Causes of renal forniceal rupture

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Renal forniceal rupture is a common finding in patients with ureteral obstruction. It is thought to be due to increased renal pelvis pressure from backup of urine, causing one or more renal fornices to leak urine. This phenomenon has not been systematically studied. Herein we retrospectively review the causes and associated clinical findings in over 100 cases of renal forniceal rupture.

OBJECTIVE

? To perform a retrospective review aiming to identify causes of renal forniceal rupture.

PATIENTS AND METHODS

? A retrospective review was performed of the longitudinal medical record and CT records for patients identified as having renal ‘forniceal rupture’ or ‘calyceal rupture’ using a radiological database.

RESULTS

? In total, 108 patients were identified with the CT diagnosis of renal ‘forniceal’ or ‘calyceal’ rupture. ? Forniceal rupture was caused by ureteric stones in 80 cases (74.1%), malignant extrinsic ureteric compression in nine cases (8.3%), benign extrinsic ureteric compression in two cases (1.9%), pelvic‐ureteric junction obstruction in two cases (1.9%), vesico‐ureteric junction (VUJ) obstruction in one case (0.9%), bladder outlet obstruction in one case (0.9%) and iatrogenic causes in four cases (3.7%). ? No definitive cause was found in nine cases (8.3%). For patients in whom a ureteric stone was the cause of forniceal rupture, the level of obstruction was proximal ureter in 24.3% of cases, distal ureter in 17.6% of cases and VUJ in 58.1% of cases. ? Mean (sd ) stone size was 4.09 (2.0) mm. Mean (sd ) stone size was 5.34 (1.87) mm for proximal stones, 4.08 (1.69) mm for distal stones and 3.53 (1.96) mm for VUJ stones (P= 0.005). ? Urinary tract infection was present in five out of 97 patients (5.2%) in whom data were available for analysis.

CONCLUSION

? The most common aetiology of renal forniceal rupture is obstruction caused by distal ureteric stones followed by malignant extrinsic ureteric compression.     

Early Surgical Repair of Acute Complete Rupture of the Proximal Hamstring Tendons

Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed.     

Covered Stents in the Treatment of Peripheral Arterial Aneurysms: Procedural Results and Midterm Follow-Up

Purpose: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents. Methods: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms (7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid). Results: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (<30 days), one patient died of puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage. At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%). Conclusion: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis.     

主动脉窦MR表现和主动脉窦瘤MR诊断

目的：探讨正常主动脉窦的ＭＲ表现和主动脉窦瘤的ＭＲ诊断。材料和方法：筛选心脏检查病例正常组３９例,主动脉窦瘤或可疑窦瘤组４例,行体轴横断位、冠状位、矢状位Ｔ１ＷＩ门控成像。对各成像位置上主动脉窦作形态学分析和测量。结果：正常主动脉窦以冠状位显示最佳,但仅能显示无名窦和左窦;矢状位显示欠清,主要显示右窦,部分可显示无名窦。形态学可分为二种：１括弧形（３４／３９）,对称或不对称,包括双括弧（３２／３９）和单括弧（２／３９）;２双钩形（４／３９）,４例均对称。横断位上变异大。冠状位上正常左窦弧度１２０°±３４°,无名窦弧度１１３°±２９°,总平均弧度１１６°±３２°,正常值范围１１６±６３°（９５％可信区间）。矢状位上右窦较小且显示欠清,难以测量。主动脉窦瘤表现为１破裂征;２凸入征;３窦弧度明显超过１８０°;４单个窦腔改变。结论：ＭＲＩ常规门控Ｔ１Ｗ成像可良好显示主动脉窦,弧度测量有助于窦腔评价;典型表现有助于主动脉窦瘤的诊断。     

脾动脉瘤27例诊治分析

目的 探讨脾动脉瘤的早期诊断和治疗方法。方法 对1957年9月－2000年6月诊治的27例脾动脉瘤作一回顾性分析。结果 27例脾动脉瘤中伴动脉粥样硬化12例,门静脉高压症9例,胰腺炎2例,外伤2例,肌纤维发育不良及细菌性心内膜炎所致各1例。发生自发性破裂大出血4例（14．8％）。术前20例经彩超及彩色多普勒血流显像（CDFI）检查初步确诊16例;5例经螺旋CT血管造影（SCTA）、5例经选择性内脏动脉造影、5例数字减影血管造影（DSA）、例经磁共振血管造影三维重建（3D MRA）而确诊;术前依靠临床表现获诊断仅1例;11例经手术探查确诊。本组行包括胰尾脾的脾动脉瘤切除术11例,脾动脉瘤切除加脾动脉重建术6例,脾动脉瘤切除术未重建脾动脉3例,动脉瘤近远端脾动脉结扎术3例,介入栓塞术4例。无死亡病例。结论 重视和警惕脾动脉瘤的可能并通过CDFI、SCTA、3D MRA及DSA等影象技术对脾动脉瘤作出早期诊断;一旦确诊应根据病情微创、安全、有效的腔内介入栓塞治疗或尽早手术。     

Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.     

成人外伤性脾破裂非手术治疗55例分析

目的对非手术治疗外伤性脾破裂进行临床分析,为外伤性脾破裂临床治疗方法的选择提供初步证据。方法回顾1992年至2006年我院收治的包括选择性脾动脉栓塞和保守治疗的非手术治疗脾破裂患者55例,对治疗成功率、死亡率和并发症发生率进行分析比较,并评价其卫生经济学效益。结果治疗总成功率87．27％（48／55）,元患者死亡。损伤严重程度分组,51例脾Ⅰ、Ⅱ级损伤,总有效率90．19％（46／51）,再次栓塞或开腹手术5例。4例脾外伤Ⅲ级患者,2例非手术治疗成功,再次栓塞或开腹手术2例。治疗分组分析,传统保守治疗组保脾成功率为81．3％（26／32）,选择性脾动脉栓塞组成功率为100％（23／23）（P=0．035）。选择性脾动脉栓塞组2例并发左侧胸腔积液,1例并发左下肺感染;保守治疗组1例并发脾周脓肿。选择性脾动脉栓塞组平均住院日较保守治疗组[（7．9±4．2．1）d比（11．9±4．4．6）d]明显缩短（P=0．045）,但住院花费增加[（4216±668．4）元比（2616±437．8）元]（P〈0．05）。结论脾损伤Ⅰ、Ⅱ级患者适宜保脾治疗,选择性脾动脉栓塞术比传统非手术保守治疗疗效更为可靠,在医疗设备和经济条件允许的情况下建议考虑栓塞治疗。     

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion.