Torn Portion Research Articles

Rupture of sinus of Valsalva aneurysm in a young adult male: A case report

Rupture of the sinus of Valsalva aneurysm (SVA) is a surgical emergency. It can be fatal if not treated properly and on time. In this report, we present a 39-year-old male patient with no known disease who was admitted to the emergency department with complaints of pressure-such as chest pain, chest tightness, and an inability to breathe easily after a heavy meal at night. Thoracic and abdominal computed tomography angiography was performed to better evaluate the vascular structures; the ascending aorta diameter was 71 mm (wider than normal). Hemorrhagic fluid was observed in the pericardial space and paracardiac recesses. The preliminary diagnosis was a rupture of the right SVA, and emergency surgery was performed. The posterior aorta was found to have ruptured at the level of the right sinus of Valsalva, and anastomosis was performed on the torn portion. The patient was extubated 8 h after surgery. On the 7th post-operative day, transthoracic echocardiography was within normal limits, and he was discharged from the hospital on the 8th day in good condition with stable vital signs.

Evidence for Phospholipids on the Surface of Human Tears.

PurposeThe structure of tears has been theoretically considered three tiers with lipids at the air interface, aqueous and proteins in the subphase, and anchored mucins on the corneal epithelial surface. While many lipid and protein species have been identified in tears by mass spectrometry, the localization of the major components within the tear film structure remains speculative. The most controversial components are phospholipids. Although surface active, phospholipids have been presumed to be bound entirely to protein in the aqueous portion of tears or reside at the aqueous-lipid interface. Herein, the possibility that phospholipids are adsorbed at the air-surface interface of tears is interrogated.MethodsPolarization-modulated Fourier transform infrared reflective absorption spectroscopy (PM-IRRAS) was used to study the presence of phosphate signals at the tear surface. In order to constrain the depth of signal detection to the surface, an extreme grazing angle of incident radiation was employed. Nulling ellipsometry was used to confirm the presence of monolayers and surface thicknesses when surface active reagents were added to solutions.ResultsSurface selection of PM-IRRAS was demonstrated by suppression of water and phosphate signals in buffers with monolayers of oleic acid. Phosphate signals were shown to reflect relative concentrations. Absorption peaks attributable to phospholipids were detected by PM-IRRAS on the human tear film surface and were augmented by the addition of phospholipid.ConclusionsThe data provide strong evidence that phospholipids are present at the surface of tears.

Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear

Background: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. Methods: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. Results: Mean total degeneration scores in the NE group (13.3 ± 3.21), the FE group (12.5 ± 2.30), and in the MTJ group (10.8 ± 3.10) were significantly higher than those in the normal control group (5.0 ± 2.87; all p Conclusions: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.

Board #306 - Technology Innovation Modifications to the SimMan3G Advanced Patient Simulator for a High-fidelity Postpartum Hemorrhage Team-based Scenario (Submission #8851)

Introduction The goal of this project was to extend the SimMan3G Advanced Patient Simulator capabilities to include postpartum hemorrhaging suitable for high-fidelity obstetric team based simulation. The female genitalia supplied with SimMan3G, while useful for providing visual indicators of gender and functionality for urinary catheterization, currently lack appropriate fidelity to facilitate detailed gynecological assessment and functionality for postpartum hemorrhage. The scenario utilized a stock SimMan3G with the following additional capabilities: A “boggy” uterus, detailed vaginal anatomy w/ 4th degree labral tear (partially repaired), active and controllable hemorrhaging, retained placental pieces, while retaining urinary catheter functionality. This model was designed to be used in conjunction with a custom designed postpartum simulation scenario for a multidisciplinary team involving physicians, nurses, secretaries, and other allied health disciplines. The simulation is part of a larger curriculum that focuses on closed loop communication using the TeamSTEPPS model and process improvement. Description A SimMan3G was retrofitted with a modified Simulab episiotomy trainer. The episiotomy trainer was modified to have hemorrhaging capabilities by inserting IV tubing from the posterior aspect of the vagina and securing the open end to the base of the internal portion of the labral tear. The exterior of the episiotomy trainer was sutured to approximate the edges of the tear; however, the internal portion of the tear was left open for discovery by the resident or physician. This allowed for pooling of the blood in the posterior portion of the vagina and also allowed noticeable hemorrhaging from the vaginal introitus. Red Jello, saturated cotton balls, and fake blood moulage were used to simulated pieces of placenta and blood clots. A chest skin from an old SimMan was placed upside-down over the abdomen covering a partially inflated IV bag with IV tubing connected to a 50cc syringe to simulate a boggy uterus. Polystyrene batting was packed around the IV bag to both secure it in place and to replicate the shape and feel of a recent postpartum female abdomen. The firmness of the uterus can be adjusted by adding or removing air with the syringe. The SimMan3G was programmed using a simple temporal trend of vital signs to represent acute blood loss for the duration of the scenario. Conclusion The postpartum hemorrhage model was constructed over a period of one week and tested for required functionality. The completed model was successfully deployed and tested with the simulation scenario for a postpartum/labor and delivery multi-department in-situ training session. The model worked as intended. Initial anecdotal reviews had favorable responses. The participants did not require additional familiarization with the model. Future research will include assessing if the participants in the postpartum hemorrhage simulation scenario improved competency and ultimately if this reflects in an improvement in clinical patient outcomes. Disclosures None

