Migration Of Fragments Research Articles

A Rare Case of Sequestered Intervertebral Disc Mimicking a Tumour

Although intervertebral disc herniation is commonly seen in clinical practice, spinal canal migration of disc fragments is rarely found and can cause a diagnosis dilemma. Intervertebral disc herniation is defined as displacement of disc material beyond its anatomical space. The lumbar spine is the most commonly affected; mostly L4/L5 and L5/S1 region. Disc sequestration refers to the migration of herniated disc fragments into the epidural space, or in rare cases intradural space. Hereby we present a case of sequestered intradural disc at the level of L3/L4 level mimicking a spinal tumour. A 46-year-old man presented with complaints of dull-aching bilateral lower limb pain for the past five years. Then, for the past three months, he experienced numbness over bilateral feet. For the past one month, there is weakness of bilateral lower limbs and he was unable to stand and walk. There is no erectile dysfunction, urinary and faecal incontinence. There was no history of trauma. Examination revealed sensory and motor deficits over bilateral lower limbs from level L3 onwards. There is no spine tenderness. Bilateral straight leg test were negative. MRI spine reported as L3/L4 intradural spinal lesion that demonstrates T1W iso-intensity, predominantly low signal intensity on T2W with minimal area of hyperintensity within. Lesion measured 1.3 x 1.4 x 2.5cm. Laminectomy was done and intra-operatively it was noted sequestered disc material protruding into dura from L2/L3 up to L4/L5. Post-operative period was uneventful and patient regained full muscle power by post-operative day-3. MRI is the gold standard diagnostic tool for spinal pathologies, nevertheless migrated disc fragments can be mistaken for spinal tumour. Hence, it important to keep intervertebral disc prolapse as a differential. In view of the excellent prognosis in these cases, it is not advisable to delay surgery with additional invasive investigation

Uma pesquisa sobre o mercado de áreas agrícolas na Turquia

ABSTRACT: The main structural problems related to agricultural enterprises in Turkey are the small scale of the enterprises, the fragmented and multi-shareholding of the enterprise land. However, insufficiencies in infrastructure investments that provide direct access to the parcel and irrigation canal, the increase in the misuse of agricultural lands, constantly shrinking and fragmented lands, migration and land abandonments threaten land management and food security. To solve these problems and create a sustainable land market, Soil Conservation and Land Use Law numbered 5403 was issued in 2005, is of great importance. In this study, the socio-economic characteristics of the farmers who made agricultural land purchases and sales (230 farmers) in September, October and November of 2019 in Konya province and the structural developments after the new land law were examined, and the factors affecting their perspectives on the policies applied on land markets were determined by “Multinominal Logistic Regression” analysis. As a result of the analysis, it was determined that as the age of the farmers selling land increased, their views on the new land law were negatively affected, and the increase in the number of shares of the sellers who had more than one share positively affected their views on the new land law.

Effectiveness of high-intensity laser light for treating large kidney stones

Introduction. This work analyzes efficacy, convenience, and safety of a high-energy laser light technique for destructing large kidney stones in patients with nephrolithiasis in comparison to other contact methods of nephrolithotripsy.Material and methods. The effectiveness of contact laser nephrolithotripsy is compared to that of hydropneumatic and ultrasonic lithotripsy. Holmium green laser light was used in this laser procedure. For other techniques, Swiss LithoClast Master devices were used. The authors have analyzed outcomes obtained after operating on 73 patients with large and complex kidney stones.Results. To evaluate the effectiveness, basic parameters were taken (degree of kidney cleaning of stones and their fragments, probability of migration of stone fragments, blood loss, duration of surgery, complications, etc.). In addition, the correlation between basic parameters was obtained and analyzed.Conclusion. The present trial has shown that laser contact lithotripsy is the most optimal technique for destructing large and complex kidney stones in comparison to traditional modalities such as contact hydropneumatic and ultrasonic lithotripsy. It takes more time but provides more effective cleaning from calculi.

