Unilateral Tears Research Articles

Penile trauma ( Fracture penis)-

Background: penile fracture is a relatively rare urological emergency that is defined as rupture of the tumescent corpora cavernosa as a result of blunt trauma , most commonly during sexual intercourse , forceful bending or masturbation . Flaccidity of the penis occurred immediately after the fracture with resultant swelling and ecchymosis of the penis "eggplant" deformity. Surgical intervention to repair the tear is highly recommended instead of any type of conservative management to prevent erectile and voiding dysfunction s in addition to significantly shortening the hospital stay. Objective . To describe the possible etiology, clinical presentation, management of fracture penis and outcomes with review of the literature. Patients and method : The files of 63 patients admitted between march 1998 and march 2017 to the department of urology – Hawari center for urology and Otolaryngology -Benghazi ,Libya were reviewed regarding the age ,marital status ,mode of trauma and the operation applied and outcomes . Result: 85.7 %( 54/63) of patients were under 40 years old and 74% were single. The mode of trauma is forceful bending of the erected penis in about two thirds of patients while sexual intercourse was the cause in less than one third of the patients. Three cases had urethral injury and all other patients had only unilateral tear in corpora Cavernosa. All patients underwent operation to repair the tear successfully .All patients were followed- up for3-16 months and there were no any complications reported during the follow-up period. Conclusion : penile fracture occurred mostly to single patients due to forceful bending of erected penis in contrast to the literature from western hemisphere where the coitus is the most common cause. Early Surgical intervention is the only management recommended in all literatures to short the hospital stay and prevent complications of this embarrassing trauma.

The Relationship Among Probable SARCopenia, Osteoporosis and SuprasPinatus Tendon Tears in Postmenopausal Women: The SARCOSP Study

We aimed to investigate the relationship among probable sarcopenia, osteoporosis (OP) and supraspinatus tendon (SSP) tears in postmenopausal women. Postmenopausal women screened/followed for OP were recruited. Demographic data, comorbidities, exercise/smoking status, and handgrip strength values were recorded. Probable sarcopenia was diagnosed as handgrip strength values < 20 kg. Achilles and SSP thicknesses were measured using ultrasound. Among 1443 postmenopausal women, 268 (18.6%) subjects had SSP tears. Unilateral tears were on the dominant side in 146 (10.1%) and on the non-dominant side in 55 women (3.8%). In contrast to those without, women with SSP tears had older age, lower level of education, thinner SSP and lower grip strength (all p < 0.05). In addition, they had higher frequencies of hypertension, hyperlipidemia, DM, OP and probable sarcopenia, but lower exercise frequency (all p < 0.05). Binary logistic regression modeling revealed that age [odds ratio (OR): 1.046 (1.024–1.067 95% CI)], hypertension [OR: 1.560 (1.145–2.124 95% CI)], OP [OR: 1.371 (1.022–1.839 95% CI)] and probable sarcopenia [OR: 1.386 (1.031–1.861 95% CI)] were significant predictors for SSP tears (all p < 0.05). This study showed that age, presence of hypertension, probable sarcopenia and OP were related with SSP tears in postmenopausal women. To this end, although OP appeared to be related to SSP tears, SSP tear/thickness evaluation can be recommended for OP patients, especially those who have other risk factors such as older age, higher BMI, hypertension, and probable sarcopenia.

Poster 268: The Relation Between Posterior Tibial Slope Angle and Bilateral ACL Tear

