Signs Of Rupture Research Articles

A case report of bioprosthetic valve dysfunction after tricuspid valve replacement in a preschool patient: the contribution of pannus and calcification

Aim. To assess the contribution of pannus and calcification to the development of bioprosthetic valve dysfunction after tricuspid valve replacement in a pediatric patient.Materials and methods. A 3-month-old patient presented with tricuspid valve dysplasia and grade 4 tricuspid insufficiency underwent tricuspid valve replacement with the bioprosthesis «PeriCor» (ZAO «NeoKor», Russian Federation). The patient at the age of 6 years required a redo tricuspid valve replacement 5 years 8 months after initial surgery. Degenerative changes of the dysfunctional bioprosthetic valve explanted from the tricuspid position were assessed using macroscopic description and light microscopy. Cellular composition, the presence of bacteria, colocalization of calcifications with recipient cells were analyzed. The distribution of calcifications and their volume in the biomaterial tissue were estimated using microcomputer tomography imaging (micro-CT).Results. Bioprosthetic valve dysfunction was mainly caused by the pannus formation which was shown to encapsulate the anterior leaflet, resulting in its total failure and severe stenosis (reduced effective orifice area). There were no signs of ruptures and perforations in the valve tissues found. All leaflets were shown to contain predominantly fibroblastic cells and single blood cells, mainly located in the surface layers of the leaflets in the regions without any signs of calcification. Bacteria staining was negative for all types of the studied biomaterials. Calcifications were present in all xeno-tissue elements of the explanted bioprosthesis (i.e. leaflets, aortic segment, and pericardium). In addition, calcifications were also found in pannus growing during a functioning bioprosthetic valve. Calcifications were predominantly located in the co-optation and commissure zones of the leaflets. Importantly, massive calcifications were observed around the bioprosthetic stent frame. The total volume of calcification accounted for 1/3 of the biological component of the bioprosthesis (729 mm3).Conclusion. According to the data obtained in this study, we may conclude that the primary cause of the bioprosthesis failure was the growth of connective tissues, resulting in pannus-related dysfunction, rather than severe calcification of all bioprosthetic components. One may assume that bioprosthetic dysfunction is related to the peculiarity of the inflammatory response of the preschool patient. However, this typeof dysfunctions requires further investigation.

Invited commentary

Invited commentary

IP139. Management Recommendations for Arterial Entrapment of an Intra-Aortic Balloon Pump Caused by Balloon Rupture and Helium-Hemoglobin Clot

Intra-aortic balloon pumps (IABPs) are lifesaving left ventricular assist devices placed in patients with heart failure to augment cardiac output and coronary perfusion. However, their use is not without complications, reported to be up to 30%. Many of these require a vascular surgeon to be familiar with the device and to repair the complications. We present the case of a 63-year-old man with severe heart failure necessitating IABP placed through the left axillary artery, necessitating removal open. The patient was brought to the operating room for routine open removal of the IABP when there was suspicion that the balloon was ruptured. The only sign of rupture was a small amount of blood in the pump tubing. The balloon and catheter could not be removed, so removal was attempted by axillary cutdown. An attempt was made to snare the balloon and to pull it into a large sheath in the iliac artery. The balloon was found to be so full of solid blood that an aortotomy had to be performed for removal. Entrapment of the IABP was due to formation of a compact, inflexible clot within the balloon after its rupture (a known complication of the mixing of the blood with helium). Ultimately, the device was removed by open retroperitoneal exposure and aortotomy. Because of the dense nature of the thrombus material within the balloon, it was necessary to perform a transection of the balloon and to remove the thrombus piecemeal using rongeurs. The balloon was able to be removed with as little trauma to the vessels as possible. The retroperitoneal exposure was used to reduce the morbidity associated with transperitoneal exposure and because the distal aorta exposure was needed. Although rupture and subsequent entrapment of IABPs is rare, reported to have an incidence of <2%, there are a handful of reports in the literature that describe open removal approaches. Most case reports describe removal by femoral arteriotomy, so the severity of this IABP rupture was rare in the need for aortotomy to remove the IABP secondary to the abundance of dense clot material within the balloon. Recommendation for removal at the first sign of rupture as well as avoidance of larger balloons than are needed will reduce the incidence of this problem. A review of the literature and subsequent recommendations for the surgical management of IABP entrapment are discussed in the context of our case.

A Study of Maternal Outcome in Uterine Rupture in Pregnancy at a Tertiary Care Institute

Aim and Objective: The present research was carried out with an objective to determine the incidence, etiology, trend, and management, maternal and fetal outcome of ruptured uterus and to identify the preventive measures. Material and Methods: A prospective observational study was conducted over a period of 2 years from Nov 2012 – Nov 2014 in a tertiary care hospital of Mumbai, India. A total of 40 patients who came with rupture of uterus in pregnancy were studied. These cases were analyzed based on clinical features, etiology and risk factors of rupture uterus, the mode of management and the foetal and maternal outcome. Results: There were 40 cases of uterine rupture out of 32,200 deliveries giving an incidence of 1 in 805 i.e. 0.12%. Most common clinical features were those of classical signs of rupture with ill defined uterine contour, superficially felt foetal parts and absent foetal heart sounds. The commonest cause of rupture was due to separation of previous cesarean scar rupture (72.5%). The lower uterine segment was the commonest site of rupture. Rent repair was the commonest procedure done in the cases of ruptured uterus. Perinatal mortality of 77.5% and maternal mortality of 10% was observed in this study. Conclusion: Skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.

Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm.

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Case series, Level IV.

Novel high-pressure windows made of glass-like carbon for x-ray analysis.

Original high-pressure glass-like carbon windows developed for x-ray spectroscopy applications are presented. The scientific and technological background of this new technical development is exposed, in particular the limitations of our existing beryllium windows in the context of x-ray absorption spectroscopy (XAS) measurements of solutions with very low solute concentrations at hydrothermal conditions (0.1-200 MPa, 30-600 °C). The benefits of glass-like carbon are exposed, notably its non-crystalline character, the absence of impurities which has been verified by micro-fluorescence laboratory measurements, and its non-toxicity which makes its machining safer. Finite elements mechanical calculations and experimental pressure tests were conducted to determine the pressure limits of windows with two different geometries: cylindrical (thickness 0.5 mm) and inversed-dome shape (thickness 0.5 mm at the tip of the dome). The former break at 150 MPa and the latter show no sign of rupture at 400 MPa. Recent XAS measurements conducted with the new dome shaped windows are presented to show the advantages of the design that allow for the detection of very low concentrations in the transmission mode (down to 30 ppm) and the acquisition of fluorescence XAS spectra in diluted solutions at high pressure. Eventually the perspectives of this original development are discussed.

Un anévrisme isolé de l’artère fémorale profonde

Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay.

The natural history and outcomes for thoracic and abdominal penetrating aortic ulcers

The objective of this report was to define the natural history of penetrating aortic ulcers (PAUs) in the descending thoracic and abdominal aorta. Data from consecutive patients with PAU from January 1, 1998 to December 31, 2012 were retrospectively reviewed. Computed tomography (CT) scans were analyzed for anatomic changes. End points analyzed were changes in size, development of symptoms or signs of rupture, morbidity, and mortality. Ninety-three patients were identified; 57 were followed up with two or more CT studies 3months apart (group 1), and 20 had immediate repair (group 2). Sixteen had one CT scan and no intervention or follow-up and were excluded from analysis. In group 1, mean age was 75years (29 men, 28 women), with 28 descending thoracic aorta and 29 abdominal aorta PAUs. Fifty patients were asymptomatic, whereas five had pain and two had emboli. Mean follow-up was 38months (range, 3-108 months). Ulcer growth rate was as follows: length, 2.0mm/y; depth, 1.2mm/y; and aortic diameter, 2.2mm/y. Thirteen (23%) went on to repair at a mean of 37months after diagnosis because of size (54%; 7/13), rapid growth (31%; 4/13), and high-risk morphology (15%; 2/13). During surveillance, 11 patients died, 10 of unrelated causes, and 1 of rupture after refusing repair. All repairs in group 1 were endovascular. The 30-day surgical mortality was 0%. One patient had an access site complication requiring bypass after descending thoracic aorta PAU repair. At a mean follow-up of 32months, all ulcers were excluded on CT; one (8%) had a type II endoleak. Group 2 included 13 men and seven women with a mean age of 70years, with 12 descending thoracic and eight abdominal aorta PAUs. Repair indications were rupture (n = 3), symptoms (n = 10), or size (n = 7) and included one open and 19 endovascular repairs with 0% 30-day mortality. Major complications (3/20; 15%) included myocardial infarction, access site disruption, and hematoma; four of 20 patients had type II endoleaks. PAU growth rate and risk of rupture are low. Endovascular repair of symptomatic, ruptured, and large PAUs is safe and effective with excellent long-term results. For asymptomatic PAUs, serial CT surveillance is associated with a low rate of rupture or complications.