GRB variabilities and following gravitational waves induced by gravitational instability in NDAFs

ABSTRACT The present work proposes a new formalism for the inner regions of a neutrino-dominated accretion flows (NDAFs) by considering the self-gravity, where the neutrino opacity is high enough to make neutrinos trapped becoming a dominant factor in the transportation of energy and angular momentum over the magneto rotational instability. We investigate the possibility of gravitational instability and fragmentation to model the highly variable structure of the prompt emission in gamma-ray bursts (GRBs). The results lead us to introduce the gravitational instability, in these inner regions, as a source of a new viscosity that is of the same functional form as that of the β-prescription of viscosity. Such a consideration brings about fragmentation in the unstable inner disc. In addition, we find the consequent clumpy structure of this area capable to account for the temporal variability of GRB’s light curve, especially for the lower choices of the parameter β, ∼10−5. Finally, we predict the formation of gravitational waves through the migration of fragments before being tidally disrupted. These waves appear to be detectable via a range of current and future detectors from LIGO to Cosmic Explorer.

Suture Tape Augmentation of Screw Fixation Reduces Fragment Migration in Tibial Tubercle Osteotomy: A Biomechanical Study.

Background:Tibial tubercle osteotomy (TTO) is a complex surgical procedure with a significant risk of complications, which include nonunion and tibial fracture.Purpose:To determine whether an additional suture tape augmentation can provide better biomechanical stability compared with standard screw fixation.Study Design:Controlled laboratory study.Methods:Five matched pairs of human cadaveric knees were divided into 2 groups: the first group underwent standard TTO fixation with 2 parallel screws (standard group). The second group underwent a novel fixation technique, in which a nonabsorbable suture tape (FiberTape) in a figure-of-8 construct was added to the standard screw fixation for extra stabilization in the inferior-superior direction (augmented group). The specimens were biomechanically tested using a multistep cyclic loading protocol from 400 N up to 800 N to simulate the rehabilitation process. Tubercular fragment migration of >50% of the initial distalization length was defined as clinical failure. A pull-to-failure test was applied to the specimens that survived cyclic loading. Tubercular fragment displacement during cyclic loading and pull-to-failure force were recorded and compared between the 2 groups.Results:Two specimens of the standard group exhibited clinical failure during cyclic loading to 400 N. All other specimens survived cyclic loading to 800 N. The augmented group showed less cyclic tubercular fragment displacement after every load level compared with the standard group, with statistically significant differences starting from 500 N (P < .05; power > 0.8). Mean ± standard deviation tubercular fragment displacement at the end of cyclic loading was 2.56 ± 0.82 mm for the augmented group and 5.21 ± 0.51 mm for the standard group. Mean ultimate failure load after the pull-to-failure test was 2475 ± 554 N for the augmented group and 1475 ± 280 N for the standard group.Conclusion:The specimens that underwent suture tape augmentation showed less tubercular fragment displacement during cyclic loading and higher ultimate failure forces compared with those that underwent standard screw fixation.Clinical Relevance:The augmentation technique could potentially increase the success of a TTO.

Onyx™ Cast Fragmentation After Embolization of Endoleaks

Purpose: Endoleaks are common following endovascular aneurysm repair (EVAR), and the liquid embolic material Onyx has been widely used in their treatment. We report our experience of long-term morphological changes of Onyx casts on surveillance imaging. Materials and Methods: We identified 10 patients over 10 years who underwent Onyx embolization in our institution. Morphological changes of Onyx casts were assessed on surveillance radiographs and computed tomography (CT) scans. Relevant outcome data and sequelae were obtained via electronic patient records. Results: Twelve procedures were performed on 10 cases, 9 for type 2, and 1 for a type 1a endoleak. Five cases showed evidence of Onyx fragmentation on follow-up imaging ranging from a single fracture to gross fragmentation with migration of fragments. Of these 5, 3 had achieved primary success but 2 went on to develop recurrence of endoleak. Onyx volume ranged from 4 to 46.5 ml (median 10.5 ml) per patient with larger volumes demonstrating the most marked fragmentation on follow-up. Follow-up ranged from 9 months to 8 years (median 2.25 years). Conclusion: To our knowledge, this is the first report of Onyx fragmentation after endoleak embolization. If long-term morphological stability of the Onyx cast is necessary to maintain aneurysm seal, then Onyx may not offer a permanent solution to some patients with post-EVAR endoleaks. Our study cannot ascertain whether the observed changes were the cause or the effect of ongoing aneurysm growth, persistent endoleak, and/or other forces acting on the solidified polymer, but it raises important questions on the use of Onyx in this setting.