Objectives: Increased posterior tibial slope (PTS) is a risk factor for primary anterior cruciate ligament (ACL) tear, as well as subsequent ACL graft tear. Prior literature has shown conflicting relationships between an increased PTS and bilateral ACL tears. The purpose of this study is to compare PTS angles for patients who had bilateral ACL tears to those who had only sustained a unilateral ACL tear. Methods: Retrospectively we identified patients who had bilateral and unilateral ACL tears at our institution over the last 10 years. Those who had bilateral surgery were matched to those who had unilateral surgery on a ratio of 1:1 based on age, sex, and BMI. Patients with unilateral ACL reconstruction were excluded if they had subsequent revisions or were less than 5 years post-operative. Lateral knee radiographs were used to measure the posterior tibial slope. The tibial axis was found using the circles measurement method which consisted of drawing circles along the tibial shaft and placing a line through the center of each to estimate the anatomical tibial axis. The PTS was then defined as the angle between the perpendicular line to this axis and the tibial plateau tangent line. Three blinded orthopedic residents performed these measurements. In addition to comparison of mean PTS between cohorts, both cohorts were stratified into “high slope” and “low slope” using 10-degress of PTS as a cutoff. An interclass correlation coefficient (ICC) was then calculated. Results: Fifty-three patients with bilateral ACL tears were successfully matched to 53 patients with unilateral tears. The average PTS in patients with bilateral ACL tears was found to be significantly higher than patients with unilateral ACL tears (11.17 vs. 9.72, p = 0.005). An intraclass correlation coefficient was calculated to 0.80 (95% confidence interval: 0.75 – 0.85). These cohorts were then stratified by the aforementioned sub-groups, finding that 69.8% of the bilateral cohort had more than 10-degrees of PTS, while this was true for only 46.4% of the unilateral cohort (p = 0.006). Conclusions: These results demonstrate that patients with bilateral ACL tears have higher PTS angles than those who only had unilateral ACL tear. Clinicians should consider routinely assessing PTS in a newly-presenting patient with an initial ACL tear, as marked deviations from the general population could be a predisposing risk factor for subsequent contralateral tear. Further prospective research is necessary to determine if patients with unilateral ACL tears who present with this radiographic finding are at greater risk for contralateral tear.

The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients

BackgroundSome studies have proved that labrum size is associated with symptoms in patients with hip labral tear. The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients is still uncertain.MethodsThe volunteers with no history of pain, injury, or surgery were recruited from the community. Patients who were diagnosed with labral tear and underwent hip arthroscopic surgery in this period in our hospital were also included. The length and height of the acetabular hip labrum were measured at three separate anatomic sites through magnetic resonance imaging (MRI) along the acetabular rim: lateral, anterior, and anteroinferior.ResultsA total of 70 volunteers (125 hips) and 70 patients (70 hips) were included in this study. Sixty-six (52.8%) hips had labral tears in all 125 hips of volunteers. The lateral labral length of volunteers with labral tears was significantly larger than those without labral tears (P < .05). In 14 volunteers with unilateral labral tears, length of lateral, anterior, and anteroinferior labrum in the side with tear were significantly larger than normal on the other side. The anterior labral height of volunteers was significantly larger than that of patients (P < .05).ConclusionsIn conclusion, asymptomatic volunteers with larger length of lateral, anterior, and anteroinferior labrum are more prone to present with labral tears. Symptomatic patients with labral tears exhibited thinner anterior labrum. Further studies are warranted to explore the mechanisms of labral tears in asymptomatic people and validate the use of labral size as a guide to differential diagnosis and treatment.

Prevalence and Risk Factors for Bilateral Meniscal Tears Identified during Treatment for Cranial Cruciate Ligament Disease Via Tibial Plateau Levelling Osteotomy in Dogs.

The aim of this study was to report the prevalence and risk factors of bilateral meniscal tears during a tibial plateau levelling osteotomy (TPLO). Data from 362 dogs that underwent staged or simultaneous TPLO between January 2006 and April 2019 were retrospectively collected. Variables such as breed, sex, weight change and intervals between surgeries were analysed with logistic regression. Preoperative tibial plateau angle, age, cranial cruciate ligament status and body weight were analysed with a generalized linear mixed model. All analyses were performed to assess the likelihood of bilateral meniscal tears versus unilateral tears and no tears. Correlation of meniscal tears between stifles was assessed with Cohen's kappa coefficient. Prevalence of bilateral meniscal tears was 48.0% (95% confidence interval [CI]: 43.0-53.0%). There was moderate agreement of the presence of meniscal tears between stifles (Cohen's kappa coefficient = 0.41, 95% CI: 0.31-0.51).The odds for bilateral meniscal tears were higher for Rottweilers (odds ratio [OR:] 4.5 [95% CI 1.1-30.3], p = 0.033), older dogs (OR: 1.2 [95% CI: 1.1-1.4 per year], p < 0.0001), smaller dogs (OR: 0.98 [95% CI: 0.97-0.99 per 0.45-kg], p = 0.001), stifles with complete cranial cruciate ligament tears (OR: 21.1 [95% CI: 7.1-62.4], p < 0.0001). Contralateral meniscal tears, breed, older age, lower patient weight and complete cranial cruciate ligament tear were significant risk factors for bilateral meniscal tears. Surgeons can use these results to determine prognoses and propensities for meniscal tears in at-risk dogs.

