Extensive Tears Research Articles

Distinction between supraspinatus, infraspinatus and subscapularis tendon tears with ultrasound in 332 surgically confirmed cases

The aim of this retrospective study was to determine the diagnostic value of preoperative ultrasonography for the characterisation of size and location of the involved tendons. in 332 consecutive patients who underwent surgery, all preoperative ultrasonographic reports were reviewed and ultrasound (US) and surgical findings were compared. Ultrasound criteria for cuff tears were complete nonvisualisation of the cuff tendons or localised absence and focal discontinuity. In all but 12 cases, US diagnoses corresponded with intraoperative findings (sensitivity 98%, confidence interval 95.1–99.3; specificity 93%, CI 85.7–97.1; accuracy 97%, CI 93.8–98.1). Size and location of the tear were correctly predicted in 69 of 96 cases (accuracy 87%, sensitivity 89%, specificity 87%). US demonstrated less extensive tears than observed at surgery in 18%. Ultrasonography was highly accurate and sensitive for detecting rotator cuff tears, but seems to be a method of limited value for evaluation of the size of cuff tears, in particular, for the detection of small tears. (E-mail: harald.zehetgruber@akh-wien.ac.at)

An approximate upper bound approach for the single-grit rotating scratch with a conical tool on pure metal

An upper bound model has been proposed for the single-grit rotating scratch with a conical tool on a rigid perfectly-plastic material. The model was validated experimentally with a newly-developed technique to make scratches on annealed pure titanium. It has been realized that the built-up edge (BUE) governs the material removal process of the rotating scratch. The current model makes use of the modification of BUE to the tool configuration so that the discretization of plastic region in the vicinity of the tool becomes feasible. The features of side-ridge and front-ridge, BUE and sub-layer plastic zone have been found to be evolving in different ways during the rotating scratch. Three material removal mechanisms were uncovered to be involved with the rotating scratch process, namely, plastic (shear) deformation, contact friction and ductile fracture. In the first-half of the scratch, the first two mechanisms dominate the process, while in the second-half, the ductile fracture plays an active role as evidenced by the extensive tearing along the both banks of scratch.

Medial meniscocapsular separation: MR imaging criteria and diagnostic pitfalls

Various magnetic resonamce imaging (MRI) signs can be used in the diagnosis of medial meniscocapsular separation. A thorough knowledge of the normal anatomy of the medial meniscocapsular junction is essential to understand these signs. MRI signs used in the diagnosis of meniscocapsular separation include meniscal displacement relative to the tibia, meniscal corner tear, perimeniscal fluid, irregular meniscal outline, meniscofemoral and meniscotibial extension tears, and interposition of contrast medium between the meniscus and the MCL. Potential causes of false positive diagnosis of meniscocapsular separation include MCL bursitis, meniscal cyst, MCL tear, joint effusion, and perimeniscal fat.

Managing anterior capsule contraction by mechanical widening with vitrector-cut capsulotomy

We present a technique, vitrectorhexis, in which a vitrector-cut capsulotomy is used to treat anterior capsule contraction syndrome. A vitrector handpiece is used to remove all fibrous capsule tissue and residual lens epithelial cells from the anterior chamber. Vitrectorhexis may be an alternative to neodymium:YAG laser capsulotomy as it decreases the risk of radial tear extension to the zonules and of secondary IOL decentration. The technique was used in a 77-year-old man with capsulorhexis contraction syndrome and extensive fibrosis after phacoemulsification with silicone piggyback intraocular lens implantation. One day postoperatively, visual acuity improved from 20/60 to 20/30 and the anterior chamber reaction was minimal. At 1 month, best corrected visual acuity was 20/20. The IOL was well centered at 6 months.