Subcriticality control elements in a reactor system with an extended plasma source of neutrons with regard for temperature

Materials have been selected for the shim rods and burnable absorbers to compensate for the excessive reactivity of the facility’s blanket part and to provide for the possibility of reactivity control in conjunction with a plasma source of neutrons. Burnable absorber is a layer of zirconium diboride (ZrB2) with a thickness of 100 μm applied to the surface of fuel compacts. Boron carbide (B4C) rods installed in the helium flow channels and used to bring the entire system into a state with keff = 0.95 have been selected as the shim rod material. Throughout its operating cycle, the facility is subcritical and is controlled using the neutron flux from the plasma source. Verified codes, WIMS-D5B (ENDF/B-VII.0) and MCU5TPU (MCUDВ50), as well as a modern system of constants were used for the calculations. The facility’s neutronic performance was simulated with regard for the changes in the inner structure and temperature of the microencapsulated fuel and fuel compact materials caused by long-term irradiation and by the migration of fission fragments and gaseous chemical compounds.

Polytetrafluoroethylene coating fragments during neuroendovascular therapy: An analysis of two damaged microguidewires.

Cerebral polymer coating embolism from intravascular devices represents a potentially serious complication to endovascular therapy (EVT). We report two cases of neuroendovascular treatment where filamentous polymer fragments were noted possibly due to damage of the surface coating during manipulation and backloading of microguidewires. As the exact origin of the debris was initially not known, microguidewires and fragments were examined with light microscopy, stereomicroscopy, scanning electron microscopy and attenuated-total-reflection Fourier transform infrared spectroscopy. Fragments consisted of polytetrafluoroethylene and silicone oil stemming from the proximal shaft of a standard microguidewire. To our knowledge, this is the first report of polytetrafluoroethylene coating fragments created during EVT. Future studies should assess the mechanism of polymer coating delamination and its potential consequences during EVT including inadvertent fragment migration into the cerebral circulation.

An Insight into the Growing Concerns of Styrene Monomer and Poly(Styrene) Fragment Migration into Food and Drink Simulants from Poly(Styrene) Packaging.

Poly(styrene) (PS) has been heavily utilised in disposable food packaging due to its insulating properties, optical translucency, and long-shelf life. Despite these desirable characteristics, (PS) poses toxicity concerns to human’s health through styrene monomer leaching into foodstuffs. Environmental and marine hazards are another growing concerns due to improper and/or absence of recycling strategies and facilities. This preliminary work aims to investigate the effect of temperature, food composition and contact times on the migration of the styrene monomer from poly(styrene) food contact materials into food simulants. Poly(styrene) cups showed a relatively low level of styrene migration with the highest being 0.110 µg/mL, whereas food containers showed a much higher level of styrene leaching with up to 6 µg/mL. This could be due to an increase in the hydrophobicity of the simulants’ characteristics from low to high fat content and the increase in the testing temperatures from 5 °C to 70 °C. ANOVA statistical analysis is used to compare the means of three or more groups of data, whereas t-test analysis is used to compare means of two groups. This was carried out on each individual sample to determine the significance of changing the temperature, simulant type, or both on the level of migration observed in the results. All significant values were tested at 95% confidence level p < 0.05, concluding that fat content and high temperatures were found to significantly increase the level of styrene migration. Nile Red staining method was used to demonstrate that particulate poly(styrene), as well as styrene monomer, migrated into tested food simulants from typical containers, which is becoming a cause for concern as evidence of microplastic ingestion increases.