Association of index finger palpatory assessment of pubovisceral muscle body integrity with MRI-documented tear.

Pubovisceral (PV) muscle tears are associated with pelvic floor disorders. The goal of this study was to determine whether index finger palpatory assessment of PV muscle body integrity through the lateral vaginal wall is a reliable indicator of PV muscle tear severity diagnosed by magnetic resonance imaging (MRI). We studied 85 women, 7 weeks after vaginal birth. All had at least one risk factor for obstetric-related PV muscle tear. The ordinal outcome measure of MRI-documented PV muscle tear was defined as: none,less than 50% unilateral tear,50% or greater unilateral tear or less than 50% bilateral tear, and 50% or greater bilateral tear. PV muscle body integrity by palpatory assessment was scored on a matrix, with each side scored independently and classified as PV muscle body "present" (assuredly felt), "equivocal" (not sure if felt), or "absent" (assuredly not felt). Proportional odds models were constructed to estimate the relationship between PV muscle body integrity palpatory assessment and MRI-documented PV muscle tears. Thirty-five percent of study participants exhibited varying degrees of MRI-documented PV muscle tears. Using palpatory assessment, we identified "PV muscle body present bilaterally" in 20%, "equivocal unilaterally or present contralaterally" in 8%, "equivocal or absent unilaterally" or "equivocal bilaterally" in 62%, and "absent bilaterally" in 9%. The odds ratio for estimating MRI results from palpatory assessment was 3.62 (95% confidence interval = 1.70-7.73, P = 0.001). A rapid and inexpensive palpatory assessment in the clinic was highly associated with the risk of MRI-documented PV muscle tear and is a useful component of a clinical assessment.

Modified gift box technique for acute compound posttraumatic Achilles tendon repair in young patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Treatment of Achilles tendon rupture in young active patient remains controversial. Open primary repair remains the mainstay of treatment with prolonged rehabilitation and high wound complication rate (20%). In compound injuries it becomes the default treatment. Newer techniques are being tried to decrease re-rupture rate, decrease local complications and facilitate early rehabilitation. Modified gift box technique of open repair, which has shown higher strength of repair in in-vitro studies and good clinical results in the hands of its inventor. The aim of our study was to evaluate the clinical results of this technique in young active patients with compound Achilles tendon injury.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective study. The parameters recorded at follow up included general demography, ability to single toe raise (on neutral, incline, decline), toe walking for 40 feet, and pain on VAS scale. Achilles tendon total rupture score and modified Rupp score were administered.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the 8 patients included in the study, 7 patients had unilateral tear and 1 patient had bilateral tear. The mean age was 27 yrs (20-35) and mean duration of follow up was 17.4 months (08-24 months). Single toe raise and toe walking for 40 ft. was possible in all patients. Two patients complained of grade 2 pain on VAS Scale. The ATRS score was 97.1 (94-99) and modified Rupp score was 28.3 (26-29)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Modified gift box technique gives excellent results in young active patients with compound Achilles tendon injury with no re-rupture and return of pre-injury activity&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

How does functionality proceed in ACL reconstructed subjects? Proceeding of functional performance from pre- to six months post-ACL reconstruction.

This is the first study examining functionality of subjects with anterior cruciate ligament (ACL) tears and a subsequent reconstruction comprehensively by multiple test sessions from pre- to six months post-reconstruction. The purpose was to evaluate if a generally applied rehabilitation program restores functionality to levels of healthy controls. Subjects with unilateral tears of the ACL were compared to matched healthy controls throughout the rehabilitation. 20 recreational athletes were tested: T1 (preoperative), 6 weeks after tear; T2, 6 weeks, T3, 3 months, T4, 6 months post-reconstruction. At all test sessions, subjects self-evaluated their activity level with the Tegner activity score and their knee state with the Knee Injury and Osteoarthritis Outcome Score. Passive range of motion during knee flexion and extension and leg circumference were measured as functional clinical tests. Bilateral countermovement jumps, one-leg jumps for distance and isometric force tests in knee flexion and extension with 90° and 110° knee angle were conducted as functional performance tests. For determination of functionality, leg symmetry indices (LSIs) were calculated by dividing values of the injured by the uninjured leg. In the ACL group most LSIs decreased from T1 to T2, and increased from T2 and T3 to T4. LSIs of ACL subjects remained lower than LSIs of healthy controls at 6 months post-reconstruction in nearly all parameters. Self-evaluation of ACL subjects showed, additionally, that activity level was lower than the pre-injury level at 6 months post-reconstruction. Low LSIs and low self-evaluation indicate that knee joint functionality is not completely restored at 6 months post-reconstruction. The study shows that multiple comprehensive testing throughout the rehabilitation gives detailed images of the functional state. Therefore, the functional state of ACL reconstructed individuals should be evaluated comprehensively and continuously throughout the rehabilitation to detect persisting deficiencies detailed and adapt rehabilitation programs individually depending on the functionality.

