Extensive Tears Research Articles

Fetus in the Abdominal Cavity After Uterine Rupture in a Primigravida Post-Adenomyosis Enucleation

A 35-year-old primigravida with a history of adenomyosis enucleation was diagnosed with abnormal fetal position at 25 weeks of gestation. The patient presented with normal vital signs and no symptoms. A cardiotocogram and transabdominal ultrasound revealed a healthy fetus, normal amniotic fluid volume, and no intra-abdominal bleeding. Pelvic magnetic resonance imaging (MRI) indicated a ruptured muscular layer of the uterine fundus, with the fetus completely prolapsed into the abdominal cavity. An emergency cesarean section was performed, during which the fetus was found wrapped within the amniotic membrane in the abdominal cavity. The uterus exhibited extensive tearing along the line of the previous surgical scar; however, no hemorrhage was observed. In this case, despite uterine rupture, blood flow through the umbilical cord from the placenta in the uterus resulted in the survival of the fetus. In addition, MRI was essential in determining the appropriate timing to save the fetus.

Factors associated with pseudoparalysis in patients with extensive chronic and atraumatic rotator cuff injury

BackgroundPatients with massive chronic atraumatic rotator cuff injuries can be asymptomatic or present severe shoulder dysfunction, a condition known as pseudoparalysis. Our hypothesis is that integrity of the subscapularis, hypertrophy of the Teres minor, and a complete tear of the long head of the biceps tendon are associated with improved active forward flexion range in such patients. Therefore, the objective of this study was to evaluate factors associated with pseudoparalysis. MethodsThis was a single-center cross-sectional study that included patients with massive chronic atraumatic rotator cuff injuries. Range of motion of the affected shoulder, demographic data, specific tests for rotator cuff assessment, and imaging studies were collected. ResultsA total of 68 patients (71 shoulders) were included in the study. At initial evaluation, 41 patients exhibited active forward flexion of the shoulder greater than 90º (No Pseudoparalysis group). Patients with active forward flexion less than 90º (n = 29) underwent subacromial injection of local anesthetic and were then reevaluated. In 15 patients the pseudoparalysis was resolved (False Pseudoparalysis group) and 14 maintained active forward flexion of less than 90° (True Pseudoparalysis group). ConclusionWe concluded that the presence of shoulder shrug sign, Goutallier grade III and IV fatty infiltration and a full-thickness tear of the subscapularis were risk factors for the occurrence of pseudoparalysis. Tear extension, as described by Wieser et al, also demonstrated statistical difference between groups, with greater anterior tear extension (involvement of subscapularis tendon) and greater global tear extension observed in True Pseudoparalysis group. Level of evidenceLevel III; Cross Sectional Design; Epidemiology Study

Cumulative damage effects of repeated underwater explosions on multi-cabin structures

This paper presents experimental and numerical findings regarding complex multi-cabin structures with the goal of elucidating cumulative damage mechanisms and assessing the influence of blast distance on damage characteristics under repeated underwater explosions. The damage characteristics of a multi-cabin structure were analyzed through single and repeated explosion tests employing equal-mass charges. The shockwave loads and structural damage observed during testing were accurately predicted through numerical simulations, which revealed that the structure experienced the combined impact of shockwaves, transmitted pressure waves, and bubble expansion loads during repeated explosions. The findings demonstrate that repeated underwater explosions produce a cumulative damage effect, leading to a significant increase in the extent of depression plastic deformation and deflection of the structure. However, the gain in cumulative damage effects is limited compared to a single explosion with an equivalent charge. A single explosion results in extensive tearing and dent deformation of the structure, causing far more severe damage than repeated explosions.

A Novel Surgical Treatment Management Algorithm for Elbow Posterolateral Rotatory Instability (PLRI) Based on the Common Extensor Origin Integrity.

Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon's point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO's condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.