Ovarian and Uterine Horn Agenesis Accompanied by Ectopic Fetal Mummifcation in Canine

Background: The uterine horn agenesis or aplasia is a rare anomaly consisting of absence or incomplete development of the paramesonephric ducts that origin the uterine horns. This change occurs during fetal formation and may occur concomitantly to agenesis of the ovary and/or ipsilateral kidney. The extra-uterine pregnancy consists of fetal growth outside the uterine cavity and can occur as a tubal or abdominal pregnancy. We report here the case of a 7-years-old mix breed dog, attended at the Veterinary Hospital of the Federal University of Mato Grosso, with accidental diagnosis of agenesis of uterine horn and ovaries and ectopic fetal mummifcation.Case: A 7-years-old mix breed dog, not spayed, was attended at the Veterinary Hospital of the Federal University of Mato Grosso (HOVET-UFMT), complaining of mucous bloody vaginal discharge. The patient had regular estrus and was multiparous. There was no mating history in the last estrus neither trauma over the past months. In previous pregnancies the patientpresented eutocic labors. On physical examination the dog showed apathy although it was alert, pale mucous membranes, presence of perivulvar blackish secretion and discreet abdominal enlargement. As preoperative exams, a complete blood count, liver and renal function (serum creatinine and alanine aminotransferase) were performed. It has also performedthe abdominal ultrasound examination, which revealed the presence of uterus flled with hypoechoic luminal content and a thickened and irregular wall. The patient was referred to therapeutic ovariohysterectomy (OHE). After anesthesia and antisepsis, the access to the abdominal cavity was made, where there was a mummifed fetus with approximately 15.5 cmfrom neck to tail set, equivalent to 57 days of gestation. After removal of the papyraceus fetus, the uterus was found and then, when exposed, there was only the left uterine horn flled by content and ovarie, both were removed. After inspection, the synthesis of the abdominal cavity was carried out as the routine. During the postoperative period, the patient had no complications or other clinical signs similar to those observed in the initial presentation. Antibiotic (enrofloxacin 5 mg/kg every 12h), analgesic (dipyrone 20 mg/kg every 8 h) and non-steroidal anti-inflammatory (meloxicam 0.2 mg/kg every 24 h) were prescribed. The fetus and uterus were sent to the Veterinary Pathology UFMT Laboratory (PVL-HOVET).The fetus was covered by omentum and fat. After the initial incision, there was a hard fbrous capsule surrounding the mummifed fetus. There were no recent signs of rupture or scarring resulting from previous trauma in the uterus. Its size was 15x4.8x2.8 cm and it was flled out with mucus bloody brownish secretion (pyometra). Microscopically, had purulent inflammatory infltrate, diffuse and severe in mucosa and submucosa associated with cell debris and moderate hyperplasia glands containing microabscesses inside.Discussion: Reports of extra-uterine fetal mummifcation in dogs and cats are scarce. Even being reported infrequently in dogs if congenital uterine and ovarian abnormalities are found during surgery, a detailed inspection of the abdominal cavity should be performed in order to rule out the possible presence of the ipsilateral ovary. Even with the lack of specifc clinical signs, fetal ectopy can be diagnosed through a detailed clinical examination and image exams. Exploratory laparotomy can be used as a diagnostic and therapeutic tool, since the treatment is the excision of ectopic tissue and OHE in cases of uterine rupture.Keywords: aplasia, fetus, mummifcation, unicornuate uterus.

