Uterine torsion in twin pregnancy

A case of uterine torsion in a 37-years-old woman during twin pregnancy is described. Diagnosis was made during caesarean section and the torsion successfully reduced through a standing laparotomy. Detorsion was accomplished by rotating the uterus to the left. A severe post-partum haemorrhage occurred and hysterectomy was required. The patient recovered and was discharged home with her baby. Uterine torsion at term is a rare obstetric event that occurs mainly in the third trimester with adverse maternal and neonatal consequences and raises several critical management considerations. We review possible diagnostic signs and management of this rare complication from literature.     

Torsed pedunculated hepatic hamartoma

We report a 9-year-old boy with a 6-h history of acute abdominal pain due to torsion of a pedunculated hepatic mesenchymal hamartoma. The lesion was seen, on US and CT, to connect to the liver through a pedicle. Mesenchymal hepatic hamartomas are unusual tumours that may be pedunculated, and this is a unique case complicated by torsion. The radiological and pathological findings, differential diagnosis, and clinical course are discussed.     

成人心脏扭转运动生物力学机制的超声速度矢量成像研究

目的 应用超声速度矢量成像(velocity vector imaging,VVi)技术评价健康成人左室壁的旋转和扭转运动特征并探讨其成因.方法 应用VVI技术评价70例健康成人左室壁3个标准短轴水平和18个不同心肌节段的心内、外膜下心肌旋转特征和左室壁扭转运动特征,分别比较左室壁不同部位心肌在一个完整心动周期内的最大旋转角(Rmax)和左室壁心、内外膜下心肌的最大扭转角(Tmax)差异,并将左室壁的Tmax与左室壁不同短轴水平的Rmax做相关分析.结果 ①左室壁前间隔或前壁的Rmax比同一短轴水平其他心肌节段小(P>0.05).②一个完整心动周期内,左室壁基底水平与心尖水平旋转的主方向相反;左室壁乳头肌水平的Rmax小于基底水平或心尖水平(P<0.05),而左室壁基底水平与心尖水平的Rmax差异无统计学意义(P>0.05);左室壁的Tmax分别与左心室壁基底水平或心尖水平的Rmax呈线性正相关(P<0.01),而与乳头肌水平的Rmax零相关.③左室壁心内膜下心肌的Rmax大于心外膜下心肌(P<0.01);左室壁心内膜下心肌的Tmax大于心外膜下心肌[(11.44±4.82)°对(7.05±3.90)°,P<0.01].结论 健康成人左室壁扭转运动具有薄壁圆筒扭转特征,以生物力学理论为依据有望阐明心脏扭转运动生物力学机制.     

速度向量成像技术评价肥厚型心肌病心脏扭转运动

目的 应用超声心动图速度向量成像(VVI)技术对肥厚型心肌病(HCM)患者心脏扭转运动(cardiac twist)进行初步分析,探讨HCM患者在左室射血分数(LVEF)正常时心脏局部和整体扭转功能是否已有改变.方法 对30例HCM患者(其中左室流出道梗阻13例)和33例正常人(对照组)行常规超声心动图检查,测量LVEF、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、每搏量(SV)等.采用VVI技术测量左室基底部腱索水平、乳头肌水平和心尖水平收缩期心内膜下心肌和心外膜下心肌的最大旋转角度、峰值旋转速率、圆周应变(circumferential strain,CS)、圆周应变率(circumferential strain rate,CSR)、径向应变(radial strain,RS)、径向应变率(radial strain rate,RSR);测定舒张期峰值解旋转速率和解扭转率,以分析两组的心脏旋转和扭转运动.结果 HCM组与正常组相比,LVEF差异无统计学意义,LVEDV、LVESV、SV明显减低,心内膜下心肌的左室扭转角度、CS较正常人明显增高,心外膜下心肌的旋转速率、解旋转速率、CS、CSR均明显减低(P＜0.05),HCM组左室三个短轴水平的RS、RSR均明显低于对照组(P＜0.01);舒张期解扭转率低于对照组.HCM组分组资料显示:左室流出道梗阻组患者心外膜下心肌的旋转速率、解旋转速率、CS、CSR进一步减低.结论 HCM患者心脏整体扭转角度较正常人增大,局部心肌圆周方向变形能力下降,左室流出道梗阻加剧局部心功能的损伤.     

