, where a ruptured allograft was found and transplant nephrectomy was performed. Postoperatively, the cause of rupture was determined to have been acute cellular rejection. This case may be the longest interval reported between renal transplant and spontaneous allograft rupture.

Lipogranuloma peritonealis caused by spontaneous rupture of a benign cystic ovarian teratoma

Lipogranuloma peritonealis caused by spontaneous rupture of a benign cystic ovarian teratoma

Four-year review of open eye injuries at the Royal Adelaide Hospital.

To review the epidemiology of penetrating eye injuries and ruptured globes presenting to the Royal Adelaide Hospital, South Australia. A retrospective case review over a 4-year period. There were 109 penetrated or ruptured globes in 105 patients. The average age was 41 years and 80.2% were men. Over half were from rural areas. The commonest cause of injury was hammering metal followed by motor vehicle accidents. Falls in the elderly were the commenest cause of globe ruptures. A final visual acuity of 6/12 or better was found in 40% of eyes and no perception of light in 27%. At the Royal Adelaide Hospital, the predominant referral centre for serious ocular injury in South Australia, approximately 25 open globe injuries are encountered a year. Although the epidemiology of these injuries was found to be similar to those previously reported in Victoria and rural New South Wales, differences were thought to reflect to the ageing population of South Australia. Rupture of an old, healed large-incision cataract extraction wound was the commonest cause of ruptured globe. An effective preventive strategy to reduce the incidence of severe ocular trauma has yet to be implemented. The concept of a national population-based severe ocular trauma database is considered.

Uterine rupture

Uterine rupture is an uncommon obstetric event. It is important because it continues to be associated with maternal mortality, especially in developing countries, and with major maternal morbidity, particularly peripartum hysterectomy. It is also associated with a high incidence of perinatal mortality and morbidity worldwide. This chapter examines the incidence, aetiology, clinical presentation, complications and prevention of uterine rupture. The key factor in the cause of rupture is whether or not the uterus is scarred. Rupture of an unscarred uterus is rare, usually traumatic, and its incidence decreases with improvement in obstetric practice. Rupture of the scarred uterus is more common, and usually occurs after a trial of labour in a patient with a previous Caesarean section. This chapter also explores how the incidence and complications of uterine rupture may be minimized, and yet the incidence of vaginal birth after Caesarean section (VBAC) optimized, in clinical practice.

Subtotal hysterectomy for uterine rupture

Objective: The aim of this paper was to stratify patients with uterine rupture in extremis (with hypotension, change in vital organ function, and altered mental status) and evaluate outcome for patients undergoing subtotal hysterectomy (STH) vs. uterine repair (UR). Methods: Of 39 667 hospital deliveries between 1993 and 1998 at a university hospital, 367 presented with uterine rupture. Of these, 96 presented in extremis and had an irregularly torn uterus found at operation. Charts were retrospectively reviewed to stratify patient population with uterine rupture and their outcome. Results were analyzed using Fisher's exact test. Results: Patients with uterine rupture were 31–35 years old, para≥3, had received no antenatal care, and presented with rupture in the lower uterine segment. Sixty-one patients underwent STH while 35 underwent UR. The groups were similar with respect to patient age, parity, cause of rupture, and clinical condition at the time of evaluation ( P=0.2). The operative time for STH was significantly less than UR, 35 min vs. 75 min ( P<0.01). Maternal mortality was significantly higher in patients undergoing UR vs. STH, 46% vs. 20% ( P=0.01). Maternal morbidity occurred in 30% of patients undergoing STH vs. 50% in patients undergoing UR ( P=0.01). The time to discharge was significantly less in patients undergoing STH compared to UR, 14.5 days vs. 27 days ( P<0.01). Conclusions: Patients with uterine rupture in extremis tend to be young, multiparous, receive no antenatal care, and have uterine rupture of the lower segment. STH significantly lowered operative time, morbidity, time to discharge, and mortality than UR in patients in extremis with uterine rupture.