Cytokine Profiles of Tear Fluid From Patients With Pediatric Lacrimal Duct Obstruction.

This study evaluated the cytokine levels in unilateral tear samples from both sides in patients with pediatric lacrimal duct obstruction. Fifteen cases of unilateral lacrimal duct obstruction (mean, 26.9 ± 28.7 months old) were enrolled in this study. Tear samples were collected separately from the obstructed side and the intact side in each case before surgery, which was performed under general anesthesia or sedation. The levels of IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL-17A then were measured in each tear sample. A receiver operating characteristic (ROC) curve was constructed for the IL-6 levels in the tears. We also measured the postoperative tear fluid levels of IL-6 in those cases from which tear fluid samples could be collected after the surgery. Only the IL-6 concentration was significantly higher on the lacrimal duct-obstructed sides, compared to the control sides (P < 0.001). An ROC curve analysis for the IL-6 levels in tears showed a high value for discriminating the lacrimal duct-obstructed side from the control side (area under the ROC curve [AUC], 0.99; 95% confidence interval [CI], 0.968-1). Significant decrease of the tear fluid IL-6 levels was observed in the seven cases from which tear fluid samples also could be collected after the surgery (P = 0.016). The IL-6 level in tear fluid was significantly higher on the sides with lacrimal duct obstruction, compared to the control sides, and could be a biomarker for pediatric lacrimal duct obstruction.

Long-term outcome of anterior cruciate ligament tear without reconstruction: a longitudinal prospective study.

To analyse subjective and objective long-term outcomes of patients with anterior cruciate ligament (ACL)-deficient knees and limited demands regarding sportive activities. This subgroup of patients might be well-treated without ligament reconstruction. We included 303 patients with unilateral tears of the ACL and conservative treatment into a prospective study. Mean age at injury was 33.8 (min. 18, max. 66) years. Follow-up was 27.1 (min. 21.3, max. 31.5) years. Follow-up examinations were conducted 12 and 27years after injury. At the last follow-up we analysed 50 patients completely. To evaluate clinical and radiological outcomes we used the Lysholm score, Tegner activity scale, visual analogue scale for pain (VAS-pain), KOOS and Sherman score. Subjective outcome (Lysholm score and VAS-pain scale) improved between the 12th and 27th year after anterior cruciate ligament tear. At the same time activity level (Tegner activity scale) decreased. Also, arthritis (Sherman score) worsened over time. Twenty-sevenyears after injury, 90% of the patients rated their ACL-deficient knee as normal or almost normal; 10% of the patients rated it as abnormal. The findings of this study show that there is a subgroup of patients with ACL tears who are well treated with physiotherapy alone, not reconstructing the ligament. Also, other authors found this correlation between activity level reduction and better subjective outcome. Conservative treatment of an ACL tear is a good treatment option for patients with limited demands regarding activity. Patient age, sportive activities and foremost subjective instability symptoms in daily life should be considered when deciding for or against ACL reconstruction.

Functional outcomes after bilateral arthroscopic rotator cuff repair

Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders.

Duane’s retraction syndrome associated with crocodile tears and hearing loss

Duane’s retraction syndrome (DRS) is a predominately congenital eye movement disorder. We present a 23-year-old female with unilateral DRS, which was diagnosed by magnetic resonance imaging (MRI), and associated symptoms of unilateral crocodile tears and bilateral high-frequency hearing loss. This case highlights that DRS may be associated with various systemic malformations. For children with newly diagnosed DRS, we recommend comprehensive evaluation for any associated abnormalities. For adults with DRS complaining of discomfiture associated with a noncentral head position, we suggest a complete examination, including strabismus tests, the forced duction test, and even MRI, to evaluate the degree of muscle modification and to identify the most suitable treatment strategy.

