Risk Factors For Rupture Research Articles

Nondestructive Evaluation of Mechanical and Histological Properties of the Human Aorta With Near-Infrared Spectroscopy

IntroductionAscending aortic dilatation is a well-known risk factor for aortic rupture. Indications for aortic replacement in its dilatation concomitant to other open-heart surgery exist; however, cut-off values based solely on aortic diameter may fail to identify patients with weakened aortic tissue. We introduce near-infrared spectroscopy (NIRS) as a diagnostic tool to nondestructively evaluate the structural and compositional properties of the human ascending aorta during open-heart surgeries. During open-heart surgery, NIRS could provide information regarding tissue viability in situ and thus contribute to the decision of optimal surgical repair. Materials and methodsSamples were collected from patients with ascending aortic aneurysm (n = 23) undergoing elective aortic reconstruction surgery and from healthy subjects (n = 4). The samples were subjected to spectroscopic measurements, biomechanical testing, and histological analysis. The relationship between the near-infrared spectra and biomechanical and histological properties was investigated by adapting partial least squares regression. ResultsModerate prediction performance was achieved with biomechanical properties (r = 0.681, normalized root-mean-square error of cross-validation = 17.9%) and histological properties (r = 0.602, normalized root-mean-square error of cross-validation = 22.2%). Especially the performance with parameters describing the aorta's ultimate strength, for example, failure strain (r = 0.658), and elasticity (phase difference, r = 0.875) were promising and could, therefore, provide quantitative information on the rupture sensitivity of the aorta. For the estimation of histological properties, the results with α-smooth muscle actin (r = 0.581), elastin density (r = 0.973), mucoid extracellular matrix accumulation(r = 0.708), and media thickness (r = 0.866) were promising. ConclusionsNIRS could be a potential technique for in situ evaluation of biomechanical and histological properties of human aorta and therefore useful in patient-specific treatment planning.

Risk Factors of Flexor Tendon Rupture After ORIF of Distal Radius Fracture.

To analyze the risk factors associated with postoperative flexor tendon rupture, after a volar plate fixation of distal radius fractures. Retrospective observational case-control study. Tertiary Care University Hospital in the Republic of Korea (2009-2020). Sixteen referred patients were treated for flexor tendon rupture, following previously performed volar plating of distal radius fractures at other institutions. 16 patients were randomly selected from our database as controls, and were matched based on the Soong grade of the case group. Not applicable. Radial tilt and radial height were measured on anteroposterior radiographs. The volar tilt, tear drop angle, carpal translation, and Soong grade were measured in a lateral view. Quantitative measurements of the volar tilt, carpal translation, and tear drop angle were positively correlated with the flexor tendon rupture. The mean volar tilt and tear drop angle in the tendon rupture group were significantly smaller than those in the control group. The mean carpal translation in the tendon rupture group was significantly greater than that in the control group. This study demonstrated that volar tilt, carpal translation, and tear drop angle are significant risk factors for flexor tendon rupture, especially for plates placed at Soong grade 1 or 2. We suggest that the potential for tendon rupture because of incomplete reduction of the distal radius fracture along with implant prominence volar to the watershed line aggravates flexor tendon irritation at the distal edge of the plate because of distorted flexor tendon paths. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Why She? A Retrospective Study on Sex Inequality Related to Subarachnoid Haemorrhage

Subarachnoid haemorrhage (SAH) is the only type of stroke with female predominance. We conducted a retrospective analysis of SAH patients throughout a decade and tried to establish any reason for such remarkable sex difference. We conducted a retrospective analysis of subarachnoid haemorrhages treated in Istria County between 2010 and 2021. Some of those patients were referred to a comprehensive stroke centre and we collected those data too. We also collected data regarding the outcome recorded at follow up exams of patients treated for SAH in that period. A total of 193 patients with subarachnoid haemorrhage were found in observed period. We found a lower incidence regarding general population but with a tendency to increase, compared with data from other studies. Among all SAH, 113 were female, which makes a Risk Ratio (RR) of 1.44. The highest RR in females was in aneurysmal subarachnoid haemorrhages, 2.06. We obtained a similar high RR of 2.03 in the case of female ruptured multiple intracranial aneurysms (IA), clearly with a worse outcome. Conversely, the RR in non-aneurysmal subarachnoid haemorrhages and perimesencephalic subarachnoid haemorrhages was lower in the case of female sex and amounted 0.67. We noticed similar sex inequality as shown in other studies, so we can also state that women are at higher risk of IA rupture than men. The reason has to be multifactorial. As found in this study, women have different predilection sites of IA rupture compared with men so we strongly believe that certain hemodynamic forces may lead to aneurysm growth and rupture. As we also confirmed IA rupture is age dependent more in women than in men. As shown in other studies, oestrogen level might be the reason for that. Future studies should further establish and prove these risk factors for IA aneurysm rupture and improve preventive measures.