Effect of ultrasound on the supercritical CO2 extraction of bioactive compounds from dedo de moça pepper (Capsicum baccatum L. var. pendulum)

Extracts with bioactive compounds were obtained from the red pepper variety “dedo de moça” (Capsicum baccatum L. var. pendulum) through supercritical fluid extraction with carbon dioxide assisted by ultrasound (SFE-US). The process was tested at pressures of 15, 20 and 25MPa; temperatures of 40, 50 and 60°C, and ultrasonic powers of 200, 400 and 600W applied during 40, 60 and 80min of extraction. The CO2 mass flow rate was fixed at 1.7569×10−4kg/s. Global yield, phenolic content, antioxidant capacity and capsaicinoid concentration were evaluated in the extracts. The application of ultrasound raised the global extraction yield of SFE up to 45%. The phenolic content of the extract increased with the application of higher ultrasound power and radiation time. The capsaicinoid yield was also enhanced with ultrasound up to 12%. However, the antioxidant capacity did not increase with the ultrasound application. The BET-based model and the broken and intact cell model fitted well to the kinetic SFE curves. The BET-based model with three adjustable parameters resulted in the best fits to the experimental data. Field emission scanning electron microscopy (FESEM) images showed that SFE disturbed the vegetable matrix, releasing particles from the inner region of the plant cells to their surface. When the ultrasound was applied this effect was more pronounced. On the other hand, cracks, fissures or any sign of rupture were not identified on the sample surface.

Autour du discours humoristique dans « Ravisseur » de Leila Marouane

Around The Humoristic Speech in "Ravisseur" by Leila Marouane&#x0D; Ravisseur is a story placed under the sign of rupture. This story, published in 1998 by Julliard, comes at a time when Algerian novel production had just run out of steam in the repetition of the themes of the black tragedy that the country had experienced. Its originality lies in the crossing of two discourses, namely tragedy and humour. Although Ravisseur is rooted in the Algerian reality, he leaves a lot of room for the imagination and denounces the tragedy of a family and a society through metaphorical, humorous and ironic writing. The humoristic discourse used makes it possible to go beyond the existential situation and make fun of a society to which the characters refuse to adhere. In this article, we will discuss one of Leila Marouane's writing strategies.

Prediction of Rupture Sites in Abdominal Aortic Aneurysms After Finite Element Analysis

Purpose: To associate regions of highest local rupture risk from finite element analysis (FEA) to subsequent rupture sites in abdominal aortic aneurysms (AAA). Methods: This retrospective multicenter study analyzed computed tomography angiography (CTA) data from 13 asymptomatic AAA patients (mean age 76 years; 8 men) experiencing rupture at a later point in time between 2005 and 2011. All patients had CTA scans before and during the rupture event. FEA was performed to calculate peak wall stress (PWS), peak wall rupture risk (PWRR), rupture risk equivalent diameters (RRED), and the intraluminal thrombus volume (ILTV). PWS and PWRR locations in the prerupture state were compared with subsequent CTA rupture findings. Visible contrast extravasation was considered a definite (n=5) rupture sign, while a periaortic hematoma was an indefinite (n=8) sign. A statistical comparison was performed between the 13-patient asymptomatic AAA group before and during rupture and a 23-patient diameter-matched asymptomatic AAA control group that underwent elective surgery. Results: The asymptomatic AAAs before rupture showed significantly higher PWRR and RRED values compared to the matched asymptomatic AAA control group (median values 0.74 vs 0.52 and 77 vs 59 mm, respectively; p<0.0001 for both). No statistical differences could be found for PWS and ILTV. Ruptured AAAs showed the highest maximum diameters, PWRR, and RRED values. In 7 of the ruptured AAAs (2 definite and 5 indefinite rupture signs), CTA rupture sites correlated with prerupture PWRR locations. Conclusion: The location of the PWRR in unruptured AAAs predicted future rupture sites in several cases. Asymptomatic AAA patients with high PWRR and RRED values have an increased rupture risk.

The Shared Dream of the Americas: An Introduction to Americanity

While the cultural identities of Latin America, Québec and the Antilles have long been forged around a single reference, namely to their European past, they currently show signs of rupture and heterogeneity. Thinkers from Québec (Sherry Simon, Pierre Nepveu, Gérard Bouchard), the Antilles (Glissant, Chamoiseau, Confiant) and Brazil (Bernd) have been revisiting the concepts of origin and space from a completely different perspective. No longer would Europe be the anchor of their totalitarian-shaped cultural identity; the roots and origins of this identity construction would have to be found elsewhere, in a new environment perhaps, embracing the modernity and diversity that are celebrated in the concepts of hybridity, transculturalism, creolization, which all slowly lead to a mythical crossroads: America.However, the establishment of a symbolic relation with the American territory remains somewhat problematic as the concept of Americanity relies on diverse discourses which can be contradictory at times. In this essay, I aim to shed light on the trendy concept that Americanity has become. On the one hand, I will point out the ambiguity that surrounds the concept, and on the other hand, I will briefly explain how the different perspectives in the reappropriation of the American space could lead to the establishment of America as a shared elsewhere.

MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications

To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications, 10 (26%) moderate complications, and 26 (69%) mild complications occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed.

Acute perioperative-stress-induced increase of atherosclerotic plaque volume and vulnerability to rupture in apolipoprotein-E-deficient mice is amenable to statin treatment and IL-6 inhibition.

ABSTRACTMyocardial infarction and stroke are frequent after surgical procedures and consume a considerable amount of benefit of surgical therapy. Perioperative stress, induced by surgery, is composed of hemodynamic and inflammatory reactions. The effects of perioperative stress on atherosclerotic plaques are ill-defined. Murine models to investigate the influence of perioperative stress on plaque stability and rupture are not available. We developed a model to investigate the influence of perioperative stress on plaque growth and stability by exposing apolipoprotein-E-deficient mice, fed a high cholesterol diet for 7 weeks, to a double hit consisting of 30 min of laparotomy combined with a substantial blood loss (approximately 20% of total blood volume; 400 µl). The innominate artery was harvested 72 h after the intervention. Control groups were sham and baseline controls. Interleukin-6 (IL-6) and serum amyloid A (SAA) plasma levels were determined. Plaque load, vascular smooth muscle cell (VSMC) and macrophage content were quantified. Plaque stability was assessed using the Stary score and frequency of signs of plaque rupture were assessed. High-dose atorvastatin (80 mg/kg body weight/day) was administered for 6 days starting 3 days prior to the double hit. A single dose of an IL-6-neutralizing antibody or the fusion protein gp130-Fc selectively targeting IL-6 trans-signaling was subcutaneously injected. IL-6 plasma levels increased, peaking at 6 h after the intervention. SAA levels peaked at 24 h (n=4, P<0.01). Plaque volume increased significantly with the double hit compared to sham (n=8, P<0.01). More plaques were scored as complex or bearing signs of rupture after the double hit compared to sham (n=5-8, P<0.05). Relative VSMC and macrophage content remained unchanged. IL-6-inhibition or atorvastatin, but not blocking of IL-6 trans-signaling, significantly decreased plaque volume and complexity (n=8, P<0.01). Using this model, researchers will be able to further investigate the pathophysiology of perioperative plaque stability, which can result in myocardial infarction, and, additionally, to test potential protective strategies.

Imaging of thoracic aortic injury

Isthmic aortic rupture or disruption should be systematically sought when there is high kinetic energy trauma to the thorax. This condition is extremely serious and life threatening. It needs to be diagnosed rapidly but diagnostic pitfalls must be avoided. CT angiography is the standard examination. The main CT signs of rupture or disruption of the thoracic aorta are periaortic hematoma, intimal flap, pseudo-aneurysm and contrast agent extravasation. There are three types of lesion: intimal, subadventitial or pseudo-aneurysmal, and complete rupture with lesion of the three tunicae, and it is important to grade them for better therapeutic management. The main diagnostic pitfalls of the CT scan are the presence of a ductus diverticulum and post-isthmic fusiform dilatation. Associated lesions must not be overlooked. The most common are ruptures of the aortic root and the thoracic aorta in the diaphragmatic hiatus.

Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms.

ObjectivesAbdominal aortic aneurysm (AAA) rupture has a high mortality rate. Although the diagnosis of a ruptured AAA is usually straightforward, detection of impending rupture signs can be more challenging. Early diagnosis of impending AAA rupture can be lifesaving. Furthermore, differentiating between impending and complete rupture has important repercussions on patient management and prognosis. The purpose of this article is to classify and illustrate the entire spectrum of AAA rupture signs and to review current treatment options for ruptured AAAs.MethodsUsing medical illustrations supplemented with computed tomography (CT), this essay showcases the various signs of impending rupture and ruptured AAAs. Endovascular aneurysm repair (EVAR) and open surgical repair are also discussed as treatment options for ruptured AAAs.ResultsCT imaging findings of ruptured AAAs can be categorised according to location: intramural, luminal, and extraluminal. Intramural signs generally indicate impending AAA rupture, whereas luminal and extraluminal signs imply complete rupture. EVAR has emerged as an alternative and possibly less morbid method to treat ruptured AAAs.ConclusionsAAA rupture occurs at the end of a continuum of growth and wall weakening. This review describes the CT imaging findings that may help identify impending rupture prior to complete rupture.Teaching Points AAA rupture occurs at the end of a continuum of growth and wall weakening. Intramural imaging findings indicate impending AAA rupture. Luminal and extraluminal imaging findings imply complete AAA rupture. Some imaging findings are not specific to AAA ruptures and can be seen in other pathologies. EVAR has emerged as an alternative and possibly less morbid method of treating ruptured AAAs.