The effect of rotator cuff tears on reaction forces at the glenohumeral joint

The rotator cuff muscles maintain glenohumeral stability by compressing the humeral head into the glenoid. Disruption of the rotator cuff compromises concavity compression and can directly affect the loads on the glenohumeral joint. The purpose of this study was to quantify the effect of rotator cuff tears on the magnitude and direction of glenohumeral joint reaction forces during active shoulder abduction in the scapular plane using nine cadaveric upper extremities. Motion of the full upper extremity was simulated using a dynamic shoulder testing apparatus. Glenohumeral joint reaction forces were measured by a universal force–moment sensor. Five conditions of rotator cuff tears were tested: Intact, Incomplete Supraspinatus Tear, Complete Supraspinatus Tear, Supraspinatus/Infraspinatus Tear, and Global Tear. Reaction forces at the glenohumeral joint were found to steadily increase throughout abduction and peaked at maximum abduction for all conditions tested. There were no significant differences in reaction force magnitude for the intact condition (337±88 N) or those involving an isolated incomplete tear (296±83 N) or complete tear (300±85 N) of the supraspinatus tendon. Extension of tears beyond the supraspinatus tendon into the anterior and posterior aspect of the rotator cuff led to a significant decrease in the magnitude of joint reaction force (126±31 N) . Similarly, such tears resulted in a significant change in the direction of the reaction force at the glenohumeral joint. These results suggest that joint reaction forces are significantly affected by the integrity of the rotator cuff, specifically, by the transverse force couple formed by the anterior and posterior aspects of the cuff. The quantitative data obtained in this study on the effect of rotator cuff tears on magnitude and direction of the reaction force at the glenohumeral joint helps clarify the relationship between joint motion, joint compression and stability.

Resultados preliminares de la esofagomiotomía por video laparoscopia en pacientes con acalasia esofágica: Preliminary results in 19 patients

Laparoscopic esophagomyotomy is becoming a good alternative to pneumatic dilatation, injection of botulinic toxin or classical surgery in the treatment of achalasia. To report the results of laparoscopic esophagomyotomy in patients with achalasia. Nineteen patients with achalasia, nine women, aged 9 to 66 years old, operated between 1996 and 2001 are reported. There was no surgical mortality. One patient had a subphrenic abscess due to an unnoticed tear of the esophageal mucosa. During surgery, esophageal mucosa was perforated in 4 patients, that was sutured in three. One patient with an extensive tear of the mucosa required conversion to classical surgery. Patients were followed for 2 to 48 months. Radiological controls showed a significant increase in the diameter of gastroesophageal junction and a diameter reduction of the mid third esophageal segment. Lower esophageal pressure was significantly reduced. All patients experienced a weight increase and reduction of dysphagia. Laparoscopic esophagomyotomy is a safe an effective therapeutic alternative for achalasia.

Extensive Left Atrial Tear during Mitral Valve Replacement: A Word of Caution

An extensive left atrial tear was encountered in a 70-year-old woman undergoing valve surgery. This potentially fatal complication was successfully repaired with autologous pericardium.

Bonding of Natural Rubber to Steel: Surface Roughness and Interlayer Structure

This paper is concerned with two aspects of the adhesion produced by the vulcanisation bonding of a simple natural rubber (N.R.) compound to mild steel. Adhesion was measured using a 45° peel test. When the N.R. was bonded, using a proprietary bonding agent (Chemlok 205/220), to ‘smooth’ steel (acid etched) or to ‘rough’ steel (phosphated) high values of peel energy (≥ 4.5 kJm−2), and good environmental resistance to water were obtained, with failure cohesive largely within the rubber. The highest values of peel energy (≈ 7.5 kJm−2) were associated with a phosphated surface which consisted of plate-like crystals which directed the stresses away from the substrate in a way which produced a failure surface within the rubber which showed extensive tearing and cracking. The nature of the layer formed in the interfacial region by interaction between bonding system and rubber was investigated using a chlorinated rubber as a ‘model compound’ representing the adhesive and uncompounded N.R. to represent the rubber. When a blend of the two was heated in air at 150°C, evidence was found of a solid state chemical reaction in which carbonyl groups were incorporated into the blend which became visually homogeneous. Further evidence points to the relevance of this change to adhesion in rubber-to-metal bonding.