Abstract TP213: Aging Promotes The Rupture Of Intracranial Aneurysm In Mice

Introduction: Aging is a known risk factor for intracranial aneurysm rupture in human clinical studies. However, clinical studies only showed the association, but not the causality of aging and aneurysm rupture. Using our well-established mouse model, we directly tested the hypothesis that aging increases the rupture rate of aneurysms. Methods: We used both male and female C57BL/6J mice at 10 weeks and 18 months of age. We induced intracranial aneurysms by a combination of elastase injection and DOCA-salt hypertension. We compared the formation and rupture rates of intracranial aneurysms and the survival curve between young mice and aged mice of each sex. Results: Aged female mice had a higher rupture rate (86.7% vs 38.9%; P<0.05, Fisher’s exact test, Fig. A and B), and a higher formation rate (88.2% vs 62.1%; P<0.05, Fisher’s exact test) than young mice. Aged female mice had a lower survival rate than young mice (Fig. C). Aged male mice had both a higher rupture rate (94.1% vs 62.5%; P<0.05, Fig. D and E) and a higher formation rate (94.4% vs 64.0%; P<0.05) than young mice. There is a trend of a worse survival rate in aged male mice (Fig. F). Conclusions: Aging promotes both the formation and rupture of intracranial aneurysms in both male and female mice. These data agree with clinical observations and will serve as a basis for further investigation of the roles of the aging-related biological changes in the development of aneurysm rupture.

Abstract TP204: Elimination Of Senescent Cells Prevents The Development Of Intracranial Aneurysm Rupture In Mice

Introduction: Aging is one of the risk factors for intracranial aneurysm rupture. Aging causes various changes in cellular homeostasis, including cellular senescence. Cellular senescence is defined as a state of irreversible cellular growth arrest. Senescence cells secrete pro-inflammatory senescence-associated secretory phenotypes (SASPs). SASPs affect surrounding cells and contribute to a vicious cycle of senescence and induce inflammation. Recent studies strongly suggest that inflammation promotes aneurysm rupture. Therefore, the accumulation of senescence cells may induce aneurysm rupture due to pro-inflammatory effects of SASPs. We hypothesized that the elimination of senescence cells reduces the aneurysm rupture. To test our hypothesis we used p16-3MR mice. P16-3MR mouse is a transgenic mouse model, in which senescence cells can be eliminated by treatment of ganciclovir (GCV). In previous reports, the elimination of senescence cells by GCV in p16-3MR mice improved senescence-related diseases. In this study, we tested whether the elimination of senescence cells by GCV in p16-3MR mice reduces the intracranial aneurysm rupture rate. Methods: We induced intracranial aneurysms by combining systemic hypertension and a single injection of elastase into the cerebrospinal fluid in mice. We compared the vehicle to GCV group in p16-3MR aged male mice (10-15 months, vehicle vs GCV: 9 vs 6). We started GCV treatment the same day after aneurysm induction. Aneurysm rupture rate was used as the primary endpoint. Results: There was no statistical difference in the formation rate of aneurysms between the vehicle and the GCV group. However, the aneurysmal rupture rate was significantly lower in the senescence cell-depleted mice (P < 0.05). Additionally, the symptom-free curve (Kaplan-Meier analysis curve) showed a significant reduction of aneurysm rupture in the GCV-treated group (P < 0.05). Conclusions: The elimination of senescence cells reduced the aneurysm rupture rate in a mouse model of the aneurysm. Our results suggest that the accumulation of senescence cells induces aneurysm rupture. Therefore, the pharmacological prevention of the accumulation of senescence cells may be a new therapeutic target in aneurysm rupture.

