Urethral injury in penile fracture: a narrative review

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Penile refracture: a preliminary report

ABSTRACT Objective: To report our institutional experience with penile refracture, including demographic data, recurrence time, etiology and operative findings in the first and second episodes. Materials and methods: Between January 1982 and September 2017, 281 patients underwent surgical treatment for penile fracture (PF) at our institution. Demographic data, clinical presentation, besides operative findings and follow-up of patients with relapsed PF were retrospectively assessed by reviewing medical records. Results: Of a total of 281 cases of PF operated at our institution, 3 (1.06%) patients experienced two episodes of trauma. Age ranged from 38 - 40 years (mean: 39.3). The recurrence time varied from 45 to 1560 days (mean: 705). Two patients presented the new fracture episode at the same site of the previous lesion, while in the other case the lesion was observed at another site. Conclusion: Recurrent FP is an extremely rare entity. The risk factors for its occurrence are still unknown. Although the lesion of the corpus cavernosum ipsilateral to the scar tissue of the prior FP is more common, contralateral rupture may be present. Nevertheless, prospective studies with larger samples should be conducted.

Traumatic rupture of liver hydatid cysts into the peritoneal cavity of an 11-year-old boy: a case report from Iran

Abstract This is the first published case report of an 11-year-old patient with a rupture of a liver hydatid cyst (HC) into the peritoneal cavity after an abdominal trauma in Iran. The disease was diagnosed using focused abdominal sonography for trauma. To date, no cases of traumatic ruptures of liver HCs in children have been reported in Iran. In the endemic regions of the world, where patients suffer from a history of trauma and constant abdominal symptoms or anaphylactic shock, early diagnosis of HC is crucial as it may disseminate to other organs. The condition needs conservative surgery and follow-up.

Simultaneous bilateral distal biceps tendon repair: case report / Reparo de ruptura bilateral simultânea do bíceps distal: relato de caso

ABSTRACT Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

RESUMO A ruptura bilateral simultânea dos tendões distais do bíceps é uma entidade rara, pouco relatada na literatura e com definição terapêutica pouco clara. Relatamos o caso de um homem branco de 39 anos que sofreu ruptura bilateral simultânea durante treino de academia em que ao pegar peso com os cotovelos em flexão de 90° sentiu dor súbita na face anterior dos braços e compareceu para avaliação após dois dias. Apresentava abaulamento do contorno do ventre muscular do bíceps braquial e equimose na região da fossa antecubital que se estendia distalmente para a face medial do antebraço, além de grande diminuição da força de supinação e dor à flexão ativa do cotovelo. Ressonância nuclear magnética (RNM) confirmou a ruptura com retração do bíceps distal, bilateralmente. Optou-se pelo reparo das lesões simultaneamente com a técnica de dupla incisão e fixação do tendão à tuberosidade bicipital com âncoras. O paciente evoluiu de forma bastante satisfatória, com retorno completo às atividades laborais e esportivas, está bastante satisfeito com o resultado após dois anos da cirurgia. Na pesquisa da literatura, foram achados muito poucos casos descritos de ruptura bilateral simultânea do bíceps distal. Desses, somente um foi tratado na fase aguda da lesão. Portanto, os autores consideram o procedimento descrito como uma boa opção para a resolução dessa complexa condição.

Correlación entre la anatomía acromial y roturas del manguito rotador: estudio caso-control / Relationship between acromial anatomy and rotator cuff tears: a case control-study