Retained Localization Wire Fragments in the Breast: Long-term Follow-up

ObjectiveHistorically, wire localization was the most widely utilized procedure for preoperative breast lesion localization. Occasionally a portion of the wire is retained in the breast. When recognized intraoperatively, the fragment can be removed immediately, but some cases are identified during post-surgical mammographic follow-up. There is little research detailing long-term stability of retained wire fragments, associated complications, or management options for cases requiring removal. We aimed to determine how often retained wire fragments remained stable, the frequency with which intervention was required, and methods available for fragment removal. MethodsFollowing IRB approval, we conducted a retrospective review of patients with a retained wire localization fragment identified by EMR search seen at our institution between January 1990 and July 2019.Mammograms, localization images, specimen radiographs, and relevant clinical notes were reviewed. Information collected included breast tissue density, patient age, associated pathology, length of time the fragment was retained, presence and/or absence of fragment migration or other complications, and management of removed fragments. ResultsEighteen eligible patients were identified with 19 retained wire fragments. Fragments ranged in length from 1 mm -33 mm. Twelve wire fragments had mammograms available to evaluate stability. All twelve fragments were stable mammographically for an average of 96.9 months. Seven wire fragments had no follow-up mammograms available. Eight wire fragments were surgically excised. None were excised due to migration. ConclusionLocalization wire fragments retained in the breast are at low risk for clinically significant migration and can be safely followed mammographically rather than undergoing immediate surgical excision or imaging-guided percutaneous removal.

Intra-Pelvic Penetration of Broken Guide Wire during Fixation of Hip Fracture: Presentation of a Case and Review of Literature

Background: The application of a cannulated device is a widely used fixation method for hip fractures. Although the breakage of the guide wire during this procedure is an uncommon complication, migration of the broken fragment might be catastrophic. Case Report: We presented a case of intertrochanteric fracture with breakage of the lag screw guide wire in the acetabulum during fixation with cephalomedullary nail. The broken fragment was located with computed tomography (CT) scan and removed through Stoppa approach. Conclusion: We found the Stoppa approach a safe and useful method for extracting the intra-pelvic broken guide wire.

A Case of Cholangitis and Cholecystitis Caused by Esophageal Stent Fracture and Subsequent Migration of the Distal Fragment to the Duodenum in an Elderly Advanced Gastric Cancer Patient with Cardiac Stenosis

A Case of Cholangitis and Cholecystitis Caused by Esophageal Stent Fracture and Subsequent Migration of the Distal Fragment to the Duodenum in an Elderly Advanced Gastric Cancer Patient with Cardiac Stenosis

Internal Carotid Pseudo-Aneurysm Caused by Migration of a Coronary Guidewire Fragment: The Case of a Broken Arrow

Internal Carotid Pseudo-Aneurysm Caused by Migration of a Coronary Guidewire Fragment: The Case of a Broken Arrow

The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures.

Nonsteroidal anti-inflammatory drugs can delay bone healing. This knowledge is mainly derived from retrospective and animal studies. The authors therefore conducted a human study to investigate whether ibuprofen affects radiological, functional, densitometrical, and biochemical outcomes following a Colles' fracture, as well as the analgesic effect of ibuprofen. This was a single-center, triple-blinded, randomized, placebo-controlled clinical trial with a total of 96 patients. All of the patients received basic treatment with 1000 mg of acetaminophen 4 times daily. The placebo group received a placebo for 7 days. The 3-day ibuprofen group received 600 mg of ibuprofen 3 times daily for the first 3 days and a placebo for the following 4 days. The 7-day ibuprofen group received ibuprofen 3 times daily for 7 days. The primary outcome was the fragment migration for a period of 5 weeks. The secondary outcomes were changes in the wrist's range of motion; Disabilities of the Arm, Shoulder and Hand score; bone mineral density of the injured wrist; changes in serum CrossLaps (Roche Diagnostics) and osteocalcin; and analgesic effects. Analyses were performed according to an intention-to-treat approach. No significant differences in radiological migration or functional, densitometrical, and biochemical effects were established among the treatment groups (.06≤P≤.9). During the first 3 days, the pain score was lower (P=.02) in the ibuprofen groups than in the placebo group. The findings of this study offer an indication for ibuprofen as a bone-safe analgesic treatment after Colles' fracture and may be translated into other fields of cancellous bone fracture treatment. [Orthopedics. 2021;44(2):105-110.].