Simple hepatic cyst predisposing to spontaneous splenic rupture

Simple hepatic cysts are mostly asymptomatic and rarely cause any complication. Liver cysts have been reported to cause portal hypertension which is a risk factor for splenic rupture. We report a case of a woman in her 70s who died from a splenic rupture. She complained of abdominal pain one day prior to death and was subsequently found collapsed on the floor the following morning. No direct impact to the chest or abdomen or other trauma was reported prior to death. Examination showed a 55 mm simple hepatic cyst located at the porta hepatis adjacent to the hepatic portal vein bifurcation.

Precocious Rupture Of Abdominal Aortic Aneurysms Below Size Criteria For Repair: Risk Factors And Outcomes

Practice guidelines recommend elective repair for abdominal aortic aneurysms (AAA) ≥5.5 cm in men and ≥5 cm in women to prevent rupture. However, some rupture at smaller diameters. We identify risk factors for precocious rupture (rAAA) below this threshold and compare outcomes following rAAA repair above/below size criteria.

Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes

Background: Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. Purpose/Hypothesis: The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. Study Design: Descriptive laboratory study. Methods: Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. Results: Mean ACL strain increased with decreasing knee flexion angle (ρ = −0.3; P = .002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, −0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = −0.01; P = .9). Conclusion: ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. Clinical Relevance: These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs.

Clinical risk factors for patients with ruptured hepatoblastoma in children: a retrospective study from a single center in China

Hepatoblastoma (HB) tumor rupture is a high-risk criterion in the International Childhood Liver Tumors Strategy Group (SIOPEL) 3/4 protocol. However, the causes and risk factors for HB rupture are still unknown, and whether tumor rupture is an independent risk factor for HB prognosis is still controversial. The purpose of this study was to retrospectively analyze the clinical characteristics of children with HB tumor rupture and to search for clinical risk factors to conduct early prediction and intervention. We conducted a retrospective study of 27 patients with HB rupture between July 2009 and July 2019. To further identify the risk factors for HB rupture, we included 97 nonruptured HB patients from January 2013 to January 2019. We searched for potentially useful characteristics for HB rupture by univariate and multivariate logistic regression analyses. There were 27 patients with HB rupture, with the median age of 31 (12, 69) months. Nineteen cases (70.37%) were spontaneous tumor rupture, 1 case (3.70%) was posttraumatic rupture, 2 cases (7.41%) were tumor rupture after the biopsy, and 5 cases (18.52%) were tumor rupture after chemotherapy. After the tumor rupture, 4 patients died of hemorrhagic shock and multiple organ dysfunction syndrome (MODS), 4 patients refused further therapy and were discharged against medical advice, and the remaining 19 patients were stable after emergency treatment. After the treatment, 14 patients survived without disease, 2 patients died, and 3 patients were lost to follow-up. The median follow-up was 48 (33, 60) months, the 3-year overall survival (OS) was 54.7%. Compared with the non-tumor rupture group by multivariate logistic regression analysis, it was found that the maximum diameter of the primary tumor > 13.4cm, and vascular invasion were independent risk factors for tumor rupture. HB rupture is rare, but it seriously threatens the life and health of children. In the acute phase of tumor rupture, surgery, rescue chemotherapy, transcatheter arterial embolization (TAE) and other supportive care can be adopted. Large tumors and vascular invasion are risk factors for HB rupture. Level IV.

Morphological evaluation of the risk of posterior communicating artery aneurysm rupture: a mirror aneurysm model.

The aim of this study was to use morphological parameters of mirror posterior communicating artery (PCoA) aneurysms to evaluate aneurysm rupture risk. The morphological parameters of 45 pairs of ruptured mirror PCoA aneurysms were analyzed. Conditional univariate and multivariate logistic regression of the following paired morphological parameters was performed: aneurysm with a daughter sac, aneurysm height, aneurysm width, neck width, internal carotid artery diameter, PCoA diameter, flow angle, PCoA angle, aspect ratio, bottleneck factor, size ratio, height/width ratio, fetal posterior cerebral artery, and aneurysm with height > width. A scoring system was established according to the odds ratios (ORs). The receiver operating characteristic was used to test the prediction accuracy of this scoring system in the authors' database of 523 PCoA aneurysms and the threshold value was used to define higher risk. Aneurysm width (OR 1.676, p = 0.014), aneurysm with daughter sac (OR 7.775, p = 0.016), and aneurysm with height > width (OR 9.067, p = 0.012) were independent risk factors for rupture. The scoring system consisted of aneurysm width (1 point per mm), aneurysm with a daughter sac (5 points), and aneurysm with height > width (5 points). The area under the curve (AUC) of the scoring system was 0.842, and its threshold value was 7.97. A score ≥ 8 points was defined as higher risk. The AUC using this definition was 0.802. Aneurysm width, aneurysms with height > width, and aneurysms with a daughter sac were independent risk factors for PCoA aneurysm rupture. The scoring system devised in this study accurately predicts rupture risk.

Risk Factors for Intracranial Aneurysm Rupture: A Clinical Case Series and Systematic Review of the Literature.

To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically reviewed the literature to identify factors that could predict the rupture of an intracranial aneurysm in patients with AcomA aneurysms or any intracranial aneurysm. We conducted a cross-sectional analysis of prospectively collected data from patients who underwent surgery for AcomA aneurysms at a single institution between January 2014 and May 2023. Predictors for the rupture of intracranial aneurysm were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Pubmed and MEDLINE databases. Younger age (odds ratio (OR): 0.957, 95% confidence interval (CI): 0.920-0.995, p=0.028), presence of a daughter sac (OR: 3.209, 95% CI: 1.095-9.408, p=0.034), and ever-smoking (OR: 0.357, 95% CI: 0.137-0.930, p=0.035) were significant predictors of increased risk of rupture in patients with AcomA aneurysms. Several aneurysm- and patient-related risk factors for rupture of intracranial aneurysms were retrieved via the literature analysis. Younger age, ever-smoking, and presence of a daughter sac increased the risk of AcomA aneurysm rupture. A systematic literature review revealed several more aneurysm- and patient-related risk factors for rupture of the intracranial aneurysms. Our results could aid neurosurgeons during their decision-making process when treating patients with unruptured intracranial aneurysms.

Posterior Uterine Wall Rupture in a Multiparous Female Presenting Post-Cesarean Deliveries: A Case Report.

Uterine rupture is a rare and one of the most dreaded complications of pregnancy. It carries potentially disastrous consequences for both the mother and the fetus. It occurs frequently during the antepartum or peripartum period. In the majority of cases, the rupture occurs at the lower anterior uterine segment. However, the rupture can rarely occur atypically at the posterior wall and away from the surgical scar. The recognized major risk factors for uterine rupture include previous cesarean deliveries, uterine surgeries, advanced maternal age, and induction of labor with prostaglandins. Our center experienced an unusual case of posterior uterine rupture in a 40-year-old gravid woman, G8P6A1, presenting four hours after cesarean delivery with non-specific clinical presentation of hypotension and paleness. Physical examination revealed no abdominal distension, pain, or tenderness. Blood per-vaginum was not remarkable. The diagnosis was initially made by ultrasonographic findings and was confirmed by exploratory laparotomy. A subtotal hysterectomy was performed. Our case represents an atypical case of uterine rupture with regard to the time of presentation and the clinical features. A high-index of suspicion is therefore necessary for prompt diagnosis and management to prevent non-desirable outcomes.

Tenocytes do not just lie in a vacuum: the role of lipids, glycemic metabolism and thyroid hormones in tendinopathy and tendon rupture. A narrative review

