The influence of torsion on disc herniation when combined with flexion

The role of torsion in the mechanical derangement of intervertebral discs remains largely undefined. The current study sought to investigate if torsion, when applied in combination with flexion, affects the internal failure mechanics of the disc wall when exposed to high nuclear pressure. Thirty ovine lumbar motion segments were each positioned in 2° axial rotation plus 7° flexion. Whilst maintained in this posture, the nucleus of each segment was gradually injected with a viscous radio-opaque gel, via an injection screw placed longitudinally within the inferior vertebra, until failure occurred. Segments were then inspected using micro-CT and optical microscopy in tandem. Five motion segments failed to pressurize correctly. Of the remaining 25 successfully tested motion segments, 17 suffered vertebral endplate rupture and 8 suffered disc failure. Disc failure occurred in mature motion segments significantly more often than immature segments. The most common mode of disc failure was a central posterior radial tear involving a systematic annulus–endplate–annulus failure pattern. The endplate portion of these radial tears often propagated contralateral to the direction of applied axial rotation, and, at the lateral margin, only those fibres inclined in the direction of the applied torque were affected. Apart from the 2° of applied axial rotation, the methods employed in this study replicated those used in a previously published study. Consequently, the different outcome obtained in this study can be directly attributed to the applied axial rotation. These inter-study differences show that when combined with flexion, torsion markedly reduces the nuclear pressure required to form clinically relevant radial tears that involve cartilaginous endplate failure. Conversely, torsion appears to increase the disc wall’s resistance to radial tears that do not involve cartilaginous endplate failure, effectively halving the disc wall’s overall risk of rupture.     

斑点追踪技术评价左心室扭转的初步临床应用

目的探讨超声心动图斑点追踪技术用于临床无创测量左心室扭转角度（left ventricular torsion,LVtor）的可行性,初步探讨LVtor的临床意义及相关影响因素。方法连续采集100例因临床需求接受常规超声心动图检查患者的二维灰阶动态图像,使用2DStrain软件,分别于左心室短轴基底及心尖水平切面测量心肌最大收缩旋转角度,计算LVtor=心尖旋转角度-心底旋转角度,分析其与受检者临床情况（年龄、性别、体表面积、心率、伴随疾病）及常规超声心动图参数间的关系。结果EF（r=0.344,P=0.003）、左室收缩末内径（r=-0.324,P=0.005）与LVtor相关良好。年龄与LVtor相关（P=0.007）,而与EF无显著相关（P〉0.05）。结论斑点追踪技术能够无创测量临床患者LVtor。LVtor与EF的正相关提示其可在一定程度上反映左心室整体收缩功能。随年龄增长EF无明显变化而LVtor增大,提示扭转运动的增强可能是维持左心室整体收缩功能的代偿机制。     

Tibial rotational osteotomy with intramedullary nail fixation

There are several theoretic advantages of using intramedullary rod fixation for tibial osteotomy fixation. We performed a retrospective review of patients who were treated with a mid-diaphyseal osteotomy of the tibia fixed with an intramedullary rod for isolated, symptomatic tibial torsion. Forty patients (59 tibias) were included in the study and were followed for a minimum of 12 months or until rod removal (average follow-up 22.6 months). Major complication rate was 8.5%, which is comparable to alternative methods of fixation. We believe that intramedullary rods are a safe alternative for fixation of tibial rotational osteotomy in patients with physeal closure.     

大网膜扭转1例并文献复习

目的探讨大网膜扭转的的诊治方法。方法回顾性分析1例并1995年1月至2009年12月部分文献报道的大网膜扭转患者73例的临床资料。结果74例患者中,男51例,女23例,男女比例为2．2：1;年龄3—65岁,平均25．3岁,其中〈18岁35例（47％,肥胖者27例）,≥18岁39例（53％,肥胖者1例）。术前确诊9例（12％）;原发性大网膜扭转49例（66％）,继发性大网膜扭转为25例（34％）;在原发性大网膜扭转患者中,肥胖儿童是相关危险因素;在继发性大网膜扭转患者中,粘连是最常见的病因;大网膜扭转的常见临床表现为腹痛和腹部压痛;在术前检查中,B超检查阳性率24％（6／25）,CT检查阳性率96％（23／24）,MRI检查阳性率100％（2／2）。治疗方式：23例采用腹腔镜手术,51例开腹手术,术中联合阑尾切除术6l例。均治愈出院,未发生大出血、肠坏死等严重并发症。结论大网膜扭转临床上不常见,术前确诊率较低,CT和MRI检查有助于做出正确的诊断;腹腔镜手术在治疗大网膜扭转中有一定的优势。     

Accessory spleen torsion: rare cause of acute abdomen in children and review of literature

Torsion of an accessory spleen is an extremely rare condition. We describe an unusual case of acute abdomen caused by torsion of an accessory spleen in a 12-year-old boy. The patient underwent a laparotomy with splenectomy; the course was favorable. We discuss the clinical findings and values of preoperative instrumental diagnosis. The literature is also reviewed. This is the 11th case reported in the English literature. Torsion of an accessory spleen should be considered in the differential diagnosis of acute abdomen or subacute abdominal pain.     

Torsion of partial cleft of ear lobule

IntroductionTorsion is a well-known phenomenon involving organs with long mesentery. Torsion in the ear lobule is rare. Ear lobule is very well vascularized. In cases of partial cleft ear lobule, there is a small segment of lobule inferior to the cleft which is vascularized through the pedicles on either side of the cleft.Case reportA lady aged 89 years presented with discoloration of the ear lobule. She was diagnosed as having gangrene of the central part of lobule. The segment of the lobule had undergone more than 360° torsion. She underwent debridement of gangrenous part and lobuloplasty.Discussion and conclusionIn our case laxity of the stretched lobule caused the torsion of the segment followed by gangrene. This rare complication indicates the need for correction of the cleft lobule not only for esthetic purpose, but also for the prevention of torsion.     

Subclinical left ventricular dysfunction during systemic lupus erythematosus activity with follow-up after remission – A speckle tracking echocardiographic study

Aim of the workTo investigate the subclinical left ventricular (LV) dysfunction in patients with active systemic lupus erythematosus (SLE) using speckle tracking echocardiography (STE). The echocardiographic parameters were followed up when the disease activity was controlled.Patients and methodsThis prospective study included 63 patients with active SLE and LV ejection fraction (EF) ≥50%.Safety of Estrogens in Lupus Erythematosus: National Assessment – Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) was assessed and categorized as mild/moderate (≤12) or severe (>12). Fifty SLE patients continued follow-up after 3–6 months of the disease remission. Fifty age- and gender-matched healthy individuals acted as the control group. The measured STE parameters included LV deformation (global longitudinal strain [GLS] and global circumferential strain [GCS]) and rotational parameters (rotation, twist, and torsion).ResultsThe patients were 56 females and 7 males (F:M 8:1) and median age 26 years (IQR: 21–31 years) and a disease duration of 3 years (IQR 2–5 years. Active SLE patients showed worse strain parameters than controls (mean GLS ?19.9%±2.1 vs ?22.7%±1.3 and mean GCS ?21.2 ± 2.5% vs ?25.1 ± 1.7% respectively; p < 0.001 for both). Patients had lower LV rotational parameters (p < 0.001 for all). STE parameters were similar in patients with mild-moderate and severe activity and improved after remission in both groups.ConclusionActive SLE patients had modest LV dysfunction by STE despite having normal function by traditional echocardiography. Disease remission resulted in the improvement of STE parameters. STE is a simple tool to use in SLE activity scores to detect early cardiac dysfunction.     

速度向量成像技术评价肥厚型心肌病左心室扭转功能

目的应用超声心动图速度向量成像技术对肥厚型心肌病患者心脏扭转运动进行初步分析,探讨肥厚型心肌病患者在左心室射血分数(LVEF)正常时心脏局部和整体扭转功能是否有改变。方法肥厚型心肌病患者和健康体检者各30名。常规测量有关左心功能参数:LVEF、舒张末期容积(EDV)、收缩末期容积(ESV)、每搏量(SV)、二尖瓣口E、A峰值血流速度等。速度向量成像模式下在系列胸骨旁短轴观图像上测量收缩期心内膜下和心外膜下心肌的最大旋转角度、峰值旋转速率、圆周应变(CS)、圆周应变率(CSR)、舒张期和等容舒张期峰值解旋转速率。结果肥厚型心肌病组EDV、ESV、SV明显减低,A峰增高(P0.01);心内膜下心肌左心室扭转角度和扭矩增高,解扭转率减低(P0.05);心外膜下心肌的基底部峰值旋转速率、峰值解旋转速率减低(P0.05);心外膜下心肌的CS、CSR明显减低(P0.05)。结论肥厚型心肌病患者心脏整体扭转角度和速度较正常人增高,局部心肌圆周方向形变能力下降,以心外膜下心肌下降更为明显。     

超声二维应变成像评价肥厚型心肌病患者左室扭转

目的 应用超声二维应变成像评价肥厚型心肌病(HCM)患者左室短轴心肌扭转角度.方法 HCM患者21例,正常对照者20例,获取左室短轴二尖瓣环水平,心尖水平二维图像及心尖位四腔图、二腔图、左心长轴的二维图像,测定左室短轴二尖瓣水平、心尖水平各心肌节段收缩期旋转角度峰值,计算左室短轴心肌收缩期扭转角度峰值.结果 (1)HCM组与正常组左室短轴心肌收缩期扭转角度峰值比较,HCM组扭转角度峰值(16.9°±6.7°)较正常组(13.0°±5.7°)显著增大(P＜0.05);(2)HCM组与正常组左室短轴二尖瓣水平心肌收缩期旋转角度峰值比较,HCM组旋转角度峰值(-8.3°±2.8°)较正常组(-5.5°±2.1°)显著增大(P＜0.01),而心尖水平心肌收缩期旋转角度峰值差异无统计学意义.结论 HCM患者在左室收缩功能正常时,左室短轴扭转角度已出现改变,利用超声二维应变成像可准确检测HCM患者左室短轴心肌扭转角度.     

Ovarian hyperstimulation and oophorectomy following accidental daily clomiphene citrate use over three consecutive months

We describe the longest-known continuous use of clomiphene citrate ever reported in a human. As a result of a pharmacy error, a woman took 50 mg/day clomiphene citrate for three months. The prolonged use of this medication resulted in ovarian hyperstimulation and unilateral oophorectomy for torsion.