Surgical options for traumatic fractures of the thoracic and lumbar spine

Background context. Thoracolumbar fractures represent a large number of spine injuries in adults. Such fractures are a result of traumatic accidents with high-energy impacts, such as falls from height or following motor vehicle accidents, often resulting in some degree of neurological deficit. Purpose. To report a total of 20 cases of thoracolumbar fractures in young adults with various neurological manifestations. The majority had indications for transpedicular fixation. Study Design. Series of 20 cases and review of the literature. Patient Sample. A series of 20 patients with a history of falling from a height or after motor vehicle accidents (RTA) with complicated fractures at the level of the thoracolumbar vertebrae which present with neurological deficits. Methods. We report here on a total of 20 patients with a history of falls from height or following RTA. Patients presented to the hospital complaining of back and abdominal pain. Fractures at the thoracolumbar vertebral level were confirmed with imaging studies revealing post-traumatic spinal deformities. All cases were initially considered for conservative medical treatment. However, unstable complicated cases with bone fragment migration as well as spinal canal compression were deemed candidates for surgical intervention via posterior spinal fusion with transpedicular screw fixation. Written informed consent was gathered from all patients. Detailed history, clinical examination, as well as X-ray, computed tomography and magnetic resonance imaging of the dorsolumbar spine were obtained in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. Results. The patients tolerated the operations without complications and remained in stable postoperative condition. Conclusion. Surgical treatments via transpedicular fixation are extremely efficient for treating unstable and complicated thoracolumbar spinal fractures. Nevertheless, conservative medical treatment is still of high value and should be considered as the first treatment option, especially in stable cases. The patients who underwent surgery showed excellent outcomes and improvement of neurological deficits. The surgical procedure preferred in the present study was the posterior spinal fusion with pedicle screw fixation.

Role of proximal femur locking plate in management of complex proximal femoral end fractures

Introduction: To study the role of proximal trochanteric contoured plate in management of complex proximal femur end fractures. Materials and Methods: A total of 30 cases 11 male and 19 female patients aged 19 to 90 years [Mean age 42] were included. Time duration of surgery, total amount of blood loss, hospital stay, mobilization and weight bearing, radiological assessment of union, complications and Harris Hip score were assessed at the end of 6 months. Results: Mean duration of surgery was 72.18 mins, average blood loss was 283.75ml, average hospital stay was 13.75 days. Mean time for radiological union was 16.8 wks and Harris hip score was 84.6. Abductor lurch occurred in 4 cases. Conclusion: Proximal Femoral Locking Compression Plate (PFLCP) provides stable fixation for fractures of proximal end of femur especially for lateral wall fracture because it provides stable fixation of lateral fragments and prevents lateral migration of proximal fragments. Keywords: Proximal femur fractures, Proximal femur locking plate, Harris Hip Score. MESH words: Proximal femur fracture, Internal fixation, Extramedullary devices

Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: Contemporary Outcomes of 612 Hips.