A cross-sectional study of demographic and morphologic features of rotator cuff disease in paraplegic patients

This study analyzed the demographic and morphologic features of rotator cuff disease in paraplegic patients who presented with or without shoulder pain. Clinical and magnetic resonance imaging examinations of both shoulders were performed in 317 paraplegic patients. Mean age was 49 (range, 19-76) years. The level of spinal cord injury was between T2 and T7 In 54% of patients and between T8 and L3 in 46%. Constant scores were measured for all shoulders. Pain was analyzed using a visual analog scale. Rotator cuff tears were not present in 51%, were unilateral in 20%, and were bilateral in 29%. Age was older and duration of spinal cord injury was significantly longer in patients with bilateral tears than in patients without or with unilateral tears (P < .001). In patients with unilateral tears, a full-thickness rupture of the supraspinatus tendon was found in 67%, whereas a partial-rupture was detected in 33%. Of the patients with bilateral tears, 75% presented with a full-thickness rupture and 25% with a partial rupture. The mean Constant score was 76 (range, 37-98) in patients without cuff tears, 69 (range, 16-94) for patients with unilateral tears, and 64 (16-96) for patients with bilateral tears (P < .001). Rotator cuff disease is common and correlates highly with age and duration of spinal cord injury, which underlines the theory of "wear and tear" in wheelchair-dependent patients.

Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus

To determine the degree of levator hiatal asymmetry in women with unilateral avulsion of the puborectalis muscle in order to estimate the likely effect of successful reconstruction. We reviewed datasets of women seen between May 2005 and January 2009 in a tertiary urogynecological unit. Archived ultrasound volume datasets were analyzed for hiatal dimensions and puborectalis muscle trauma in patients with unilateral avulsion. From 929 eligible datasets we identified 71 patients with isolated complete unilateral tears. Unilateral avulsion was associated with a significant increase in hiatal area (P ≤ 0.002). Relative to a hypothetical normal hiatus (intact hemi-area × 2), avulsion was associated with a larger hiatus on Valsalva maneuver (+2.1 cm(2) or 7%). Unilateral puborectalis muscle avulsion results in an asymmetric increase in the size of the levator hiatus. This increase is relatively minor, accounting for < 10% of hiatal area. Surgical repair of an avulsion may have only limited effects on hiatal dimensions.

No difference in clinical results between femoral transfixation and bio-interference screw fixation in hamstring tendon ACL reconstruction: A preliminary study

Hamstring tendon autograft has become a popular graft choice for anterior cruciate ligament (ACL) reconstruction, but there is no consensus on the ideal technique of fixation. We performed a pilot randomized controlled study to compare the clinical and mechanical outcome of two femoral fixation techniques for anterior cruciate ligament (ACL) reconstruction using hamstrings graft. We recruited 30 patients with a chronic unilateral tear of the anterior cruciate ligament. In all patients, quadrupled hamstring graft was used for ACL reconstruction. In 15 patients, femoral graft fixation was performed using Bio-interference Screws fixation (Arthrex, Inc. Naples USA) (Group 1). In the other 15 patients, femoral graft fixation was performed using BioTransFix femur extra cortical transverse fixation (Arthrex, Inc. Naples USA) (Group 2). In both groups, tibial fixation was achieved with a Delta bio-absorbable interference screw (Arthrex). Both groups were comparable with regard to demographic data, pre-operative activity level, mechanism of injury, interval between the injury and the operation, and pre-operative knee laxity measurements. An independent observer, who was blinded with regard to the involved leg and the type of graft, performed the outcome assessment with the use of a Rolimeter® arthrometer (Aircast), and the International Knee Documentation Committee. At 13 months follow up, all patients except one had functionally normal or nearly normal IKDC objective scores. The mean IKDC subjective score was 83.38 ± 9.4 in Group 1 and 79.92 ± 11.01 in Group 2 ( P > .05). The side to side laxity as measured with the Rolimeter® arthrometer was 1.5 mm ± 1 (range 0–3) for Group 1, and 2 mm ± 1 (range 0–3) for Group 2 ( P > .05). Femoral Biotransfix fixation and Bio-interference Screws fixation provide comparable mechanical stability and clinical outcome at 13 months follow up. BiotransFix fixation is an effective alternative to other devices. Our preliminary study shows that there is no evidence to prefer femoral transfixation to the more traditional, technically less demanding, and more economical interference screw fixation. A full study requires 368 participants.