Three-dimensional endoanal sonography in assessing anal canal injury.

Instrument design limits endosonography of the anal canal to the axial plane, with no capability for longitudinal imaging or measurement. Using three-dimensional reconstructions, the relationship between the radial and linear extent of an anal sphincter tear has been explored, and sex differences in anal canal and sphincter length have been established. Three-dimensional reconstructions were performed in 20 controls and 24 patients with faecal incontinence found to have 25 external and five internal sphincter defects. The radial and linear extent of any sphincter tear was measured. In controls the length of the sphincters was compared with the total anal canal length, and the maximum and mean internal sphincter thickness was compared. The radial angle of an internal or external sphincter defect was significantly related to its length (R2 = 96.8 per cent and R2 = 84.4 per cent respectively; both P < 0.001). The anal canal was longer in men than in women (mean(s.d.) 32.6(5.3) versus 25.1(3.4) mm; P < 0.001). The internal anal sphincter was also longer in men (25.6(6.3) versus 19.8(4.0) mm; P < 0.02), but the mean internal sphincter length as a percentage of total anal canal length did not differ (78.3 versus 78.7 per cent; P not significant). The anterior external anal sphincter was longer in men than in women (32.6(5.3) versus 15.3(2.8) mm; P < 0.001), and formed a greater percentage of total anal canal length (100 versus 62.9 per cent; P < 0.001). Multiplanar imaging has revealed a direct relationship between the length of a sphincter tear and its radial extent as shown on axial scanning. Marked sex differences in sphincter configuration have been demonstrated. In women the shorter anterior sphincter length highlights the risk of complete sphincter disruption with extensive tears.

Traumatic dislocation of the knee

Sixteen patients with traumatic dislocation of the knee were treated during the period 1977–1995. The average period of follow up was 7 years. The mean age was 39.07 years for men and 45.6 years for women. One patient sustained a rupture of the popliteal artery and peroneal nerve at the same time, while two others sustained peroneal nerve neurapraxia. Fourteen out of 16 patients underwent surgical treatment for various combinations of ligamentous injuries, and the following techniques were used: suturing, pullout, reconstruction by using the semitendinosus tendon or the iliotibial band or the patellar tendon, and finally reattachment. Simple peripheral menisceal tears were sutured, while partial meniscectomy was performed only in extensive tears of the posterior horn of the meniscus. Postoperatively all the patients had a long backslab applied for 3 weeks and from the first postoperative day commenced isometric quadricep exercises and mobilised on elbow crutches non weight bearing on the injured side. After the backslab was removed, all started active knee exercises. The postoperative results were satisfactory regarding the knee stability, the pain and the patient's level of activity despite the seriousness of the injury.

A mechanism for entrapment of the tibialis posterior tendon in lateral subtalar dislocation

The entrapment of the tibialis posterior tendon causing a block to reduction of lateral subtalar dislocation is recognized. The mechanism which allows tendon excursion is less clearly understood. We present a case in which extensive tearing of the musculotendinous junction of the tibialis posterior muscle occurred during tendon displacement and entrapment in lateral subtalar dislocation. In view of this previously poorly recognized finding the two theories regarding entrapment are discussed. Recognition of the cause of the tendon lengthening with an intact flexor retinaculum allows appropriate early treatment.

Acute traumatic tears of the rotator cuff: value of sonography.

To determine the value of sonography in the evaluation of acute traumatic tears of the rotator cuff. Preoperative sonography was performed within 3 weeks of trauma in 184 patients, 98 of whom underwent surgery. The rotator cuff tears were preoperatively classified as partial-thickness tears or as small, large, or massive full-thickness tears. Sonographic findings were correlated with surgical findings (n = 70) and arthroscopic inspection (n = 28). Adequate examination was possible in 163 (88%) of 184 patients. Sonography demonstrated 42 (91%) of 46 full-thickness tears and seven (78%) of nine partial-thickness tears. Sonography showed more extensive tears than were found at surgery in four (4%) of 98 patients and less extensive tears in seven (7%) of 98 patients. Sonographic patterns were a defect (31 [63%] of 49 tears), focal thinning (10 [21%] of 49 tears), and nonvisualization (eight [16%] of 49 tears). Sonography is useful in the evaluation of acute shoulder trauma when a rotator cuff tear is suspected and findings at plain radiography are negative.