Flexor tendon rupture in the rheumatoid wrist caused by bony spurs in the carpal tunnel

Five cases of flexor tendon rupture in surgically treated rheumatoid wrists were studied. The tendon ruptures occurred in the thumb and index finger, and the ruptures site was in the carpal tunnel in all five cases. The main cause of rupture was the formation of bony irregularities in the form of bony spurs in the carpal bones, mainly in the scaphoid, or at the volar aspect of the distal radius, as a result of rheumatoid erosion. In all five cases, tendon reconstruction and bony spur excision were conducted, and good recovery of phalangeal function was achieved. To clarify the causes of the rupture of the flexor pollicis longus in rheumatoid hands, we used three-dimensional computed tomography on 19 rheumatoid wrists without tendon rupture to investigate the presence or absence of bony spurs in the volar aspect of the scaphoid. The results showed a correlation between the frequency of scaphoid spurs and progression of bone changes as checked by radiography.

Flexor tendon rupture in the rheumatoid wrist caused by bony spurs in the carpal tunnel

Five cases of flexor tendon rupture in surgically treated rheumatoid wrists were studied. The tendon ruptures occurred in the thumb and index finger, and the ruptures site was in the carpal tunnel in all five cases. The main cause of rupture was the formation of bony irregularities in the form of bony spurs in the carpal bones, mainly in the scaphoid, or at the volar aspect of the distal radius, as a result of rheumatoid erosion. In all five cases, tendon reconstruction and bony spur excision were conducted, and good recovery of phalangeal function was achieved. To clarify the causes of the rupture of the flexor pollicis longus in rheumatoid hands, we used three-dimensional computed tomography on 19 rheumatoid wrists without tendon rupture to investigate the presence or absence of bony spurs in the volar aspect of the scaphoid. The results showed a correlation between the frequency of scaphoid spurs and progression of bone changes as checked by radiography.

Performance of W-Beam Splices

Structural failure of post-and-beam W-beam guardrails during impact sometimes is due to the rupture of the W-beam rail where two sections are spliced together with bolts. Summarized is a study of the mechanics of failure of the splice connection. The causes of rupture are identified, and a design alternative is formulated that will reduce the likelihood of rupture of the splice connection. The tensile forces in the W-beam rail and the mode of deformation of the splice connection during impact were critical factors considered in the study. The results of full-scale crash tests, laboratory tests, and finite element analysis indicate that relocating splices to midspan locations would greatly reduce the chance of observing a rupture of the guardrail in full-scale crash tests and in real-world collisions.

A rare cause of rupture of the quadriceps tendon

Examination of the excised section of the quadriceps tendon showed a fresh rupture of the tissue of the tendon. Furthermore, there was an extensive infiltrate of the tendon in the area of the rupture by a B-cell chronic lymphocytic leukaemia (figure), besides moderate, partially mucoid degenerative alterations. He mobilised well and was transferred to a rehabilitation centre, where he stayed for 4 weeks. He was given oral chemotherapy. Spontaneous rupture of tendons can be due to degenerative changes after recurrent microtrauma, reduced blood supply, or metabolic diseases. 1 Morphologically, the degenerative changes are visible as mucoid degeneration, chondroid metaplasia, fibrosis, scarring, and calcification. 2

Bulbar palsies and chest pain

A previously healthy 46-year-old man presented with a 2 week history of malaise, sore throat, dysphagia, and, latterly, headache with behavioural changes and episodic confusion. On admission he had upper abdominal and transient interscapular pain. There was no history of hypertension or of cardiovascular or neurological disease. DEPARTMENT OF ERRORBulbar palsies and chest pain—This Case Report by H Gleeson and colleagues (Sept 2, p 826) was mistakenly listed on the front cover as A rare cause of rupture of the quadriceps tendon by P Benecke and others. Full-Text PDF

MR appearance of ruptured tubal ectopic pregnancy

The usual clinical course of ectopic pregnancy is punctuated by the onset of severe abdominal pain when rupture of the Fallopian tube leads to a pelvic haemorrhage [1]. Spontaneous rupture occurs in most patients, although the immediate cause of rupture may be trauma associated with coitus or vigorous bimanual examination [2,3]. The diagnosis is suggested by the typical history and physical examination revealing an overdue menstrual period and a palpable adnexal mass [4]. Torsion of the pedicle of ovarian tumors may simulate ruptured ectopic pregnancy clinically. The serum b-hCG determinations are crucial in diagnosis of ectopic pregnancy. However, imaging examinations make the diagnosis probable while awaiting confirmatory laboratory results. We describe magnetic resonance (MR) findings in a 25-year-old woman with acutely ruptured tubal ectopic pregnancy.