Purpose: Tendinopathies and tendon ruptures are a common cause of pain and disabilities. The pathogenesis is considered multifactorial, and currently described as the failed healing response. Traditionally, tendon injuries have been mostly referred to age, overuse or mechanical factors. Recently, some authors have focused their attention on the influence of metabolic diseases and hormones on tendon homeostasis, opening new perspectives. There are even more studies which show how systemic condition and pathologies are able to influence the proliferation of tenocytes, the synthesis of extracellular matrix proteins, and the organization and properties of the extra cellular matrix of the tendons. Methods: In this article, we reviewed the current knowledge about the influence of lipids, glucose and thyroid hormones on the pathogenesis of tendinopathy. Results: Beside the traditional extrinsic and mechanical risk factors, this article showed the importance of metabolism and hormones of tendon health, reinforcing the idea of their great influence on the pathogenesis of tendinopathy. Current literature indicates that hypercholesterolemia, obesity, diabetes mellitus and hypothyroidism are all risk factors for tendinopathies and tendon ruptures. Conclusions: The precise role of each predisposing factor remains incompletely understood, and further epidemiology and laboratory studies should be performed to establish the strength of the association with tendon pathologies and their pathogenetic mechanism. Keywords: inertial measurement unit; acceleration; max speed; metrics; team sports.

An abdominal aortic aneurysm rupture risk score: a pilot study for combining precise aortic measurements and clinical factors

ObjectiveCurrent screening and management for abdominal aortic aneurysms (AAAs) are based on maximal aortic diameter criteria. This study sought to compare anatomic and clinical factors between ruptured and intact AAAs to identify predictors of rupture. MethodsPatients treated for AAAs at Thomas Jefferson University Hospital from 2010 to 2021 were reviewed from intact AAAs (iAAAs), ruptured AAAs (rAAAs), and no aortic pathology (NP) groups. Preoperative computed tomography angiography (CTA) studies were retrospectively measured with Aquarius iNtuition (TeraRecon Inc). Maximal diameter, length, mural thrombus volume (MTV), and calcification volume were measured from the lowest renal artery to the femoral artery. A rupture risk score was calculated using AAA diameter (1 point), percent ≥MTV 50% (1 point), number of antihypertensive agents <2 (1 point), not on cholesterol-lowering medication (1 point), and active smoking (1 point) for a 5-point total score. ResultsCTAs from 48 patients (age, 69.5 ± 8.1 years; 87.5% male) were measured (23 iAAAs, 15 rAAAs, and 10 controls). When compared with iAAAs, the maximal AAA diameter (rAAA, 7.71 cm; iAAA, 6.02 cm; P = .005) and %MTV (rAAA, 66.1%; iAAA, 45.3%; P = .0001) were greater in patients with rAAAs. Mean AAA rupture risk score was greater in patients with rAAAs than those with iAAAs (rAAA, 3.40 ± 1.12; iAAA, 1.78 ± 1.44; P < .001) with 100% of rAAAs and 47.8% of iAAAs having a score 2 or greater. ConclusionsThis study demonstrates that AAA diameter, percent MTV, blood pressure control, and active smoking are significant risk factors for AAA rupture. Patients with multiple risk factors (risk score ≥2) were more likely to rupture and should be considered high risk.

Assessing risk factors for iatrogenic preterm prelabor rupture of membranes after fetoscopic laser ablation

Assessing risk factors for iatrogenic preterm prelabor rupture of membranes after fetoscopic laser ablation

New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section

PurposeWe performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations.MethodsThis retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a “niche” in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16–21, 22–27, and 28–33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon’s rank-sum and Mann–Whitney U test with a significance level of P < 0.05.ResultsThe lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22–27 weeks. At 22–27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22–27 and 28–33 weeks in cases with and without uterine dehiscence.ConclusionA model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.

A case of uterine rupture in second term delivery after septum resection

Introduction: The decision to resect a uterine septum remains individualized. Hysteroscopic approach is the gold standard for uterine septum resection. Uterine rupture in subsequent pregnancy is a known but rare complication without identified methods of prevention. Case Report: A 32-year-old woman underwent uncomplicated hysteroscopic uterine septum resection followed by uncomplicated term vaginal delivery, with uterine rupture and intrauterine fetal demise at 38 weeks gestational age in the subsequent pregnancy. Conclusion: Term uterine rupture is possible when the only history of uterine surgery is hysteroscopic septum resection, even with an intervening delivery. Providers should have a low threshold to initiate diagnostic evaluation with fetal or maternal distress in pregnancy after any uterine surgery. Modifiable risk factors for uterine rupture after septum resection may include residual septa, short interval between surgery and pregnancy, and labor induction methodology. Providers should consider these factors when counseling regarding the risks and benefits of resection.