Implantation of foldable intraocular lenses in the presence of anterior capsular tears.

A consecutive series of patients who had undergone small-incision phacoemulsification cataract surgery with foldable lens implantation were reviewed. Seven patients had sustained anterior capsular tears during surgery. In all cases a three-piece foldable intraocular lens (IOL) was successfully inserted by careful positioning of the haptics. In all 6 patients available for long-term assessment the IOL remained stable and well centred, the tears having been sealed by fibrous tissue. We show that, if logical measures are taken to limit tear extension, the lack of an intact capsulorhexis need not result in conversion to extracapsular cataract extraction.

The ultrastructure of arteries proximal to chronic experimental carotid-jugular fistulae in rabbits

The afferent arteries from 11 normocholesterolemic rabbits with carotid-jugular arteriovenous fistulae ranging in duration from 107 to 718 days were examined by transmission electron microscopy to determine long term effects of an arteriovenous shunt on the afferent artery. Extensive tears and fragmentation of the internal elastic lamina of the elastic common carotid arteries were observed in all animals. Fragmentation and loss of elastic tissue as well as loss of muscle in the media accompanied progressive mural atrophy and tortuosity. Close to the fistula and in regions of tortuosity, fibromusculoelastic intimal proliferation was superimposed on the atrophic medial changes. The accumulation of matrix vesicles (cell debris), bizarre shaped smooth muscle cells, irregularly thickened multilaminated and reticulated basement membrane material beneath the endothelium and about smooth muscle cells, and abnormal shaped collagen fibrils were observed in the intima. Lipid was frequently found in the extracellular matrix and within smooth muscle cells while monocytes and lipid-laden macrophages were a feature of the more advanced intimal changes. These experiments confirm that in the absence of hypercholesterolemia the hydraulic stresses associated with an arteriovenous shunt cause severe mural atrophy and proliferative changes in the intima similar in nature to those of atherosclerosis.

Direct visualization of left ventricular free wall rupture by transesophageal echocardiography in acute myocardial infarction

clinical significance in the majority of cases, it has been reportedly related to putative embolic events, systolic clicks, and atrial arrhythmias. 4 ASA may also masquerade as a right atrial mass. 5 The presence of ASA in our patient with symptomatic severe mitral stenosis was clearly clinically relevant, and it presented a therapeutic dilemma and challenge. In view of her young age and pliable, noncalcified mitral valve, the patient was an ideal candidate for PTMC. 6 On the other hand, PTMC requires passage of a large-caliber 12F balloon catheter across the interatrial septum, and it may thus cause extensive tear of the thin septum if atrial septal puncture is made in the fossa ovale where ASA is located. With the aid of biplane follow-through right atrial angiograms, which well delineated the relationship between the atria and ASA, puncture of the latter was avoided. The puncture was made cephalid and dorsal to the ASA, and after PTMC there was no atrial septal shunt demonstrated by oximetry or color Doppler echocardiography. The PTMC resulted in a marked improvement of the patient 's hemodynamic and clinical status.

Obstetric hysterectomy: Ramathibodi's experience 1969–1987

Obstetric hysterectomy was performed on 121 women at Ramathibodi Hospital, Bangkok, between 1969 and 1987, an incidence of 1:875 deliveries. Of 88 women whose records were available, 91% had emergency hysterectomy, with uterine atony as the most common indication (32.5%), followed by placenta accreta (26.2%), uterine rupture (10.0%), extension of cervical tear to the lower uterine segment (8.7%), broad ligament hematoma (6.2%) and placenta previa (5.0%). The intraoperative and postoperative problems included febrile morbidity (52%), intraoperative hypotension (41%), and disseminated intravascular coagulation (5.7%). Late complications included Sheehan's syndrome (3.4%), post-transfusion hepatitis (2.3%), hematoma (2.3%) and wound infection (2.3%).

