Torsion of the Gallbladder Diagnosed by Magnetic Resonance Cholangiopancreatography

Torsion of the gallbladder is a rare entity that is difficult to diagnose preoperatively, the principal differential diagnosis being cholecystitis. The condition occurs most often in the elderly. Although its etiology is unknown, the presence of a redundant mesentery is a prerequisite for torsion. Computed tomography, ultrasound, and magnetic resonance cholangiopancreatography can provide important diagnostic clues. Torsion of the gallbladder occurs when it twists axially, with subsequent occlusion of bile or blood flow. Therefore, prompt surgical treatment is necessary in order to prevent necrosis and perforation. In the present study, we report a case of torsion of the gallbladder diagnosed by magnetic resonance cholangiopancreatography. This condition was successfully treated by laparoscopic cholecystectomy.     

Renal allograft torsion associated with prune-belly syndrome

We report a 26-month-old child diagnosed with prune-belly syndrome and end-stage renal disease who received intraperitoneal implantation of an adult cadaveric renal graft which functioned very well for approximately 6 weeks. The patient then presented with acute renal failure which was proved to be secondary to torsion of the graft, twisting the artery and vein. The ureter was wrapped 360° around the graft. These conditions resulted in loss of the graft and nephrectomy. Ours is the second report of such an occurrence; the first was from a living-related kidney donor. We believe the lack of abdominal wall tone contributes to graft mobility and risk of torsion of the kidney. We recommend that nephropexy be considered in these patients. In addition, the risk of torsion must be at the forefront of the differential diagnosis in a prune-belly renal transplant patient with acute onset of oliguria. Renal sonorgraphy with Doppler should be employed as soon as possible so that the graft can be saved.     

Colonoscopy in the emergency treatment of colonic volvulus in Nigeria

The commonest cause of large-bowel obstruction in Nigeria is sigmoid volvulus. Patients usually present late, dehydrated, and in very poor condition. The mortality of emergency colonic surgery is undoubtedly high, more so in developing countries poorly equipped to cope with such a condition. To reduce the mortality rate and improve management of the patients, a four-year prospective study of detorsion followed by elective surgery after adequate resuscitation and bowel preparation was carried out between January 1979 and December 1982. Volvulus is classified into three groups: torsion, obstruction, and strangulation. Criteria for short colonoscopic detorsion of torsion and obstruction types are discussed, and the contraindication in the case of strangulation type mentioned. This article describes the management of 92 cases of sigmoid volvulus between 1979 and 1982.     

Morphological and Immunological Observations in Experimentally Induced Torsion of Testis in Rats

ABSTRACT: In an experimentally established model of torsion of the testis, morphological and immunological observations were evaluated on 180 Wistar rats. Torsion of the testis was carried out to observe in animals the biological phenomenon that naturally occurs in man. The effect of the twisted testis on the contralateral testis was carefully checked. The morphological observations revealed serious damage to the seminiferous tubules in the contralateral testis. In four rats, persistent infertility was observed as an effect of torsion. The infertility was confirmed by total atrophy of seminiferous epithelium in testis section. The cell-binding abilities of sera obtained from rats at different times after torsion were studied by cell-binding radioimmunoassay with different types of germinal cells. The presence of autoantibodies to epididymal spermatozoa was revealed in most cases, being a secondary effect of the thus-far unknown, nonspecific factors responsible for damage of the contralateral testis.     

兔附件扭转模型的建立及其意义探讨

目的建立一种操作简单、病变典型、稳定性好的兔在体附件扭转模型并探讨保留卵巢术后卵巢的病理变化和iNOS的改变。方法40只日本大耳白兔采用随机数字法分为附件扭转(adnexal torsion,AT)模型组(n = 32)和对照组(n = 8)。模型组兔将左侧附件按顺时针方向扭转3周,避开血管,以4/0丝线横穿扭转形成的3个螺旋圈后固定于左侧腹壁,然后再将之分成4组,每组8只,分别于扭转24、48、72、96h后解除扭转后取双侧卵巢;对照组假手术后96h后取双侧卵巢。所有切除之右侧卵巢组织行病理学研究的内对照,左侧卵巢取1/2行病理检测,另1/2行iNOS生化水平检测。结果左侧附件扭转3周固定左侧腹壁24 h后可见卵巢充血、炎细胞浸润、细胞水肿;48h见较多的炎细胞浸润,细胞结构紊乱;72 h见大量炎细胞浸润,结构损坏和局灶性坏死;96 h见弥漫性细胞坏死;卵巢组织病理评分呈现相同的时相性变化。各组iNOS生化检测水平(左侧vs.右侧),AT组 ［24 h (3.542±0.987) vs. (1.521±0.214)U/mgprot,P<0.01;48 h (4.986±1.321) vs. (1.832±0.321) U/mgprot,P<0.01;72 h (7.991±1.832) vs. (1.124±0.357)U/mgprot,P<0.01;96 h (6.991±1.227) vs. (1.732±0.572)U/mgprot,P<0.01］。且AT组卵巢均有iNOS不同程度表达,72 h组表达达高峰,96 h下降。 结论成功地制备兔附件扭转模型,方法简单、病变典型、重复性好,可模拟女性附件扭转的病理生理过程,对进一步研究附件扭转具有重要意义。初步认为附件扭转72h后卵巢发生不可逆改变,是临床处理附件扭转并保留卵巢的时间临界点。      

左心室应变和扭转对冠心病患者心脏功能水平的关系研究

【摘要】目的 应用斑点追踪技术检测冠心病患者左心室应变和扭转情况,研究左心室应变和扭转对冠心病患者心脏功能水平的关系。方法 选取我院于2016年10月到2017年10月收治的冠心病患者70例,按照纽约临床心功能分级积分(NYHA-P)分为纽约临床心功能分级正常组38例,心功能分级异常组32例,以及再选择体检正常的志愿者30位作为对照组,比较受检者的NYHA-P、左室射血分数(LVEF)、总体心肌整体径向应变(GRS)、纵向应变(GLS)、左室心肌收缩期心肌扭转角度(TA)。结果 冠心病患者组与对照组比较,LVEF、GLS、GRS、TA降低。心功能分级正常组与异常组相比,LVEF、GLS、GRS、TA降低。心功能正常组GLS、GRS、TA与LVEF无相关性,与NYHA-P相关。心功能异常组GLS、GRS、TA与LVEF及NYHA-P都相关。心功能分级异常组以GLS-14.75%截断点判定患者NYHAP积分高于4.5分的灵敏度为87.45%,特异度为72%,Youden指数最高为0.653。结论 左心室应变和扭转与冠心病患者心脏功能水平相关,可以有效评价冠心病患者的临床心脏功能水平。     

EZ取钉器的生物力学测试和临床初步应用

目的 通过生物力学测试和临床初步应用验证EZ取钉器对断钉、打滑螺钉的取出效果。方法 采用新鲜尸骨标本,股骨、胫骨、尺桡骨各4具,并随机分为两组：A组为起子取螺钉扭力组;B组为骨髓腔内灌骨水泥固定螺钉组,其中B1为螺钉打滑时最大扭力组;B2为EZ取钉器一个手柄时取钉器最大扭力组;B3为两个手柄时取钉器的最大扭力组,制成4种生物力学测试模型,内固定螺钉分为4.5 mm和3.5 mm两种类型。在万能材料试验机上测试实验标本,施加轴向载荷2 kN,测量扭转拔出螺钉时的最大扭矩值、扭角及螺钉拔出时功耗大小和效率。实验数据经统计学处理, 进行组间比较。并用EZ取钉器在12例患者中初步应用。结果 A组最大拔出扭矩为1.42～1.96 N·m,B1组为2.87～3.27 N·m,B2组为3.06～4.83 N·m,B3组为4.12～8.36 N·m,各组间均呈显著性差异（P<0.05）。其相对应各组的扭角均值分别为1.59°、0.77°、0.28°和0.16°,各组间有明显差异（P<0.05）。螺钉拔出（旋出）时,各组的功耗均值分别为12、21、32和45J;对应各组间的功率（机械效率）分别为0.20、0.35、0.53和0.75 J/s,组间呈明显差异（P<0.05）。在12例临床断钉和打滑螺钉患者中初步应用,均成功取出,未出现术后并发症。结论EZ取钉器具有足够的抗扭强度和刚度,夹持力大,拔钉稳定可靠,是取出骨骼中断钉和打滑螺钉较理想的工具。     

睾丸扭转50例临床分析

目的探讨睾丸扭转的早期诊断与治疗方法。方法对运用彩色超声检查确诊为睾丸扭转的50例患者的临床资料进行回顾性分析。结果 5例行睾丸切除术,45例手术复位并行睾丸固定术。术后随访3年,25例患者术后睾丸发生不同程度的萎缩,但尚未发现生育能力受限者。结论彩色多普勒超声检查是早期诊断睾丸扭转的可靠方法,早期诊断、及时治疗对提高睾丸存活率有重要意义。