Reparación percutánea del tendón de Aquiles con sutura reabsorbible: resultados y complicaciones

ObjectiveThe purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures. Material and methodsA prospective cohort study including patients treated for an achilles tendon rupture from January 2016 to March 2019 was conducted. Inclusion criteria≥18 years of age, non-insertional (2–8cm proximal to insertion) achilles tendon ruptures. Open or partial ruptures were excluded. The diagnosis was based on clinical criteria and confirmed by ultrasonography in all patients. Epidemiological data, rupture and healing risk factors, previous diagnosis of tendinopathy, pre-rupture sport activity, job information, mechanism of rupture and the time in days between lesion and surgery were collected.Patients were assessed using visual analogue scale at the 1, 3, 6 and 12-month follow-up. The achilles tendon rupture score were assessed at the 6 and 12 month follow-up. Ultrasound was performed at the 6-month follow-up. The re-rupture rate and postoperative complications were also collected. ConclusionsIn our experience, percutaneous achilles tendon repair with absorbable sutures in patients with an acute achilles tendon rupture has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, this complication would be avoided in patients treated conservatively. For this reason, conservative treatment associated with an early weightbearing rehabilitation protocol should be considered a viable option for patients with achilles tendon ruptures, mainly in cooperative young patients.

Urethral rupture concomitant with penile fracture does not adversely affect functional outcomes.

The aim of this study was to identify possible risk factors for urethral rupture and to evaluate the effect of urethral rupture repair on long-term functional outcomes and complications. The medical records of consecutive penile fracture patients were retrospectively reviewed. Penile fracture patients with and without urethral rupture were compared according to demographics, clinical and intraoperative findings. Comparisons of postoperative functional results of the groups were performed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS). Finally, among them, long-term penile complications including penile curvature, painful erection, palpable nodule, and paresthesia were assessed. Fifty-three patients participated. Patients with urethral rupture (n = 8) were older (44.50 ± 10.69, 36.58 ± 10.33 years, p = 0.052). There was no significant difference in fracture etiology (p = 0.64). Urethral bleeding was present only in patients with urethral rupture (p < 0.001). Although no bilateral corpus cavernosum rupture was encountered in penile fracture patients without urethral rupture, this rate was significantly higher in those with urethral rupture at a rate of 62.5% (p < 0.001). The time from surgical repair to sexual activity was similar in both groups (p = 0.66). There was no significant difference in IPSS and IIEF-5 scores, the presence of erectile dysfunction and complication rates (p > 0.05). Older age is a possible risk factor for a concomitant urethral rupture with penile fracture and it seems to be associated with urethral bleeding and bilateral corpus cavernosum involvement. Additionally, urethral rupture repair neither adversely affected functional outcomes nor increased penile complication rates.

STUDY OF SECOND TRIMESTER CERVICAL LENGTH AS A PREDICTOR OF PRETERM LABOUR-A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL

Introduction:- Cervical dysfunction either due to disruption of intact cervical epithelial barrier or mechanical incompetence of the cervix has been associated as one of the risk factors for preterm premature rupture of membranes and preterm birth. Our aim was to study second trimester cervical length as a predictor of preterm labour in our population. Methodology:-This hospital based prospective study was conducted in a tertiary care hospital over a period of one and a half year (2019-2021). The relationship of cervical length between the 16th and 24th week of pregnancy and preterm delivery was evaluated for the 82 women after inclusion and exclusion criteria. Data was analyzed using SPSSversion 11.0. Results:- The mean age of study patients was 29.3±2.52 years, with 52.4% (most common) being in the age group of 28-31 years. 26.8% patients had a cervical length of ≤2.5 cm while 73.2% had cervical length of &gt;2.5 cm at the time of examination. 45.1% women delivered at &lt;37 weeks of gestation while 54.9% delivered at term. Most of the patients i.e., 64.6% delivered by normal vaginal delivery and 35.4% delivering by Cesarean section. 72.7% patients with short cervical length delivered at &lt;37 weeks while only 35% of those with normal cervical lengths delivered at &lt;37 weeks. This difference was statistically signicant (p&lt;0.0002). Conclusion:- We concluded that a short cervical length of&lt; 2.5 is a risk factor for development of spontaneous preterm labour and that ≤ 2.5mm is an optimum threshold for it.