Reverse Segond Fracture Variant Without Posterior Cruciate Ligament Injury

Objectives:Reverse Segond fracture, which was described as the association of an avulsion of deep capsular portion of medial collateral ligament and tears of both posterior cruciate ligament (PCL) and medial meniscus, is an extremely rare injury, unlike Segond fracture. The aim is to report successful surgical treatment of a case with “Reverse Segond Fracture” with intact PCL.Methods:The patient was a 16 years old male, who admitted to emergency department of our Level I trauma center after a pedestrian traffic accident. The main complaint was pain on left knee and shoulder. Physical examination revealed mainly limitation in range of motion (ROM) of relevant joints. Radiology revealed Reverse Segond fracture in the left knee and associated left clavicula mid-shaft fracture. Imaging with MRI and CT revealed neither PCL injury or additional ligamentous pathologies of knee. MRI only revealed medial meniscus tear.Results:In surgery, avulsed bony portion of Reverse Segond fracture was fixed to tibia with a suture anchor and a cannulated screw securely under medial meniscus. Peripheral longitudinal medial meniscus tear was fixed with a 2-0 absorbable suture. Clavicle was internally fixed meanwhile. Knee range of motion (ROM) was started early on postoperative first day, then augmented progressively. The patient was mobilized partially-weight bearing after 1.5 months and returned to his active daily life after 2.5 months. He was without any residual complaints after a final follow-up period of 26 months.Conclusion:This case report would be evaluated as a Reverse Segond Fracture variant, as no injury to PCL was noted, in contrast to its original definition in the relevant literature, which is also scarse. To the best of knowledge, this is the first report of successful surgical treatment of a case with Reverse Segond Fracture variant without PCL tear in the relevant literature.

Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain

In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer's Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.

Influência da toxina botulínica tipo A na função lacrimal de pacientes com distonias faciais

To analyze the influence of botulinum toxin on the lacrimal function of patients with facial dystonias. Patients with the diagnosis of hemifacial spasm or benign essential blepharospasm were evaluated and invited to answer the Ocular Surface Index Disease (OSID) questionnaire. All patients underwent Schirmer I and basal tests; break-up time (BUT) test and lacrimal clearance evaluation. On the following day, the patients were treated with botulinum toxin. The Ocular Surface Index Disease questionnaire and all the initial tests were reapplied 30 days after the treatment by the same examiner. Twenty-six patients were enrolled in this study, 15 (57.7%) with hemifacial spasm and 11 (42.3%) with benign essential blepharospasm. The mean age of patients with hemifacial spasm was 70.9 ± 13.3 years and the male:female ratio was 1:1.5. In the group of patients with benign essential blepharospasm, the mean age was 68.9 ± 8.4 years with a female preponderance (90.0%). After the treatment, the Ocular Surface Index Disease score, Schirmer I and basal tests score decreased in both groups. The mean of Break-up time test increased significantly in both groups. The lacrimal clearance evaluation showed a greater number of eyes that achieved a complete drainage of the tears after the treatment in both groups. The treatment with botulinum toxin improved dry eye symptoms in patients with facial dystonia. Despite of the aqueous portion of tear have decreased, blink modifications improved the tear stability and drainage.