The Demographic and Morphological Features of Rotator Cuff Disease

Very little comparative information is available regarding the demographic and morphological characteristics of asymptomatic and symptomatic rotator cuff tears. This information is important to provide insight into the natural history of rotator cuff disease and to identify which factors may be important in the development of pain. The purpose of the present study was to compare the morphological characteristics and prevalences of asymptomatic and symptomatic rotator cuff disease in patients who presented with unilateral shoulder pain. Five hundred and eighty-eight consecutive patients in whom a standardized ultrasonographic study had been performed by an experienced radiologist for the assessment of unilateral shoulder pain were evaluated with regard to the presence and size of rotator cuff tears in each shoulder. The demographic factors that were analyzed included age, gender, side, and cuff thickness. All of these factors were evaluated with regard to their correlation with the presence of pain. Of the 588 consecutive patients who met the inclusion criteria, 212 had an intact rotator cuff bilaterally, 199 had a unilateral rotator cuff tear (either partial or full thickness), and 177 had a bilateral tear (either partial or full thickness). The presence of rotator cuff disease was highly correlated with age. The average age was 48.7 years for patients with no rotator cuff tear, 58.7 years for those with a unilateral tear, and 67.8 years for those with a bilateral tear. Logistic regression analysis indicated a 50% likelihood of a bilateral tear after the age of sixty-six years (p < 0.01). In patients with a bilateral rotator cuff tear in whom one tear was symptomatic and the other tear was asymptomatic, the symptomatic tear was significantly larger (p < 0.01). The average size of a symptomatic tear was 30% greater than that of an asymptomatic tear. Overall, patients who presented with a full-thickness symptomatic tear had a 35.5% prevalence of a full-thickness tear on the contralateral side. There is a high correlation between the onset of rotator cuff tears (either partial or full thickness) and increasing age. Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common in patients who present with unilateral symptomatic disease. As the size of a tear appears to be an important factor in the development of symptoms, we recommend surveillance at yearly intervals for patients with known rotator cuff tears that are treated nonoperatively.

THE DEMOGRAPHIC AND MORPHOLOGICAL FEATURES OF ROTATOR CUFF DISEASE

Background: Very little comparative information is available regarding the demographic and morphological characteristics of asymptomatic and symptomatic rotator cuff tears. This information is important to provide insight into the natural history of rotator cuff disease and to identify which factors may be important in the development of pain. The purpose of the present study was to compare the morphological characteristics and prevalences of asymptomatic and symptomatic rotator cuff disease in patients who presented with unilateral shoulder pain. Methods: Five hundred and eighty-eight consecutive patients in whom a standardized ultrasonographic study had been performed by an experienced radiologist for the assessment of unilateral shoulder pain were evaluated with regard to the presence and size of rotator cuff tears in each shoulder. The demographic factors that were analyzed included age, gender, side, and cuff thickness. All of these factors were evaluated with regard to their correlation with the presence of pain. Results: Of the 588 consecutive patients who met the inclusion criteria, 212 had an intact rotator cuff bilaterally, 199 had a unilateral rotator cuff tear (either partial or full thickness), and 177 had a bilateral tear (either partial or full thickness). The presence of rotator cuff disease was highly correlated with age. The average age was 48.7 years for patients with no rotator cuff tear, 58.7 years for those with a unilateral tear, and 67.8 years for those with a bilateral tear. Logistic regression analysis indicated a 50% likelihood of a bilateral tear after the age of sixty-six years (p < 0.01). In patients with a bilateral rotator cuff tear in whom one tear was symptomatic and the other tear was asymptomatic, the symptomatic tear was significantly larger (p < 0.01). The average size of a symptomatic tear was 30% greater than that of an asymptomatic tear. Overall, patients who presented with a full-thickness symptomatic tear had a 35.5% prevalence of a full-thickness tear on the contralateral side. Conclusions: There is a high correlation between the onset of rotator cuff tears (either partial or full thickness) and increasing age. Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common in patients who present with unilateral symptomatic disease. As the size of a tear appears to be an important factor in the development of symptoms, we recommend surveillance at yearly intervals for patients with known rotator cuff tears that are treated nonoperatively.