Two-stage capsulorhexis for endocapsular phacoemulsification

The continuous tear anterior capsulotomy or capsulorhexis technique is important for safe, successful cataract extraction and intraocular lens (IOL) implantation surgery. A two-stage continuous tear capsulotomy or capsulorhexis extends the possibility of achieving continuous tear capsulotomy to challenging and complicated cases. In endocapsular phacoemulsification this technique preserves the integrity of the capsule because it prevents the extension of radial tears in the capsule and thus facilitates safe cataract extraction and secure in-thebag IOL placement. The benefits and advantages of the continuous tear capsulotomy are preserved by two-stage capsulorhexis.

Glenoid labrum: preliminary work with use of radial-sequence MR imaging.

The authors describe a magnetic resonance imaging method for examination of the glenoid labrum of the shoulder joint that utilizes a radial fast-imaging sequence. Seven shoulders were examined: a total of five in three healthy asymptomatic volunteers, one in a symptomatic patient not suspected of having a lesion of the glenoid labrum, and one in a patient with recurrent shoulder dislocation and surgical proof of an extensive tear of the labrum. The preliminary results suggest that this technique may advantageously demonstrate pathologic changes in the glenoid labrum and may contribute to the evaluation of the unstable and painful shoulder.

Rotator cuff tear--relationship between clinical and anatomopathological findings.

Rotator cuff tears (RCT) are frequent and increase with age. Why do only a relatively small percentage cause a permanent severe handicap justifying surgery? Is there a relationship between size and site of the tear and the clinical symptoms? How do they influence the postoperative result? These questions were answered in a prospective study of 76 operated patients. We adopted D. Patte's classification of the RCT into four groups according to the site and size of the lesion. Our figures were compared with those obtained by Patte in an analogous study of 256 cases. Of the tears in our series, 56.5% belonged to groups I and II, which means that only the supraspinatous and occasionally also the subscapular muscles were involved. In 100% of the cases in group I we found only pain, whereas a pure symptomatology with pain alone was presented in only 51% of group II, in 48% of group III, and in 0% of group IV. Groups III (35.5%) and IV (8%) represent more extensive tears, involving not only the anterior part of the rotator cuff, e.g., the supraspinatous tendon, but also to a more or less severe extent, the infraspinatous and sometimes even the teres minor. In group IV the extensive tear is combined with osteoarthritic changes. In both groups a mixed symptomatology (pain and pseudoparalysis) is the rule. The result of operative treatment is satisfactory in all groups as far as pain relief is concerned. The improvement of active ROM is not as evident and seems, as expected, to be related to the severity of the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

SMALL-TYPE TOM TURKEYS VERSUS HEAVY-TYPE HENS MARKETED AT MEDIUM WEIGHT: PERFORMANCE, CARCASS CHARACTERISTICS, SENSORY EVALUATION, AND THE EFFECT OF COMMERCIAL BASTING OF THE BREAST WITH OIL

Small-type tom turkeys and heavy-type hens were reared on a common regimen until 17 wk of age when they attained medium weight (ca. 7–10 kg). Toms progressively gained substantial weight and had a feed conversion advantage throughout the last half of production. Commercial processing led to results where similar relative chilled carcass yields occurred between the sexes. Extensive skin tearing at the back and thigh appeared with hens which could be attributed to an excessive finish. Percentage of breast and thigh as commercial cuts from the carcass and meat yield of these parts was the same for hens and toms. Total cooking loss was similar for both sexes, although hens released additional fat in the process. Fat concentration in the thigh meat was high and was greater with hens than toms. Evaluation of whole carcass appearance and meat eating quality by a trained panel failed to reveal any differences between the small tom and heavy hen. Commercial basting of each sex in the breast with oil during processing increased total cooking loss, fat associated with the loss, fat content of the meat and its eating quality. Key words: Turkey, carcass processing, meat composition, sensory evaluation