Determinar si existe correlación entre la anatomía acromial documentada por radiología y la presencia de roturas del manguito rotador (MR) evaluadas en forma artroscópica. Hipótesis: Existe correlación positiva entre la morfología acromial y las roturas del MR. Métodos: Serie retrospectiva caso-control de 279 casos consecutivos tratados mediante cirugía artroscópica. Se analizaron 2 cohortes; un grupo con roturas completas del MR (N = 155) y un grupo control, tratados por inestabilidad glenohumeral (N = 124) a los que se documentó indemnidad del MR durante la artroscopia. Se documentó la anatomía acromial preoperatoria mediante radiografías de hombro anteroposterior verdadera y axial subacromial y se midieron la pendiente acromial según Bigliani (B), la inclinación acromial según Kitay (K) y el índice acromial según Nyffeler (AI). Resultados: Las diferencias entre los valores promedios de B y K entre grupos no fueron significativas (p = 0,6 y p = 0,3). No existió correlación entre B y AI (r = 0,054; p = 0,377). Evidenciamos una correlación positiva en ambos grupos entre la inclinación acromial (r = 0,2; p = 0,008) y la pendiente acromial (r = 0,1; p = 0,03). Encontramos diferencias significativas en el IA entre grupos, que fue mayor para los casos (p = 0,01). Conclusión: En los resultados de las mediciones radiológicas de la anatomía acromial en nuestra población, documentamos una correlación significativa entre extensión del AI y roturas del MR confirmadas durante artroscopia...

To study the anatomical relationship between acromial morphology documented on X- rays and rotator cuff (RC) tears evaluated using arthroscopy. Hypothesis: There is a positive correlation as regards acromial morphology and RC tears. Methods:A retrospective, case control series of 279 consecutives cases, who underwent arthroscopic surgery were included in this study; cases were separated into 2 cohorts; one group with complete RC tears (N=155) and a control group treated for glenohumeral instability (N=124) with indemnity of the RC confirmed during arthroscopy. Pre-operative acromial anatomy was documented with X- rays – true anteroposterior and sub-acromial outlet views – measuring the acromial slope according to Bigliani (B), acromial tilt according to Kitay (K), and acromial index according to Nyffeler (AI). Results: The differences in the mean values of B and K between groups were not significant (P=.6 and P=.3). There was no correlation between B and AI (r= 0.05; P=.3). A positive correlation was observed between the acromial tilt (r= 0.2; P=.008) and acromial slope (r= 0.1; P=.03). A significant difference was found regarding AI, with greater values in the case group (P=.01). Conclusion:In this study, the acromial slope according to Bigliani, and acromial tilt according to Kitay, does not correlate with RC tears. A positive correlation of the AI with RC tears was observed...

Laparoscopic correction of experimentally induced diaphragmatic rupture in dogs

PURPOSE:To describe the dog as a model for studying laparoscopic correction of experimental diaphragmatic ruptures.METHODS: Five male dogs were used in this study. Under laparoscopic approach, a defect of 7cm was created on the left ventral insertion of the diaphragm. Fourteen days after this procedure, the abdomen was explored using laparoscopic access and the diaphragmatic defect was corrected with intracorporeal suture. The dislocated organs, surgical time, and suturing time were recorded. Analgesia and clinical condition were monitored during the postoperative period.RESULTS:All animals recovered well from the diaphragmatic rupture creation. After 14 days, abdominal organs (liver, spleen, omentum and/or intestine) were found inside the thoracic cavity in all animals. It was possible to reposition the organs and suture the defect by laparoscopic access in three animals. These animals showed excellent postoperative recovery. It was not possible to reposition the liver safely when it was friable.CONCLUSIONS:Laparoscopic creation of diaphragmatic rupture in dogs is feasible. Dogs are a good model for training and studying the correction of experimentally created diaphragmatic rupture by the laparoscopic approach. A friable liver is a complicating factor that should be taken into account. Animals submitted to laparoscopic correction showed excellent postoperative recovery.

Cornual Pregnancy and its Management: A Case Report.

Ectopic gestation can be present at various parts of the tube; the most common site being the ampulla. If it occurs in the interstitial region, it is called cornual gestation. 2-4% of ectopic gestation can be in the cornual region. Management depends upon the time at diagnosis. Early cornual gestation can be managed medically while advanced cornual gestation needs surgery that may range from conservative to radical depending upon clinical presentation. Th e mortality rate due to rupture of a cornual pregnancy can range from 2 to 2.5% if not managed promptly. Th e high mortality rate is due to the presence of increased vascularity of the cornual region. A case report of a cornual pregnancy and its management is being presented.