Quantitative evaluation of natural progression of fatty infiltration and muscle atrophy in chronic rotator cuff tears without tear extension using magnetic resonance imaging

BackgroundThe pathology of and mechanisms underlying muscle degeneration remain unclear. We aimed to quantitatively evaluate the natural changes in fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears using 3-dimensional 2-point Dixon magnetic resonance imaging (MRI). MethodsThirty patients with nonoperatively observed rotator cuff tears without tear extension were evaluated using multiple MRI examinations with a minimum interval of 2 years. The fatty infiltration ratio (%fat) and muscle volume of the rotator cuff muscles were compared between the two examinations in those with supraspinatus tear <2 cm (<2 cm SSP group), supraspinatus tear ≥2 cm (≥2 cm SSP group), and massive tear (massive group). The supraspinatus (SSP), infraspinatus and teres minor (ISP+TM), and subscapularis (SSC) muscles were evaluated. ResultsThe massive group showed a significantly greater %fat than the <2 and ≥2 cm SSP groups in the SSP (P=0.002) and ISP+TM muscles (P<0.001). The total muscle volume did not differ among the three groups for all rotator cuff muscle components. The %fat values did not change in any rotator cuff components during the follow-up period in all groups. The total muscle volume in the massive group significantly decreased in the SSP (P=0.018) and ISP+TM muscles (P=0.013). ConclusionThe present results indicate that fatty infiltration of the torn muscle occurs in the early phase after a rotator cuff tear, whereas muscle atrophy appears to progress gradually in chronic rotator cuff tears. Early intervention before muscle degeneration should be considered if the tear involves the infraspinatus tendon.

Analysis of clinical characteristics and imagological features of the aortic dissection patients with negative D-dimer results.

D-dimer (DD) is a vital biomarker to rule out the diagnosis of aortic dissection (AD). However, the DD level in some patients with AD is not high in clinical practice, which often leads to missed diagnosis; therefore, understanding the characteristics of patients with AD and negative DD is of great clinical value. From May 2015 to October 2020, 286 patients with AD who visited the first medical contact (FMC) within 24 h of symptom onset and were hospitalized in the Xiamen Cardiovascular Hospital of Xiamen University were enrolled in this study. Clinical characteristics and outcomes of patients were assessed. Among them, 13 cases (approximately 4.5%) had negative DD results. Compared to patients with positive DD results, patients with negative DD results had significantly higher platelet counts and lower aortic dissection detection risk scores (ADD-RS). The imagological analysis showed that patients with AD and negative DD had lower extension scores and milder damage to the mesenteric artery and three branches of the aortic arch. Furthermore, the results of the multivariable analysis showed that white blood cell count (WBC) [odds ratio (OR): 1.379, P = 0.028], FMC (OR: 0.904, P = 0.028), and extension score (OR: 1.623, P = 0.046) were associated with negative DD result. Patients with AD and negative DD results had longer FMC and lower WBC. Imaging showed a smaller tear extension range and less damage to the mesenteric artery and three branches of the aortic arch. A negative DD result could not completely rule out AD even if the ADD-RS was zero.

Netzhautriss – optometrisches Management

Purpose. This case report describes the optometric manage- ment of a peripheral retinal tear that was discovered during an optometric eye examination. It is intended to sensitize optometrists and ophthalmic opticians to the topic of retinal tears and retinal detachment. Material and Methods. During an optometric eye examina- tion, the fundus was examined using an ultra-widefield laser scanning ophthalmoscope. A retinal tear was detected in the fundus periphery. Results. After the comprehensive optometric examination, the patient was informed about the finding of a peripheral retinal tear and its consequences and referred to an eye clinic. At the eye clinic, the diagnosis was confirmed. Treatment consisted of preventive laser retinopexy to reduce the risk of subsequent tear extension and retinal detachment. Conclusion. The retinal tear presented in this case report was detected as an incidental finding. The patient was referred to an eye clinic for specialist diagnosis and preventive treat- ment. The case shows that a comprehensive optometric eye examination not only enables the management of relevant refractive errors, but can also make a contribution in terms of preventive health care. Optometric involvement in eye care has the potential to lead to earlier diagnosis, allowing treatment strategies to be implemented at an earlier stage. Together, earlier diagnosis and earlier intervention can lead to better long-term health outcomes. Keywords Fundus examination, fundus periphery, retinal tear, retinal detachment, retinopexy

Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears.

Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. Cohort study; Level of evidence, 3. A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; P = .036) were associated with an increased risk of a rotator cuff retear. Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.

Clinical and MRI Outcomes of Repaired Peripheral Longitudinal Tears of the Posterior Horn of the Medial Meniscus With ACL Reconstruction: Results According to Tear Size.

Arthroscopic repair of longitudinal tears in the medial meniscal posterior horn (MMPH) has been reported to result in high rates of meniscal healing when performed alongside anterior cruciate ligament reconstruction (ACLR). However, studies that have focused on longitudinal tears and their impact on clinical outcomes after arthroscopic repair are insufficient. To investigate the clinical outcome and healing status after concomitant arthroscopic ACLR and repair of MMPH peripheral longitudinal tears, with respect to the tear length. Cohort study; Level of evidence, 3. A total of 263 patients who underwent concurrent arthroscopic suture repair of longitudinal tears of the MMPH and ACLR were enrolled. All patients had 2-year postoperative magnetic resonance imaging (MRI) evaluations, and 61% of patients underwent a second-look arthroscopy. The exclusion criteria were partial meniscectomies and multiligament injuries. Patients were assessed pre- and postoperatively for clinical scores, amount of anterior translation, grade of pivot shift, and presence of meniscal tear extension. According to the length of longitudinal tears, patients were classified into 2 groups: (1) patients with tears that were located in the posterior compartment and (2) patients with tears that extended to the midbody of the meniscus. Binary stepwise logistic regression analysis was used to evaluate the risk factors for unhealed menisci as identified by MRI. A total of 83 patients were included in this study-52 patients (group 1) had MMPH tears without tear extension and 31 patients (group 2) had MMPH tears with tear extension. There were no differences in outcomes between the groups, including the healing rate after meniscal repair (P > .05). Based on postoperative MRI scans, 67 patients (80.7%) were categorized as completely healed and 16 patients (19.3%) as unhealed. There were no significant differences between the completely healed and unhealed groups in outcomes or the rate of preoperative midbody tear extension. Higher body mass index and lower preoperative Lysholm scores were identified as risk factors for unhealed menisci. Overall, the rate of complete healing of MMPH tears repaired concomitantly with ACLR was 80.7% (67/83), and midbody tear extension did not affect the healing rate of the repaired meniscus. Results indicate that suture repair for unstable MMPH tears should be considered regardless of tear size.

Effect of shape and size of supraspinatus tears on rotator cuff strain distribution: an invitro study.

The impact of the size and shape of a supraspinatus tear on the strain of the intact rotator cuff and the kinematics of the shoulder is still unknown. This, however, can be relevant when deciding whether surgical reconstruction is required to prevent an increase in a tendon defect. In this study, the effect of tear width and shape on rotator cuff strain and glenohumeral kinematics was evaluated during active abduction. Twelve fresh-frozen cadaveric shoulders with intact rotator cuffs were used in this study. We created 50% and 100% wide (full-thickness) crescent-shaped (CS) tears (n=6) and reverse L-shaped (rLS) tears (n=6) in the supraspinatus tendon and measured strain and kinematics during active humeral elevation until 30°. Both tear shapes and sizes led to an increase in internal rotation, supraspinatus loading force, and superior translation of the humerus. For the 100% wide tear size, anterior translation was observed in the CS tear group, whereas in the rLS tear group, this translation occurred mainly in the posterior direction. Strain was higher in the infraspinatus during the first 25° of abduction in comparison with the supraspinatus tendon in both tear shape groups. An analysis of the anterior and posterior tear borders showed a higher strain concentration on the same side of the tear in the CS tear group with 50% and 100% wide tears. The influence of different tear shapes on translation in the anterior-posterior direction was evident as both CS and rLS tears led to an oppositely directed translation of the humeral head. The strain analysis showed a stress-shielding effect of the infraspinatus at the beginning of abduction. Therefore, special attention must be paid to correctly identify the tear extension and adequately reconstruct the rotator cuff footprint. Moreover, the constant location of maximum strain in the CS tear group may lead to an earlier progression than in the rLS tear group.

Magnetic resonance arthrographic demonstration of extension of labral defects in paraglenoid labral cysts.