Extended trochanteric osteotomies (ETOs) provide wide femoral and acetabular exposure, give direct access to the femoral medullary canal, and facilitate implant removal and new implant placement during selected revision total hip arthroplasties (THAs). Previous studies are limited by modest patient numbers and limited length of follow-up. The goals of the current study were to assess the union rate, complications, and outcomes of contemporary ETOs performed during revision THAs. From 2003 to 2013, 612 ETOs were performed during revision THAs at 1 institution using 2 techniques: Paprosky (laterally based osteotomy; n = 367) and Wagner (anteriorly based osteotomy; n = 245). The indications for the revision procedures were aseptic loosening (65%), periprosthetic joint infection (18%), periprosthetic fracture (6%), femoral implant fracture (5%), and other (6%). The mean patient age was 69 years, and 57% of the patients were male. The mean number of previous THAs was 1.6. The median duration of follow-up was 5 years (range, 2 to 13 years). The mean Harris hip scores increased from 57 preoperatively to 77 at the latest follow-up (p < 0.001). Radiographic and clinical union was achieved in 98% of the patients at a mean of 6 months (range, 1 to 24 months). The mean migration of the proximal trochanteric osteotomy fragment prior to union was 3 mm (range, 0 to 29 mm). ETO fragment migration of >1 cm occurred in 7% (37) of the 501 hips that had radiographic analysis. Nine hips (2%) had nonunion of the ETO. Intraoperative fracture of the ETO diaphyseal fragment occurred in 22 hips (4%), postoperative fracture of the ETO diaphyseal fragment occurred in 3 hips (0.5%), and postoperative fracture of the greater trochanter occurred in 41 hips (7%). Survivorship at 10 years free of revision for aseptic femoral loosening, free of femoral or acetabular component removal or revision for any reason, and free of reoperation for any reason was 97%, 91%, and 82%, respectively. This large series of ETOs shows that the union rate is high and clinically important trochanteric migration is infrequent. The most common complications are fracture of the osteotomy fragment intraoperatively or postoperatively. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

In situ Management of Large Upper Ureteric Calculus by Mini-Percutaneous Nephrolithotomy in the Era of Retrograde Intrarenal Surgery.

PurposeThe aim of the study is to demonstrate the ease and success of in situ management of large upper ureteric stones with mini percutaneous nephrolithotomy (PCNL).MethodsThis was a prospective observational study conducted in the Department of Urology between January 2018 and June 2019. All patients underwent standard prone mini PCNL with 15Fr amplatz with 80 cases of fluoroscopic and 12 cases of ultrasound guided access. In three cases of tortuous ureters, wire was passed via retrograde catheter and retrieved via amplatz to straighten the ureter. Calculi fragmented with laser.ResultsA total of 77 patients were included in this study, 62 unilateral and 15 bilateral cases (92 renal units). The mean age was 45.4±13.7 years (range 17–71), male to female ratio was 61:16, the disease laterality (left: right) was 28:34. The mean stone size was 17.6±1.4 mm. Mean operative time was 22.4±1.5 min. 88% patients were discharged as day care. Complication rate was 6.5%, three patients had transient fever and two patients had distal migration of small fragments and they were extracted at the time of DJ stent removal by rigid ureteroscopy (100%).ConclusionWe conclude that it is easy and effective to deal with large upper ureteric calculus when it is in a fixed position. In situ management of large upper ureteric calculus by mini-PCNL can be done safely and effectively as it is a fast procedure, prevents unnecessary manoeuvres, less complication rates and has good stone clearance rates.

A case of needle embolism in a drug abuser, a diagnostic and therapeutic challenge

BackgroundNeedle embolism is a rare complication of intravenous habit. Clinical manifestations include recurrent pericarditis, tamponade, cardiac perforation, and infective endocarditis. We describe the case of needle embolization in a young intravenous opiate abuser.Case presentationWe describe a rare complication of intravenous misuse in a 23-year-old patient. He presented at the emergency department with chest pain and shortness of breath. He complained of remittent fever ensued 6 months before. Echocardiographic and radiologic images revealed pericardial effusion and a needle fragment inside the pericardium. The needle was removed through left-anterior mini-thoracotomy, after CT-guided carbon tracking.ConclusionsThe presence of a foreign body within the heart resulted from the migration of a needle fragment from a peripheral vessel. It caused fever and recurrent pericarditis. In similar cases, surgical extraction is the therapy of choice.

Осложнения перкутанной нефролитотрипсии: диагностика и лечение

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.