Hernia diafragmática complicada con rotura de víscera hueca dentro de la cavidad torácica / Complicated diaphragmatic hernia with hollow viscus rupture in thoracic cavity

Introduction: diaphragmatic hernias (DH) are a rare condition in adult patients. Most of the cases are asymptomatic findings in imaging studies. Rarely do they present as complicated cases. Clinical cases: we report two clinical cases of complicated DH, one of Bochdalek and another with history of a penetrating thoracic trauma two years before, both with hollow viscus rupture in the thoracic cavity.

Introducción: las hernias diafragmáticas (HD) son una patología relativamente poco frecuente en adultos. La gran mayoría son hallazgos asintomáticos en exámenes de imágenes, y en ocasiones debutan con complicaciones de éstas. Casos clínicos: se presentan dos casos clínicos de HD, una de Bochdalek y otra con antecedente de trauma penetrante torácico hace 2 años, ambas complicadas con rotura de víscera hueca en la cavidad torácica.

Carotid artery rupture following radioiodine therapy for differentiated thyroid carcinoma / Ruptura de carótida pós-iodoterapia em carcinoma diferenciado de tireoide

INTRODUCTION: Radioiodine therapy for patients with differentiated thyroid cancer aims at reducing tumor recurrence by eradicating residual macro- and microscopic foci. Side effects are generally rare, tenuous and transient, with little clinical significance. OBJECTIVE: To report a rare case of differentiated thyroid carcinoma presenting a large expansive solid mass at the base of the skull, with invasion of the left masticatory muscle and adjacent subcutaneous tissue, and without invasion of the carotid space, which evolved to carotid artery rupture following radioiodine therapy. DISCUSSION: Side effects are uncommon after radioiodine therapy and when present, have mild intensity. Serious adverse events are very rare, especially those arising from structures not directly invaded by metastatic tissue with radioiodine uptake, as occurred in this case. This occurrence serves to raise awareness of the need for increased care when using radioiodine therapy on high-avidity masses located close to important structures.

INTRODUÇÃO: Iodoterapia em pacientes com carcinoma diferenciado da tireoide tem o objetivo de reduzir a recorrência tumoral erradicando focos residuais macro e microscópicos. Os efeitos colaterais, em geral, são raros, tênues e transitórios, com pouca repercussão clínica. OBJETIVO: Relatar um caso raro de carcinoma diferenciado da tireoide apresentando grande massa sólida expansiva na base do crânio, com invasão da musculatura mastigatória esquerda e do tecido subcutâneo adjacente, sem invasão do espaço carotídeo que evoluiu com ruptura de carótida pós-iodoterapia. DISCUSSÃO: Os efeitos colaterais pós-iodoterapia são pouco frequentes e, quando presentes, de intensidade discreta. Os eventos adversos graves são muito raros, em especial, aqueles decorrentes de estruturas não invadidas diretamente pelo tecido metastático iodocaptante, como nesse caso, alertando também para a necessidade do aumento dos cuidados na terapia de grandes massas ávidas pelo radioiodo próximas às estruturas nobres.

Cardiac tamponade following post myocardial ventricular wall rupture: A case report.

Cardiac tamponade is a clinical syndrome caused by an increase in intrapericardial pressure due to the accumulation of blood, pus, other fluid, or gas in the pericardial space. Cardiac tamponade typically leads to a crisis by decreasing venous return, which impairs diastolic ventricular filling. Ventricular wall rupture is an uncommon complication after a myocardial infarction that is associated with a high mortality rate from pericardial tamponade, especially in the elderly. Cardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Cardiac tamponade is a life-threatening clinical syndrome that requires timely diagnosis. A high index of suspicion of this clinical entity as cause of death during autopsy in suspected cardiac cases is imperative. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. We present a case of a 41 year-old man who suffered myocardial infarction, had findings of ventricular wall rupture complicated by pericardial tamponade. A brief overview of the clinical presentation, diagnosis, and management of this challenging and potentially fatal complication is presented.