This study aimed to investigate the extension of labral tears associated with paraglenoid labral cysts by magnetic resonance arthrography. The magnetic resonance and magnetic resonance arthrography images of patients with paraglenoid labral cysts who presented to our clinic between 2016 and 2018 were examined. In patients with paraglenoid labral cysts, the location of the cysts, the relation between the cyst and the labrum, the location and extent of glenoid labrum damage, and whether there was contrast medium passage into the cysts were investigated. The accuracy of magnetic resonance arthrographic information was evaluated in patients undergoing arthroscopy. In this prospective study, a paraglenoid labral cyst was detected in 20 patients. In 16 patients, there was a defect in the labrum adjacent to the cyst. Seven of these cysts were adjacent to the posterior superior labrum. In 13 patients, there were contrast solution leak into the cyst. For the remaining seven patients, no contrast-medium passage was observed in the cyst. Three patients had sublabral recess anomalies. Two patients had rotator cuff muscle denervation atrophy accompanying the cysts. The cysts of these patients were larger compared to those of the other patients. Paraglenoid labral cysts are frequently associated with the rupture of the adjacent labrum. In these patients, symptoms are generally accompanied by secondary labral pathologies. Magnetic resonance arthrography can be successfully used not only to demonstrate the association of the cyst with the joint capsule and labrum, but also to reliably demonstrate the presence and extension of labral defects.

Surgical Reconstruction of Perineal Laceration in a Crossbred Jersey Cow

A 6-year-old Jersey × Holstein Friesian cow was presented with history of vulval tear due to improper handling of dystocia by the owner. The foetal membranes were hanging from the vaginal canal through vulval tear. Clinical examination revealed all physiological parameters were within the normal range. Obstetrical examination revealed extensive tear from the caudal vagina up to vulva and the fetal membranes were hanging from both vulval passage and through tear in the vulva. The reconstructive surgery was performed under epidural anaesthesia. Post-operatively the animal was treated with Inj. Calcium borogluconate 450 ml i.v. besides Inj. Ceftriaxone at 20mg/kg i.v., Inj. Flunixin meglumine at 2.2mg/kg i.m., and Inj. Chlorpheniramine maleate at 0.5mg/kg i.m. for three days. The skin sutures were removed on 10th post operative day. The animal recovered uneventfully.

The Maternal factors and short term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital , Lusaka, Zambia

Background: An episiotomy is a surgically planned incision on the posterior vaginal wall and perineum performed during the second stage of labour to facilitate the delivery of the neonate. The practice has been used for many decades in the belief that it offers benefit to the mother and the neonate. With the objective of protecting the pelvic floor and preventing fetal trauma, during the birth, its routine use was widely accepted in the past, principally in woman in her first delivery. However, it is not free from complications which include iatrogenic injury to the anal canal, perineal pain and excess bleeding. This study was therefore conducted to explore the short term maternal outcomes and factors associated with episiotomy.&#x0D; &#x0D; Methodology: An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls. A semi-structured interviewer administered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) were without episiotomies.&#x0D; &#x0D; Results: A total of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p&lt;0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) delivered by a medical officer. Multivariate regression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p&lt;0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3). The mean blood loss among those who has had no episiotomy was 230mls compared to 270mls among those who had an episiotomy. However, post-delivery blood loss was found to be a poor predictor of an episiotomy (OR=0.998; 95%CI 0.991-1.006; p=0.670).&#x0D; &#x0D; Conclusion: Maternal factors associated with episiotomy included age, parity, method of induction, and the personnel conducting the delivery Short term maternal outcomes of episiotomy were perineal tear extension, excess blood loss and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

The Maternal factors and short term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital , Lusaka, Zambia

Background: An episiotomy is a surgically planned incision on the posterior vaginal wall and perineum performed during the second stage of labour to facilitate the delivery of the neonate. The practice has been used for many decades in the belief that it offers benefit to the mother and the neonate. With the objective of protecting the pelvic floor and preventing fetal trauma, during the birth, its routine use was widely accepted in the past, principally in woman in her first delivery. However, it is not free from complications which include iatrogenic injury to the anal canal, perineal pain and excess bleeding. This study was therefore conducted to explore the short term maternal outcomes and factors associated with episiotomy.&#x0D; Methodology: An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls. A semi-structured interviewer administered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) were without episiotomies.&#x0D; Results: A total of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p&lt;0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) delivered by a medical officer. Multivariate regression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p&lt;0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3). The mean blood loss among those who has had no episiotomy was 230mls compared to 270mls among those who had an episiotomy. However, post-delivery blood loss was found to be a poor predictor of an episiotomy (OR=0.998; 95%CI 0.991-1.006; p=0.670).&#x0D; Conclusion: Maternal factors associated with episiotomy included age, parity, method of induction, and the personnel conducting the delivery Short term maternal outcomes of episiotomy were perineal tear extension, excess blood loss and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

