[Surgical correction of subjective excyclotorsion by tucking the anterior part of the superior oblique muscle tendon]

BACKGROUND

Asymmetrical folding of the anterior portion of the superior oblique muscle is a simplified variant of the Harada-Ito procedure that is supposed to selectively correct ocular torsion.

PATIENTS AND METHODS

This surgical technique was applied to 22 patients suffering from bilateral acquired IV nerve palsy. Ocular torsion was evaluated with the Harms tangent screen. Pre- and post-operative torsional values were compared. Post-operative follow-up was 12 months.

RESULTS

Pre-operatively, mean excyclotropia was 8.8 degrees in primary position and 15.9 degrees in downgaze. Post-operatively, these values decreased to 1.5 degrees and 4.1 degrees, respectively. An enlarged field of binocular single vision, extending beyond 10 degrees inferiorly, was obtained in 17/22 patients.

CONCLUSIONS

The selective technique of superior oblique muscle anterior tendon tucking allows one to efficiently correct the ocular torsion induced by acquired bilateral IV nerve palsy.

Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion

OBJECTIVE

To determine the diagnostic value of preoperative levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and E-selectin in patients with an adnexal mass who had surgery for ovarian torsion.

DESIGN

Prospective study.

SETTING

University hospital.

PATIENT(S)

Fifty consecutive women with adnexal mass who were admitted with a diagnosis of ovarian torsion.

INTERVENTION(S)

All had a single preoperative measurement of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA.

MAIN OUTCOME MEASURE(S)

To determine if a single preoperative serum sampling of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA can diagnose ovarian torsion.

RESULT(S)

Thirteen patients had proven torsion of the ovary. Serum levels of IL-6 were significantly higher in the 13 patients with proven ovarian torsion compared with the 37 without ovarian torsion. Patients with IL-6 serum values > or =10.2 pg/mL had a 16 times higher risk of having ovarian torsion. No significant difference was found in TNF-alpha, IL-8, and E-selectin between the two groups.

CONCLUSION(S)

The IL-6 levels might assist in the prompt diagnosis of ovarian torsion and allow a timely surgical intervention.

Twisting and infarction of the entire greater omentum managed by laparoscopy: a report of two cases

Twisting with infarction of the greater omentum is a rare cause of acute abdominal pain. Depending on the location, clinical symptoms can mimic other acute abdominal pathologies. The etiology remains elusive. Because of its rarity, correct diagnosis is difficult to make, but it can be helped by computed tomographic scan. The laparoscopical approach allows exploration of the abdominal cavity and surgical intervention. The preferred treatment remains resection of the necrotic omentum. We describe two cases of twisting with infarction (one left and one right) of the entire greater omentum managed laparoscopically over a period of two weeks.

The effects of N-acetylcysteine on antioxidant enzyme activities in experimental testicular torsion

Testicular torsion is a serious problem in male children and, if not treated at the right time, can lead to subfertility and infertility. The main reason for testicular damage is ischemia-reperfusion injury. A number of chemical substances have been used to protect testes against ischemia-reperfusion injury in experimental animals. The possible protective effect of N-acetylcysteine on testicular tissue after testicular detorsion was examined in the current study. Twenty-four rats were divided into four groups: sham operation, torsion, detorsion, and NAC + detorsion groups (n = 6 for each group). Excluding sham operation group, the rats were subjected to unilateral torsion (720-degree rotation in clockwise direction). After torsion (5 h) and detorsion (2 h), unilateral orchidectomy was performed. Malondialdehyde levels and superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase activities were determined in testicular tissue. Administration of N-acetylcysteine caused a decrease in malondialdehyde levels and an increase in glutathione peroxidase levels compared to detorsion group. The results suggest that N-acetylcysteine may be a potential protective agent for preventing the negative biochemical changes related to oxidative stress in testicular injury caused by testis torsion.

A case of torsion of a mucinous cystadenoma in triple-X syndrome with pure gonadal dysgenesis

Triple-X female characterized by primary amenorrhea and pure gonadal dysgenesis is extremely rare. We present a patient of triple-X syndrome who has not had menarche or the development of the secondary sexual characteristics. She had a hypoplastic uterus and streaked gonads on both sides with a twisted mucinous cystadenoma in the right adnexa.

Cranial strains and malocclusion: IV. Torsion

The cranial strain known as torsion does not fit within the Angle Classification. This strain is described and how to identify it. Torsion may occur as the only strain or is more commonly superimposed on another strain. Recognizing the presence of a torsion has a significant bearing on treatment sequencing. An approach to treatment is demonstrated.

Omental torsion mimicking acute appendicitis: a case report

Primary omental torsion is an uncommon cause of an acute abdomen that can mimic acute appendicitis. Herein we report a case of suspected acute appendicitis that proved to be a distal segment of infarcted omentum secondary to primary torsion.

Omental torsion with right-sided inguinal hernia

Omental torsion is a rare cause of acute abdomen. The diagnosis is usually not established before surgery, but recently some reports have described the usefulness of computed tomography (CT) for the detection of this condition. We encountered a 58-year-old man with torsion of the greater omentum secondary to right-sided inguinal hernia, and present the characteristic CT findings of a whirl-like mass with hyperattenuated fatty tissue.

Abdominal pain in a patient with osteosarcoma

Abdominal pain often occurs in patients receiving chemotherapy. The authors describe a patient with osteosarcoma who developed severe right-sided abdominal discomfort several days after being admitted for fever, neutropenia, and mucositis. Unexpectedly, the patient's pain was not therapy-related, but rather was caused by a midline pelvic mass.

Treatment of osteochondral fracture of the trochlea of the PIP joint

INTRODUCTION

Osteochondral (OC) fractures of the trochlea of the PIP joint are rare but the treatment of these fractures can be challenging [2, 5, 6, 10]. And the therapeutic guideline is not determined.

MATERIALS AND METHODS

All of the three cases were male. Two were delayed union with minimal displacement and the other was a fresh displaced fracture. All cases were treated with ORIF using small K-wires. In delayed union cases, bone grafting was added.

RESULTS

Although bone union was obtained in all cases, rotation of the fragment due to the absorption of the grafted bone resulted in deformity of the trochlea in one of the delayed union cases. The functional recovery at the 2-year follow-up was satisfactory in all cases.

CONCLUSION

Although OC fracture of the trochlea of PIP joint carry significant fixation implications, successful treatment could be done with ORIF using small K-wire fixation technique.

Ocular overelevation in adduction in craniosynostosis: is it the result of excyclorotation of the extraocular muscles?

PURPOSE

We sought to determine whether radiological evidence supports excyclorotation of the extraocular muscle cone as a cause of overelevation in adduction in children with craniosynostosis.

METHODS

This was a retrospective case series of 40 patients with craniosynostosis. Ophthalmic findings were assessed for incomitant vertical strabismus in particular excessive elevation in adduction. Computed tomography and magnetic resonance imaging scans were reviewed. Those scans with adequate coronal imaging of their orbits to assess the position and angulation of the horizontal extraocular muscles were identified, and the degree of rotation of the muscles formally measured along with aged matched controls. These groups were analyzed for the association between presence of overelevation in adduction and degree of excyclorotation of the extraocular muscle cone.

RESULTS

The identified updrift on adduction that mimics inferior oblique muscle overaction was present in 63% (25/40) of patients. Imaging that permitted accurate measurement of the muscles positions was available in 10 of the 40 patients. Of these 10, 8 had the updrift, and 7 of these 8 (88%) demonstrated more excyclorotation than their aged matched controls. Comparison of scan measurements of patients revealed a significant difference in degree of excyclorotation (mean difference = 16.2, 95% confidence interval 6.2-31.5; P = 0.006) between patients with and without excess elevation in adduction.

CONCLUSION

Overelevation in adduction is significantly associated with excyclorotation of the extraocular muscle cone in children with craniosynostosis. We demonstrate a simple method to assess for the excyclorotation. Our findings support the importance of imaging of the orbits in these children before strabismus surgery.

Preterm Torsion of a Gravid Uterus Didelphys Horn of a Twin Pregnancy

BACKGROUND

Simultaneous pregnancy in each horn of a uterus didelphys is a rare and complex clinical situation.

CASE

Torsion of one horn of a gravid didelphic uterus during a twin pregnancy was diagnosed during cesarean delivery after erroneous diagnosis of abruptio placentae.

CONCLUSION

Localization of the placenta in a pregnancy complicated by uterine didelphys may improve the ability to diagnose hemiuterus torsion.

[Gallbladder torsion as a rare cause of acute abdomen; a case report and review of literature.]

Torsion of the gallbladder is a rare cause of acute surgical abdomen. Less than 300 patients have been reported so far. On the other hand incidence seems to be higher than expected especially in elderly patients. This condition must be suspected in an elderly patient who represents signs and symptoms of toxemia and cholecystitis . Diagnosis is usually established during laparotomy. Torsion occurs at the base of the gallbladder around cystic duct and artery. Treatment is emergent cholecystectomy.

Stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a spinner bowler: a case report and a review of the literature

Stress fractures of the ulnar shaft are uncommon injuries, which have been documented in a variety of sports. The location of the fracture is influenced by the activity and mechanism of injury with which it is associated. The combined traditional approach of clinical history, physical examination, plain radiographs and nuclear scintigraphy for unusual stress fracture may be troublesome. This report is the first to describe a stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a bowler due to chronic torsional stress. We discuss the possible mechanism of injury and describe the diagnostic imaging. A review of the literature is also given and compared with the findings and data of this case.

Müllerian agenesis and ovarian torsion. A case report and review of literature

A case report of a premenarcheal patient with an ovarian torsion and müllerian agenesis is presented. An 11-year-old prepubertal girl presented with severe left lower quadrant abdominal pain and mild rebound. A computed tomography showed a normal appendix; an ultrasound showed a left ovary measuring 3 x 2 cm with multiple 0.5-mm simple cysts. A diagnostic laparoscopy showed the left ovary tube to be twisted, but the uterus was absent, and the right ovary and tube were not visualized in the appropriate location; instead, a right adnexal structure was buried in the right sidewall. The ovary was untwisted and fixed to the pelvic sidewall. Chromosomes were 46,XX, and her hormonal evaluation was normal. Ovarian torsion and müllerian agenesis are rarely reported. An association between the lax attachment of the adnexa and torsion may be a contributing factor in this condition.

Pathologic uterine torsion associated with placental abruption, maternal shock, and intrauterine fetal demise

Torsion of the uterus is a rare obstetric complication. This report describes a 270-degree uterine torsion associated with placental abruption, maternal shock, and fetal demise. At laparotomy, the uterus and ovaries were necrotic. This patient presented in a manner typically managed by labor induction, thus delaying her diagnosis of uterine torsion.

Meconium peritonitis secondary to torsion of fallopian tube cyst and transient central diabetes insipidus in a preterm infant

Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.

Acute scrotum -- etiology and management

OBJECTIVE

Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation can confidently exclude torsion of testis from the differential diagnosis.

METHODS

A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983 and March 2003 was performed.

RESULTS

195 boys were included in this study. They were divided into 3 groups: group 1-73 with epididymo-orchitis, group 2-63 with torsion of testicular appendages and group 3- 57 with spermatic cord torsion. The patients in group 2 were older than group 1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion, whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was 2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was 37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups.

CONCLUSION

We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be applied routine surgical exploration.