The rat exorbital lacrimal gland as a site of synthesis of EGF-like growth factors.

The lacrimal gland produces the complex aqueous portion of tears that contains many components including electrolytes and proteins.1,2 The pH, electrolyte concentration, and protein composition of lacrimal fluids are crucial to maintain the health of the ocular surface. The proteins that lacrimal glands synthesize and secrete are very specific, but only a few of them have been characterized. These proteins are thought to be involved in the bacteriostatic action of tears. It has been shown that human3,4 and mouse5 tears contain epidermal growth factor (EGF) or an EGF-like immunoreactivity. The EGF precursor mRNA has been detected by Northern blot in moûse6 and by RT-PCR in human7 lacrimal glands. Moreover, EGF-like immunoreactivities have been detected in mouse,6 rabbit,8 and rat9,10 lacrimal tissues, but the immunoreactive proteins have not been further characterized. The EGF receptor mRNA has also been detected, by RT-PCR, in the human lacrimal gland,11 and by RT-PCR and Northern blot in the rat exorbital lacrimal gland.12 The EGF receptor protein has been identified and shown to be activated by EGF in the rat tissue.12

Intrinsic healing capacity and tearing process of torn supraspinatus tendons: in situ hybridization study of alpha 1 (I) procollagen mRNA.

To determine the healing potential and healing process of torn supraspinatus tendons, in situ hybridization was used to localize cells containing alpha 1 type-I procollagen mRNA. Biopsy specimens of torn supraspinatus tendons from 19 patients with complete-thickness tears and 13 patients with incomplete-thickness tears were obtained during surgery. Four macroscopically normal supraspinatus tendons were obtained to serve as normal controls. Specimens were fixed in 10% buffered formalin and embedded in paraffin. A 22-mer oligonucleotide probe was labeled with digoxigenin and used as an in situ marker. The labeled cells were mainly composed of tenocytes and undifferentiated mesenchymal cells. In complete-thickness-tears, the labeled cells at the proximal tendon-stumps in the specimens that were obtained less than 4 months after trauma were significantly more abundant than in the specimens obtained 4 months or more after trauma. However, the number of labeled cells was maintained at the torn portion even in long-standing incomplete-thickness tears. The labeled cells at the margins of concomitant intratendinous extensions of the tears were detected even in the long-standing tears. The intratendinous extensions exhibited more labeled cells than the bursal-side or joint-side layers of the tendon substance in the incomplete-thickness tears (p < 0.05). The torn supraspinatus tendon may possess an intrinsic healing capability in the intermediate and late phases of tendon healing. Incomplete-thickness tears and concomitant intratendinous extensions can continue to rupture after the initial injury.

Paradoxical phenomena of the McMurray test. An arthroscopic investigation.

We evaluated 200 patients who had a positive McMurray test and found atypical McMurray test results in 24 patients (12%). These patients revealed pain or clicking or both either in the medial compartment of the knee when the leg was internally rotated or in the lateral compartment of the knee when the leg was externally rotated. The authors analyzed these paradoxical findings at arthroscopic examination to identify the relationship between the type of meniscal tear and the direction of leg rotation that elicited the catching and displacement of the torn meniscal portion during the McMurray test. Contrary to conventional McMurray test findings, three different types of meniscal tears were found on the side of the knee where pain or a clicking sound occurred. The three types were 1) anteriorly based posterior oblique tears with anterior displacement of the meniscus, 2) bucket-handle tears in the posterior half of the menisci, and 3) peripheral detachment of discoid menisci in the posterior half of the torn portions.

A Note on the Presence of Supernumerary Lobes in Salivary Glands of Anopheline Mosquitoes

It is presumed that the majority of investigators who dissect anopheline mosquitoes for the purpose of detecting the parasites associated with malarial fever are not concerned with the finer details of anatomical relationships. Nor do they take the time to completely isolate the two acinus glands with the accompanying normal six lobes. This latter is assumed not essential in a search for protozoan organisms, as the sporozoites may be found in the torn portions of the acinus material as well as in the muscular tissue and mounting fluid in which the dissection is made.