Clinical parameters obtained during tear film examination in domestic rabbits

BackgroundOne of the contributing factors to ocular surface health is a stable precorneal tear film. Considering the increasing interest in rabbits as pets and the limited literature available on domestic rabbit tearing, the aim of this study was to establish normative data for examination of the tear film in domestic rabbits.ResultsThe study included 75 client-owned domestic Holland Lop rabbits (150 eyes). The following examinations were performed in each eye: Schirmer tear test-1, tear osmometry, interferometry, tear meniscus height measurement and meibography (quantifying meibomian gland loss as a percentage). The resulting median (95% central range) values were 10.0 (5.0–17.3) mm/min for the Schirmer tear test-1, 345.0 (280.5–376.1) mOsm/L for tear osmolarity, grade 2 (1–4) of interferometry, 0.28 (0.20–0.47) mm for tear meniscus height and 0.0 (0.0–67.6) % meibomian gland loss. A significant association was found between tear osmolarity and age, with an estimated decrease of − 4.0 mOsm/L with each additional year of age (p < 0.001). The distributions of interferometry grades were significantly different between males and females (p < 0.001), with grade 1 and grade 2 being the most frequent in females and males, respectively. A weak negative correlation was also observed between interferometry grade and the percentage of meibomian gland loss (r = − 0.22, p = 0.006).ConclusionsThis is an original study that documents extensive tear film parameters in healthy Holland Lop rabbits. The results can be used as normative data for the examination of the tear film in this lagomorph breed.

Characterization of fracture toughness and damage zone of double network hydrogels

Double-network (DN) hydrogels have received extensive attention owing to their excellent mechanical properties such as high fracture toughness. It is widely accepted that the toughening mechanism of DN gels is based on the mutual interaction of two contrasting interpenetrating networks. However, the quantitative interpretation of this toughening mechanism during fracture is still lacking; there are also some contradictions regarding the fracture toughness. In this study, we developed a quantitative framework to decompose the fracture toughness and feature size of the crack-tip field. Through extensive tearing tests with varying free widths of the tearing specimens, we propose an exponential function to describe the relationship between the apparent fracture energy and free width. Using the proposed function, the fracture energy and feature size of the dissipation zone were decomposed into their different components, and their quantitative values were obtained. Tearing tests were also conducted on prestretched DN gels, which showed that the intrinsic fracture energy is related to the historical deformation. Finally, we established an intrinsic fracture model with a clear physical meaning by considering the complex interactions between the two interpenetrating networks of DN gels. The model revealed the physical mechanism behind the dependence of the intrinsic fracture energy of DN gels on the historical loading. The contributions of the two interpenetrating networks of DN gels to the intrinsic fracture energy were quantitatively decomposed by the model, and the feature size of the intrinsic field was also obtained. The study reveals the physical inconsistencies in some opinions about DN gel fracture and resolves some paradoxes on the toughness of DN gels.

Anatomical and functional outcomes of retinal detachment associated with nontraumatic giant retinal tears compared to simple rhegmatogenous retinal detachment

BackgroundTo compare the functional and anatomical outcomes of primary surgery in patients with giant retinal tear (GRT)-associated retinal detachment (GRT-RD) to patients with simple rhegmatogenous RD (RRD).MethodsThis is a retrospective study at the CHU de Québec - Université Laval. Medical records of all consecutive patients operated for RD between 2014 and 2018 were reviewed. Patients with GRT-RD and RRD were included. Preoperative, intraoperative, and postoperative data were compared between both groups, including extension of giant tears, number of RD quadrants, preoperative macula and lens status, type of surgery, best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) preoperatively and at follow-up, and single surgery anatomical success (SASS).ResultsThere were 39 patients (1.7%) with GRT-RD and 1661 patients (74%) with RRD. Median [Q1, Q3] ages were 59 [52, 62] years and 62 [56, 69] years (p = 0.003), while number of affected quadrants were 2 [2, 3] and 2 [2, 3] (p = 0.96) in GRT-RD and RRD patients, respectively. In GRT-RD patients, GRT size was 120 [90, 150] degrees. Final BCVA was 0.30 [0.10, 0.30] and 0.30 [0.10, 0.40] (p = 0.76) in GRT and RRD patients, respectively. SSAS was 82% (32/39) in the GRT-associated-RD group and 90% (1495/1661) in the RRD group (p = 0.10). After correcting for other preoperative factors, GRT was a risk factor for worse SSAS (odds ratio: 0.422, p = 0.047).ConclusionsGRT-RD is still challenging to treat, and our results suggest that it is a risk factor for poorer SSAS.

Renal cyst mimicking hydronephrosis after uterine artery ligation for postpartum haemorrhage.

The proximity of the uterus and the cervix to the urinary tract predisposes the latter to injury during obstetrical and gynaecological surgical procedures. Following a difficult surgical procedure on the lower uterine segment and or adnexa, urinary tract injury should be excluded. A booked 39-year-old G3P2 lady who suffered an ischaemic stroke in the index pregnancy had a caesarean delivery at 39 weeks of gestation and sustained an extensive tear that extended inferiorly on the left lateral aspect of the uterus and this resulted in postpartum haemorrhage. Following the repair of the tear, uterine artery ligation was performed to achieve haemostasis. Postoperatively, conventional ultrasonography which was performed to exclude ureteric injury suggested left hydronephrosis and a preliminary report of computerized tomography (CT) showed the same finding. The patient subsequently had left ureteric stenting. The final report of the CT scan was delayed but showed a simple left renal cyst and no hydronephrosis. Renal cyst is a differential diagnosis of hydronephrosis. Delayed availability of the final result of medical investigations jeopardises patients' safety. A preliminary imaging report is prone to error and its use to determine the indication for an invasive procedure should be limited to emergencies.

Arthroscopic Repair of a “Floating” Posterior Inferior Glenohumeral Ligament

Background: Combined posterior glenoid labrum lesions with posterior humeral avulsion of the glenohumeral ligament, also known as the “floating” posterior inferior glenohumeral ligament (PIGL), occur infrequently. These combined lesions are frequently missed on magnetic resonance imaging in the workup of posterior shoulder instability. Correct identification of the “floating” PIGL lesion allows for appropriate preoperative planning and treatment to decrease the risk of recurrent posterior shoulder instability. Indications: A “floating” PIGL lesion is a cause of posterior shoulder instability and demonstrates increased translation when compared with isolated labral lesions. Surgical repair of an acute “floating” PIGL lesion with concomitant superior labral tear is described. Technique Description: The patient is placed in the lateral decubitus position. Standard posterior and anterior portals are created. In this case, a superior labral tear with anterior labral tear extension was also identified and repaired. The posterior labrum was repaired prior to the posterior humeral avulsion of the glenohumeral ligament (HAGL). The torn posterior labrum is mobilized and glenoid bony bed prepared. Short, 2.9-mm biocomposite knotless suture anchors loaded with suture tape are used for labral fixation. A 70° arthroscope is used to visualize the posterior HAGL from the anterior cannula and an additional posterior inferior portal established. The footprint of PIGL on the humerus is identified, debrided, and two 3.0-mm anchors loaded with suture placed. The sutures are passed through the capsule and PIGL and tied in a mattress pattern external to the capsule and ligament. The posterior portals are closed with nonabsorbable suture. Results: While few outcomes are described in the literature for the “floating” PIGL, the literature suggests good outcomes following surgical repair. Conclusion: The “floating” PIGL lesion is a rare cause of posterior shoulder instability. It is important to perform a thorough evaluation for concomitant pathology in patients with posterior shoulder instability as multiple structures can be injured. Arthroscopic repair of the posterior labrum and posterior humeral avulsion of the glenohumeral ligament can be performed to restore posterior stability to the shoulder in the setting of a “floating” PIGL.

Star CanVac-continuous curvilinear capsulorhexis - A novel, safe rhexis technique in intumescent total cataracts.

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26-G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25-G flat-tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.