Ruptured disc after arthroscopic repositioning in the temporomandibular joint: a retrospective magnetic resonance imaging study

Our aim was to explore the incidence of rupture after arthroscopic repositioning of the disc of the temporomandibular joint (TMJ) by reviewing magnetic resonance images (MRI) of the TMJ taken before and after operation, and to investigate correlations retrospectively. We studied 247 patients with anterior disc displacement of the TMJ, and categorised them into 3 groups based on the postoperative MRI. The first group comprised those whose disc ruptured after repositioning, the second those who had a possible rupture of the disc after repositioning, and the third had no rupture of the disc after repositioning. Age, sex, duration of symptoms, maximum incisal mouth opening, whether the anterior disc displacement was unilateral or bilateral, and the Wilkes stage, were included in the analysis. The incidence of rupture (5/247) was 2%. Weak points at the intermediate zone of the disc were found in 4 of the 5 joints. The patients whose discs ruptured were significantly younger than the other 2 groups (p=0.001). There was no statistically significant difference in preoperative duration of symptoms and mouth opening among the groups. The proportions of unilateral and bilateral disc displacement (p=0.047) and Wilkes stage (p=0.027) differed among the 3 groups. The Wilkes stages was significantly more advanced in the ruptured group than in the other 2 groups (p=0.027) with 4/5 being bilateral. The weak point in the intermediate zone of the disc on MRI could be a sign of rupture. Teenagers and young adults with anterior disc displacement without reduction, particularly those in whom it is bilateral, are at a higher risk of a rupture after repositioning of the disc by arthroscopy.

Magnetic Resonance Imaging of the Middle and Inner Ear After Intratympanic Injection of a Gadolinium-Containing Gel

To investigate the distribution and elimination of a gadolinium containing high viscosity formulation of sodium hyaluronan (HYA gel) after injection to the middle ear. The T1 contrast agent gadolinium-diethylenetriamine pentaacetic acid-bis methylamine (Gd-DTPA-BMA) was added to HYA gel and delivered to the middle ear of 13 albino guinea pigs by 3 different ways of injection. Magnetic resonance imaging was performed with a 4.7 T MRI system using a T1-weighted 3-dimentional rapid acquisition with relaxation enhancement sequence. An injection technique where the Gd-DTPA-BMA-containing HYA gel was delivered to the middle ear through a percutaneous injection through the auditory bulla after a small incision had been made in the tympanic membrane gave the best filling of the middle ear, covering the cochlea and the region of the round window niche for 24 hours in a majority of the ears studied. Ears injected without an incision in the tympanic membrane showed an immediate uptake of Gd-DTPA-BMA in the inner ear as a sign of rupture of the round window membrane. A percutaneous injection of a HYA gel into the tympanic bulla is distributed in a predictable way and gives a good filling of the middle ear cavity. The HYA gel remains in close vicinity to the RWM for more than 24 hours. Injection should be performed after an incision of the tympanic membrane has been made to prevent rupture of the round window membrane.

A rare but severe complication of filgrastim in a healthy donor: Splenic rupture

Granulocyte-colony stimulating factor (G-CSF) is widely administered to donors who provide peripheral blood stem cells (PBSCs) for individuals who undergo hematopoietic stem cell transplants. G-CSF administration is associated with a small but definite risks of serious adverse events like splenic rupture. In this case, we report a 40 year old women, a healthy donor for her sister who has aplastic anemia, who had sharp left upper abdominal pain on the forth mobilization day. The diagnosis at CT scan was splenic rupture; irregular intrasplenic low-attenuation areas consistent with ruptured spleen and perisplenic high density fluid. Her bidimensional spleen size was 16×6 cm. She was followed conservatively. One month later the CT scan signs of rupture disappeared. We must pay attention to this rare but serious adverse event during filgrastim use.