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Anaesthesia Jan 2013Patients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower... (Review)
Review
Patients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management.
Topics: Anesthesia; Anesthesia, Conduction; Anesthesia, General; Emergency Medical Services; Endovascular Procedures; Humans; Postoperative Care; Rupture; Vascular Diseases; Vascular System Injuries
PubMed: 23210558
DOI: 10.1111/anae.12048 -
JNMA; Journal of the Nepal Medical... Oct 2022Penile fracture is a rare condition with an incidence of 1 case per 175000 United States male population. It can be caused by vigorous sexual intercourse and...
UNLABELLED
Penile fracture is a rare condition with an incidence of 1 case per 175000 United States male population. It can be caused by vigorous sexual intercourse and masturbation. Patients usually present with pain and swelling of the penis and can be diagnosed clinically. It mostly occur as a result of rupture of tunica albuginea of corpora cavernosa. Ultrasound is the most reliable investigation to detect penile fractures. Patients need prompt treatment with exploration and repair of defects to prevent long-term sequelae. Here we present a case of 44 years male who developed a penile fracture following sexual intercourse and underwent surgical exploration and repair.
KEYWORDS
masturbation; penis; sexual intercourse.
Topics: Humans; Male; Penis; Rupture; Coitus; Masturbation; Edema
PubMed: 36705147
DOI: 10.31729/jnma.7876 -
Medical Principles and Practice :... 2017Iatrogenic tracheal rupture (ITR) represents a life-threatening condition requiring prompt diagnosis, management, and treatment. The management of ITR is challenging,... (Review)
Review
Iatrogenic tracheal rupture (ITR) represents a life-threatening condition requiring prompt diagnosis, management, and treatment. The management of ITR is challenging, and treatment options depend on tear location, size, injury extent, and the patient's respiratory status. Although this complication has been extensively reported in published literature, the best evidence practice, for the management, requires clarification. In this review, the authors focused on the establishment of a differential diagnosis and the potential mechanism of the injury, the decision-making process, and the therapeutic approaches. It is suggested that for small lacerations or stable patients, conservative management could be considered sufficient, whereas invasive surgical therapy would be more appropriate in cases of large defects with significant air leak and patient instability.
Topics: Clinical Protocols; Humans; Intubation, Intratracheal; Respiration, Artificial; Rupture; Trachea; Tracheotomy
PubMed: 28208144
DOI: 10.1159/000455859 -
Plastic and Reconstructive Surgery Jan 2022Patient compliance has been low for U.S. Food and Drug Administration-recommended magnetic resonance imaging scans to screen silicone gel breast implants for silent...
BACKGROUND
Patient compliance has been low for U.S. Food and Drug Administration-recommended magnetic resonance imaging scans to screen silicone gel breast implants for silent rupture. High-resolution ultrasound scans are a convenient, in-office alternative that may improve screening compliance; however, women's attitudes and feelings about silent rupture and their desire for rupture screening are unknown.
METHODS
Plastic surgeons and staff in nine private practices received 1-day training in high-resolution ultrasound scanning, then screened women with silicone gel implants implanted since 2000. Suspect scans were reviewed by a high-resolution ultrasound-experienced plastic surgeon to determine if they showed ruptures. Surgical and scan findings were correlated. To learn attitudes and feelings about silent rupture, women took surveys before and after the scan.
RESULTS
Of 584 women screened, 82 (14.0 percent) had scans showing ruptures; of 1153 implants, 92 (8.0 percent) showed ruptures. Forty women with scans showing ruptures underwent surgery, of which 30 (75 percent) had their ruptures confirmed. Surveys found 99.5 percent of women want to know if they have a rupture and 95.2 percent want the ruptured implant removed. If the scan showed no rupture, women felt relieved and 95.5 percent would get future high-resolution ultrasound screening for silent rupture. If a rupture was found, women expressed various concerns and 87.8 percent would remove the ruptured implant within 12 months.
CONCLUSIONS
Surveys show that women with silicone gel implants have concerns and feel anxious about possible silent rupture. Based on 14 percent of women showing a ruptured implant on high-resolution ultrasound scans and 75 percent of ruptures on high-resolution ultrasound scans surgically confirmed, 10.6 percent of women in this study have a silent rupture.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Diagnostic, IV.
Topics: Adult; Breast Implants; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Middle Aged; Prospective Studies; Prosthesis Failure; Rupture; Silicone Gels; Ultrasonography, Mammary
PubMed: 34936597
DOI: 10.1097/PRS.0000000000008632 -
Ugeskrift For Laeger Sep 2017Anterior cruciate ligament (ACL) injuries are typically seen in cutting sports. Rehabilitation can be tried in athletes in non-cutting sports and in recreational... (Review)
Review
Anterior cruciate ligament (ACL) injuries are typically seen in cutting sports. Rehabilitation can be tried in athletes in non-cutting sports and in recreational athletes. If knee instability is experienced, the cessation of risk activities or reduction in activity level are recommended. With recurrent episodes of instability ACL-reconstruction is recommended. 65% return to sports at preinjury level after ACL-reconstruction, 18% after non-operated partial rupture and 7% after non-operated total rupture.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Athletic Injuries; Humans; Joint Instability; Magnetic Resonance Imaging; Practice Guidelines as Topic; Return to Sport; Rupture; Time-to-Treatment
PubMed: 28918789
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Feb 2017
Topics: Conservative Treatment; Humans; Rupture; Tibial Meniscus Injuries
PubMed: 28225222
DOI: 10.4045/tidsskr.16.1028 -
BMJ Case Reports Jul 2020Extensor mechanism injuries are not uncommon in young active individuals. Patellar tendon is a part of extensor mechanism of the knee which is commonly ruptured due to...