Spontaneous Rupture of the Extensor Pollicis Longus Tendon in a Tailor

A spontaneous rupture of the extensor pollicis longus (EPL) tendon is associated with rheumatoid arthritis, fractures of the wrist, systemic or local steroids and repetitive, and excessive abnormal motion of the wrist joint. The authors encountered a case of a spontaneous rupture of the EPL tendon. The patient had no predisposing factors including trauma or steroid injection. Although the patient had a positive rheumatoid factor, he did not demonstrate other clinical or radiological findings of rheumatoid arthritis. During surgery, the EPL tendon was found to be ruptured at the extensor retinaculum (third compartment). Reconstruction of the extensor tendon using the palmaris longus tendon was performed. At the 18-month follow-up, the patient showed satisfactory extension of the thumb and 40degrees extension and flexion at the wrist.

Death due to ruptured ectopic pregnancy natural death or negligence.

A young adult female of low socio-economic status, and a labourer by profession, was brought dead to the Government Medical College & hospital, Chandigarh. History provided by her husband revealed that she had pain abdomen for the last five days for which she was getting treatment from a private practitioner. She had been prescribed NSAIDs and antispasmodics for the same. However, she was not investigated upon and no attempt was made by the practitioner to arrive at any diagnosis. The autopsy was conducted on the next day and at autopsy, about two-and-a-half liters of blood was present in the abdomen and pelvic cavity. Careful internal examination revealed a ruptured ectopic pregnancy as the source of bleeding. The case is discussed with regard to establishing whether the death could have been natural, due to the negligence of the treating doctor or due to contributory negligence. However, even in cases of contributory negligence, the “last chance doctrine” may not save the physician.

Hepatic hydatid cyst rupture and anaphylaxis after a fall.

A 15-year-old boy presented to the emergency unit complaining of dyspnea, urticaria and vomiting developed after he fell down when he was playing football. Abdominal ultrasound showed a ruptured hydatid cyst in the right lobe of the liver which was of communicating type. Echinococcus granulosus serologic tests were positive. Medical treatment was started immediately. One week later, follow up US showed no changes in the findings. Intrabdominal fluid leakage was not detected. Patient's general condition showed improvement and he was discharged 12 days later.

Intrabiliary rupture of hepatic hydatid cyst: role of ERCP

We report a case of hepatic hydatid cyst presenting with obstructive jaundice following cholecystectomy. ERCP showed intrabiliary cyst rupture with biliary obstruction due to cyst remnants. Endoscopic sphincterotomy was performed and cyst debris removed with complete resolution of symptoms

Multiple cardiovascular complications in a patient with Behcet's disease

Arterial and cardiac involvement of Behcet's disease is a rare but life threatening complication. The rupture of an arterial aneurysm might result in sudden death. We report a 54-year-old man with an established diagnosis of Behcet's disease who presented with multiple cardiovascular complications that eventually lead to his death. He presented with extensive venous occlusions, and sequentially developed right ventricular thrombosis with multiple pulmonary thromboembolisms, and a pulmonary artery aneurysm. We report this unusual sequence of cardiovascular complications in a patient with Behcet's disease.

Traumatic globe rupture after deep anterior lamellar keratoplasty.

We report a case of traumatic globe rupture following blunt trauma in the left eye of a 20-year-old male who had undergone deep anterior lamellar keratoplasty for keratonus. Prolapse of both, the crystalline lens and the vitreous was present through the inferior 180 degrees donor host junction. After repositioning, anterior vitrectomy and repair of graft host junction, the graft regained clarity in eight weeks and there was good visual recovery.