Spatial orientation perception and reflexive eye movements—A perspective, an overview, and some clinical implications

When head motion includes a linear velocity component, eye velocity required to track an earth-fixed target depends upon: a) angular and linear head velocity, b) target distance, and c) direction of gaze relative to the motion trajectory. Recent research indicates that eye movements (LVOR), presumably otolith-mediated, partially compensate for linear velocity in small head excursions on small devices. Canal-mediated eye velocity (AVOR), otolith-mediated eye velocity (LVOR), and Ocular Torsion (OT) can be measured, one by one, on small devices. However, response dynamics that depend upon the ratio of linear to angular velocity in the motion trajectory and on subject orientation relative to the trajectory are present in a centrifuge paradigm. With this paradigm, two 3-min runs yields measures of: LVOR differentially modulated by different subject orientations in the two runs; OT dynamics in four conditions; two directions of “steady-state” OT, and two directions of AVOR. Efficient assessment of the dynamics (and of the underlying central integrative processes) may require a centrifuge radius of 1.0 meters or more. Clinical assessment of the spatial orientation system should include evaluation of central integrative processes that determine the dynamics of these responses.     

Torsion of the spermatic cord — A long term study of the contralateral testis

Summary The object of the present investigation was to study the long-term effects of the unilateral torsion of the spermatic cord on the contralateral testis. Eighteen guinea pigs were divided into 3 groups. In group I of six animals, unilateral torsion of the spermatic cords was maintained until the time of sacrifice. In group II of six animals, torsion of the spermatic cords was maintained for 8–12h, then the spermatic cords were untwisted and the animals were maintained until the day of sacrifice. Group III six animals, received an injection of pentobarbital, which served as control. All animals were sacrificed after 16 months. Extensive light and electron microscopic studies were carried out. In the contralateral testes of the experimental group of animals, several degenerative changes were noted, which included excessive intraepithelial vacuolization, a loss of germ cells and the presence of tubules containing only Sertoli cells and a few spermatogonia. 10.6% and 19.5% seminiferous tubules were damaged in the contralateral testes of torsion maintained and the torsion reversed groups of animals, respectively in comparison to 3.1% tubular damage (indicated only by occassional presence of intraepithelial vacuoles and necrotic germ cells), in the control testis. It was concluded that long-term effect of unilateral torsion of the spermatic cord is permanent and irreversible in nature.     

Torsion of an accessory hepatic lobe in a child: ultrasound, computed tomographic, and magnetic resonance imaging findings

A case of acute epigastric pain resulting from torsion of an accessory hepatic lobe is reported. Sonographic, computerized tomographic, and magnetic resonance findings are illustrated and the surgical management is discussed. Accepted: 12 June 1997     

不同激动顺序犬左心室收缩期跨壁扭转运动的超声实验研究

目的 应用斑点追踪成像技术评价不同电机械激动顺序下收缩期左室跨壁扭转运动特征.方法 5只开胸比格犬模型,分别在基础(BASE),右心耳(RAA)、右室心尖(RVA)、左室侧壁(LVL)和左室心尖(LVA)起搏状态采集左室心尖、基底短轴和四腔心图像.QLAB软件分析短轴切面心内膜下、心外膜下和整体旋转角度(RA)及节段角位移(AE),计算左室扭转及射血分数(EF).结果 ①RAA组心内膜下、心外膜下和整体扭转,基底和心尖水平心内膜下、心外膜下和整体RA及AE与BASE组间差异无统计学意义(P>0.05);②RVA组心内膜下、心外膜下和整体扭转及LVA组心内膜下和整体扭转均小于RAA组(P<0.05);RVA和LVA组基底心内膜下、心外膜下和整体RA均小于RAA组(P<0.05);③心室起搏后起搏位点相邻节段心肌AE小于RAA组(P<0.05);④BASE状态心内膜下扭转大于心外膜下(P<0.05),起搏仅呈心内膜下扭转大于心外膜下趋势(P>0.05);⑤BASE组与RAA组心外膜下和整体扭转与左室EF呈正相关;基底心内膜下、心外膜下和整体RA与左室EF呈正相关.结论 RVA及LVA起搏明显抑制左室跨壁扭转运动;正常激动顺序下左室整体及外膜下心肌扭转和基底旋转运动与左室EF关系密切.     

Torsed wandering spleen as a cause of recurrent abdominal pain in a child

Wandering spleen is an uncommon cause of acute abdomen in children. Diagnosis of this condition is challenging due to its non-specific symptoms, varying intensity and protracted history of presentation. Radiographs and ultrasound imaging provide rapid and reliable means to diagnose this condition without exposure to excessive radiation. We present a case of a torsed wandering spleen in a child with recurrent abdominal pain. We highlight the role of imaging in identifying salient radiographic and sonographic signs for diagnosis.