Extensor mechanism injuries are not uncommon in young active individuals. Patellar tendon is a part of extensor mechanism of the knee which is commonly ruptured due to forced eccentric contraction against flexed knee. There have been reports of pathological changes in the patellar tendon which eventually lead to the rupture. The common pathologies include hypoxic tendinopathy, mucoid degeneration, calcific tendinopathy and tendolipomatosis. We report a rare case of ossified proximal patellar tendon rupture in a fit and active skittle player, who sustained indirect injury to knee while playing soccer. The rupture was confirmed on examination and radiographs. We discovered intraoperatively that the ruptured proximal patellar tendon was ossified which was sequentially repaired with two Krackow sutures, JuggerKnot suture anchor and finally augmented with Leeds Keio tape. Postoperatively, a knee brace was used to immobilise in knee extension with progressive increase in range of motion. This report supports the pool of evidence suggestive of patellar tendon pathology in causing ruptures.
Topics: Humans; Knee; Knee Injuries; Male; Middle Aged; Orthopedic Procedures; Ossification, Heterotopic; Patellar Ligament; Range of Motion, Articular; Rupture; Suture Techniques; Tendon Injuries
PubMed: 32675119
DOI: 10.1136/bcr-2020-235143 -
Journal of Vascular Surgery Dec 2022
Topics: Humans; Aortic Rupture
PubMed: 36410845
DOI: 10.1016/j.jvs.2022.06.028 -
Acta Orthopaedica Et Traumatologica... Mar 2023The study aimed to investigate the polymorphism of fibrillin-2 (FBN2) and elastin genes in patients with Achilles tendon rupture and to compare the results with a...
OBJECTIVE
The study aimed to investigate the polymorphism of fibrillin-2 (FBN2) and elastin genes in patients with Achilles tendon rupture and to compare the results with a control group of participants who did not experience such an injury.
METHODS
In this prospective study, 106 consecutive patients in whom traumatic Achilles tendon rupture was diagnosed and treated were included. The control group consisted of randomly selected 92 athletes (10 women and 82 men) 85 of whom had practiced sports in the past, aged 40-76 years, who during their sports career did not experience Achilles tendon ruptures. Material for genetic tests was obtained by the swab from the oral cavity epithelium of all the study population.
RESULTS
102 (96%) of patients with traumatic Achilles tendon ruptures were people with polymorphism B or heterozygotes for the elastin gene. 97 (92%) of patients with traumatic Achilles tendon ruptures were people with polymorphism B and heterozygotes for the FBN2 gene. Patients with homozygote A of the elastin gene and homozygote A of the FBN2 gene demonstrated a considerably lower incidence rate of sport-related Achilles tendon rupture. The type of sport that led to the Achilles tendon rupture and the amount of experience practicing it, as well as BMI and drug usage, did not contribute to a higher rate of incidence of any additional musculoskeletal problems or a longer time to return to their pre-injury sports activity. Polymorphisms of the fibrillin 2 (P=.0001) and elastin (P=.0009) genes impact the occurrence of traumatic injury to the Achilles tendon. However, it does not affect the length of full recovery time (P =.2251).
CONCLUSION
Minimally invasive and, above all, safe collection of genetic material from the epithelium of the oral cavity in order to assess the polymorphic state of the FBN and elastin genes may allow the identification of a group of players at risk of Achilles tendon rupture resulting in long-term injury, which will significantly affect their sports career in the future.
LEVEL OF EVIDENCE
Level II, Prognostic Study.
Topics: Female; Humans; Male; Achilles Tendon; Elastin; Fibrillin-2; Polymorphism, Genetic; Prospective Studies; Rupture; Tendon Injuries
PubMed: 37140249
DOI: 10.5152/j.aott.2023.22024 -
PloS One 2023To compare the rerupture rate after conservative treatment, open repair, and minimally invasive surgery management of acute Achilles tendon ruptures. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the rerupture rate after conservative treatment, open repair, and minimally invasive surgery management of acute Achilles tendon ruptures.
DESIGN
Systematic review and network meta-analysis.
DATA SOURCES
We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to August 2022.
METHODS
Randomised controlled trials involving different treatments for Achilles tendon rupture were included. The primary outcome was rerupture. Bayesian network meta-analysis with random effects was used to assess pooled relative risks (RRs) and 95% confidence intervals. We evaluated the heterogeneity and publication bias.
RESULTS
Thirteen trials with 1465 patients were included. In direct comparison, there was no difference between open repair and minimally invasive surgery for rerupture rate (RR, 0.72, 95% CI 0.10-4.4; I2 = 0%; Table 2). Compared to the conservative treatment, the RR was 0.27 (95% CI 0.10-0.62, I2 = 0%) for open repair and 0.14 (95% CI 0.01-0.88, I2 = 0%) for minimally invasive surgery. The network meta-analysis had obtained the similar results as the direct comparison.
CONCLUSION
Both open repair and minimally invasive surgery were associated with a significant reduction in rerupture rate compared with conservative management, but no difference in rerupture rate was found comparing open repair and minimally invasive surgery.
Topics: Humans; Achilles Tendon; Bayes Theorem; Rupture; Tendon Injuries; Acute Disease; Minimally Invasive Surgical Procedures; Ankle Injuries; Treatment Outcome
PubMed: 37130120
DOI: 10.1371/journal.pone.0285046