Invited commentary to: “Spontaneous splenic rupture during pringle maneuver in liver resection for hepatic abscess”

Trauma is the most frequent cause for splenic rupture, which typically occurs along the peritoneal attachments of the splenic convexity or at the splenic hilum after deceleration trauma or as avulsion fractures of the spleen after direct lateral impact to the left lower ribcage. Spontaneous splenic ruptures are described as complications after infectious or neoplastic afflictions of the splenic parenchyma (5). Intraoperative splenic injury usually occurs at the splenic insertion of the splenocolic ligament, especially if the left colonic flexure is not detached from the spleen. The case reported by Kling et al. is indeed a rare case of spontaneous splenic rupture that has been reported in a similar setting only once (1). The site of rupture does not present like an intraoperative splenic injury, but was attributed by the authors to an increased intrasplenic pressure after Pringle's maneuver for a left lateral liver resection. Control of the hepatic inflow by Pringle 's maneuver is one of the measures to decrease bloodloss during major liver resection (2). While the consequences of Pringle 's maneuver on systemic and pulmonary macro hemodynamic parameters have been studied in humans (3), little is known about the impact of Pringle 's maneuver on the splanchnic, especially splenic circulation. Delva et al. demonstrate that Pringle 's maneuver causes a significant increase in systemic peripheral vascular resistance and consequently an increase in blood pressure and a decreased cardiac index (3). The authors here hypothesize that splenic venous congestion during Pringle 's maneuver was the cause for the rupture. In the only comparable case published by Baradaran et al. (1) that ve-

A CASE OF GENERALIZED PERITONITIS DUE TO A RUPTURE OF THE BLADDER CAUSED BY RADIATION CYSTITIS

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

Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture

Objectives. We analyzed the possible relation between the presence of a hospital admission delay (≥24 h), undue physical effort or recurrence of anginal pain, alone or in combination, with the development of free wall rupture (FWR), septal rupture (SR) or papillary muscle rupture (PMR) in patients with an acute myocardial infarction (AMI).Background. Physical activity as a trigger of FWR in AMI remains controversial, and its contribution to SR or PMR remains unknown. Moreover, the role of ischemia or reinfarction as an additional cause of rupture has not been explored.Methods. The incidence of hospital admission delay ≥24 h with maintenance of some ambulatory activity and the incidence of postinfarction angina were analyzed in consecutive patients with a first AMI with (n = 225) or without rupture (n = 1,012 [control group]) over different time periods.Results. An admission delay ≥24 h occurred in 27 (27.6%) of 98 patients with FWR, 47 (47.0%) of 100 with SR and 14 (51.9%) of 27 with PMR but in only 81 (8%) of 1,012 control patients (p < 0.0001). Information on undue in-hospital effort preceding rupture was available for 111 patients and was present in 17 (32.7%) of 52 with FWR, 9 (18.4%) of 49 with SR and 3 (30%) of 10 with PMR versus only 76 (7.5%) of 1,012 control patients (p < 0.001). Information on postinfarction anginal pain was available for 114 patients with rupture and occurred in 30 (56.6%) of 53 with FWR, 30 (60%) of 50 with SR and 4 (36.4%) of 11 with PMR versus 120 (11.9%) of 1,012 control patients (p < 0.0001). Mean age and incidence of male gender, hypertension, absence of heart failure, single-vessel disease or occlusion of the infarct-related artery were comparable among the groups with FWR, SR or PMR.Conclusions. Delayed hospital admission or undue in-hospital physical activity appears to increase the risk of rupture in patients prone to this complication (i.e., a first transmural AMI, absence of overt heart failure and advanced age); recurrence of ischemia/infarction emerges as a potential additional trigger in a proportion of these patients.

Spontaneous rupture of choledochal cyst: An unusual cause of acute abdomen in children

Rupture is one of the rare complications of choledochal cysts. The cause of rupture is unknown in many cases and is considered to be spontaneous. Two patients admitted to the hospital with acute abdominal picture were initially thought to have postoperative abscess and appendicitis. However, the presence of bilelike fluid suggested a bile tract pathology, and evaluation showed ruptured choledochal cysts. Although spontaneous rupture of a choledochal cyst is a rare complication, and can sometimes be the initial manifestation of a choledochal cyst, it should be considered in the presence of bilelike fluid and differentiated from spontaneous perforation of the bile tract. In spontaneous rupture of choledochal cyst, cystectomy, cholecystectomy, and Roux-Y hepaticoportoenterostomy is the treatment of choice.