Platelet-Activating Factor in Human Normal Tears

Purpose: To measure the concentrations of platelet-activating factor (PAF) and lyso-PAF in tears of human eyes. Methods: Unilateral tear samples were collected from the conjunctival cul-de-sac of 12 healthy volunteers without any past histories of ocular surface diseases and 10 patients with allergic conjunctivitis (AC) by graduated disposable microcapillaries. C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF levels were determined by liquid chromatography-tandem mass spectrometry (LC/MS/MS). Results: The concentrations of C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF in tears from healthy volunteers were 0.44 ± 0.39, 51.7 ± 63.4, 61.9 ± 75.9, and 10.7 ± 14.7 ng/ml, respectively. Higher, but not significantly different, concentrations of all the four kinds of PAF molecules were detected in tears from AC patients. Significant correlations were demonstrated between the concentrations of C18:0-PAF and C18:0-lyso-PAF (r = 0.906; p < 0.01 in normal healthy volunteers and r = 0.939; p < 0.01 in AC patients), and between those of C16:0-PAF and C16:0-lyso-PAF (r = 0.944; p < 0.01 in normal healthy volunteers and r = 0.806; p = 0.015 in AC patients). Moreover, C18:0-PAF concentrations correlated significantly with those of C16:0-PAF (r = 0.885; p < 0.01 in normal healthy volunteers and r = 0.927; p < 0.01 in AC patients), while C18:0-lyso-PAF concentrations correlated significantly with those of C16:0-lyso-PAF (r = 0.972; p < 0.01 in normal healthy volunteers and r = 0.891; p < 0.01 in AC patients). Conclusions: To our knowledge, this is the first report of the concentrations of different species of PAF (C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF) in human tears.

Carpal bone postures and motions are abnormal in both wrists of patients with unilateral scapholunate interosseous ligament tears

Purpose The recent ability to measure 3-dimensional in vivo carpal kinematics has facilitated the noninvasive study of complex carpal bone motion. Methods In this study we examined the flexion/extension carpal kinematics of both wrists in 8 patients with unilateral scapholunate interosseous ligament (SLIL) tears by using computed tomographic (CT) imaging and a markerless bone registration technique. Carpal bone neutral posture and flexion/extension motion of both wrists of the injured patients were compared with the same parameters in wrists of 10 uninjured male and female volunteers (normals). Results The neutral posture of the injured scaphoid and lunate were significantly more extended than those of normals. In these patients, however, the postures of the scaphoid and lunate in the contralateral uninjured wrists also were abnormal and were similar to those of the injured wrist. In addition, extension of the lunate and flexion of the scaphoid in both the injured and uninjured wrist were significantly different from normal but not different from each other. Conclusions This study was unable to attribute altered carpal posture and motion to SLIL tears because abnormalities were found in both wrists of patients with unilateral injury. The etiology of abnormal wrist kinematics in the asymptomatic wrist of patients with unilateral tears of the scapholunate ligament is not known.

Fracture of the penis: treatment and complications.

Fracture of the penis is an unusual blunt traumatic injury of the erect penis. Twenty-five such cases, treated at the 2 main urological departments in the town of Varna between 1984 and 1999, were analyzed retrospectively. The average annual incidence in this series was 0.33 per 100,000 inhabitants. Most of the injuries occurred during vigorous sexual intercourse. Clinical diagnosis was mainly based on the patient's history and the physical findings. The diagnosis was verified by ultrasonography. In a few cases retrograde urethrography and cavernosography were used as additional diagnostic tools. Cavernosography was complicated by postprocedural priapism in 1 case. Unilateral tear of the corpora cavernosa was found in 24 cases. In 3 cases, partial (in 2) or complete (in 1) disruption of the corpus spongiosum and the urethra was found as well. The trauma was bilateral in 1 case in which 2/3 of the entire circumference of the penis was ruptured, including both corpora cavernosa and the urethra. Seventeen patients received immediate surgical repair. Most of them experienced an uneventful postoperative period with no serious consequences affecting their sexual function. Surgery was delayed in 6 and rejected in 2 cases. In all cases in which conservative (nonsurgical) management was the first treatment option, late complications (penile aneurysm, induration, penile curvature, erectile dysfunction) were observed and the final results were assessed as satisfactory or poor. We recommend immediate surgical treatment of all cases of penile fracture. Emergency surgical repair offers a chance for complete recovery and is the best method for providing a good functional prognosis.