Prenatal Torsion of Radial Polydactyly: A Gangrenous Mass at the Base of the Thumb.

A patient was born with a mass at the base of the thumb approximately 1.5 cm in diameter on the radial side of the fingers. The mass had globular swelling filled with hemorrhagic fluid and was dark red. X-rays and histology of the excised specimen suggested the diagnosis of gangrene and torsion of polydactyly. Prenatal torsion of polydactyly is not a common occurrence; moreover, prenatal torsion of polydactyly has only been found in ulnar polydactyly. Our case is a novel case of radial polydactyly that was gangrenous at birth owing to prenatal torsion. Diagnosing such a mass at the base of the thumb is important.

Increased femoral antetorsion correlates with higher degrees of lateral retropatellar cartilage degeneration, further accentuated in genu valgum.

PURPOSE: The role of increased femoral antetorsion (femAT) as a contributor to patellofemoral (PF) osteoarthritis (OA) is unknown. The purpose of this study was to investigate whether increased femAT was associated with advanced cartilage degeneration in the lateral PF joint. METHODS: Patients who underwent complete radiographic workup for surgical intervention due to OA in any knee joint compartment were included. Cartilage morphology according to the International Cartilage Repair Society (ICRS) cartilage lesion classification system in the PF joint, femoral and tibial torsion, frontal leg axis, and tibial tuberosity-trochlear groove (TT-TG) distance were assessed. Increased femAT was defined as > 20° according to previous reports. RESULTS: A total of 144 patients were included. Ninety-seven patients had a femAT of < 20° and 45 of > 20°. A significant odds ratio (OR) was found for lateral retropatellar (OR 3.5; p = 0.02) ICRS grade 3 and 4 cartilage degeneration and increased femAT ≥ 20°. In the medial PF compartment, increased femAT had an inverse effect (OR 0.16; p = 0.01). No significant ORs were found for TT-TG distance, tibial torsion, or leg axis. The lateral retropatellar ICRS grade showed a linear correlation to increased femAT values. In valgus knees, isolated lateral PF OA had an even more pronounced correlation to increased femAT (p = 0.004). CONCLUSION: Increased femAT showed higher grades of lateral retropatellar cartilage degeneration, which was even more pronounced in valgus knees. LEVEL OF EVIDENCE: Cohort study: Level III.

Objective ocular torsion outcomes after unilateral horizontal rectus surgery in infantile esotropia.

PURPOSE: To analyse objective ocular torsion among patients with infantile esotropia and to determine the effects of unilateral horizontal rectus surgery. METHODS: Sixty-eight patients (136 eyes) (range 4 to 16 years) who underwent unilateral horizontal rectus surgery for infantile esotropia participated in this retrospective single-centre study. Objective ocular torsion using fundus photography was assessed before surgery and 1 year later. We defined three groups of patients based on preoperative qualitative objective ocular torsion: physiological extorsion and pathological extorsion and intorsion. For each group, the disc-foveal angle was measured and analysed both before and after surgery. We looked for possible correlations between amount of esodeviation and disc-foveal angle size. RESULTS: Preoperatively, 28 (41%) patients had + 6.73 (± 2.66) degrees of physiological extorsion. Thirty-one (46%) patients had + 12.94 (± 3.67) degrees of pathological extorsion. Nine (13%) patients had - 1.99 (± 2.52) degrees of intorsion. After surgery, the number of subjects with physiological extorsion increased to 45 (66%). The number of patients with pathological extorsion decreased to 17 (25%) and the mean disc-foveal angle was significantly reduced by 1.80°. Six (9%) patients presented intorsion and the mean disc-foveal angle was significantly reduced by 2.28°. For the pathological extorsion group, the size of the disc-foveal angle before surgery was positively correlated to its reduction after surgery. Disc-foveal angle variation and distance esodeviation variation after surgery were positively correlated. CONCLUSIONS: These results highlight that pathological objective ocular torsion can be frequently found in infantile esotropia and is decreased after unilateral recession-plication surgery.

[Corrective osteotomy of the hand]. / Korrekturosteotomie an der Hand.

Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be successfully treated conservatively. Nevertheless, various malformations, such as malrotation, spur development, bone shortening, deviation of the axis and combinations of these individual deformities may appear in the course of time. Corrective osteotomy can correct these deformities with clinically impaired function and improve/optimize hand function. Prerequisites for corrective osteotomy are a precise analysis of the deformity, precise osteotomy, exercise stable osteosynthesis and intensive follow-up treatment of the hand. Complications, such as implant failure, postoperative tendon and joint adhesions, joint contracture and nonunion are however possible.

Malignant mixed epithelial tumour of ovary-serous papillary cystadenocarcinoma and transitional cell carcinoma with tubo-ovarian torsion: a rare tumour with rare presentation.

Ovarian torsion can be associated with various pathophysiological factors. Most commonly, benign epithelial ovarian tumours present with torsion. We present an unusual case of mixed malignant epithelial ovarian tumour with a predominant component of high-grade serous cystadenocarcinoma (85%) and transitional cell carcinoma (TCC) (15%) in a patient who presented with acute lower abdomen. The tumour was associated with tubo-ovarian torsion.

Left upper lobe and lingula torsion after transplantation of single lung with complete major and minor fissures: A case report.

BACKGROUND: Native lung torsion is rare and torsion in a lung transplant is even rarer. CASE PRESENTATION: Here we report a case of left upper lobe (LUL) and lingula torsion in a patient with a unilateral left lung transplantation. The transplant was complicated by a graft with a short pulmonary artery cuff, which required significant vascular reconstruction and manipulation. Additionally, the graft had complete left major and minor fissures, which are documented risk factors for torsion. After 24 h postoperatively, the patient failed to wean off ventilation. The patient was worked up with bronchoscopy, a computed tomography (CT), and a CT angiogram (CTA). A CT without intravenous (IV) contrast showed the findings suggestive of torsion of the LUL and lingula and the CTA confirmed the diagnosis. Immediate re-exploration was performed for detorsion to preserve the vitality of the allograft. Following the failed detorsion, the patient had re-transplantation of the left lung with good results. CONCLUSION: Lung torsion should be watched for in patients with major risk factors like complete fissure. CT and/or CTA are effective tools to confirm the diagnosis.

Preoperative CT image-based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic pain.

PURPOSE: To define and weight the preoperative CT findings for ovarian torsion and to develop an integrated nomogram for estimating the probability of ovarian torsion in women with ovarian lesion and pelvic pain. METHODS: This retrospective study included 218 women with surgically resected ovarian lesions who underwent preoperative contrast-enhanced CT for pelvic pain from January 2014 to February 2019. Significant imaging findings for torsion were extracted using regression analyses and a regression coefficient-based nomogram was constructed. The diagnostic performance with sensitivity, specificity, and accuracy of the significant imaging findings and the nomogram were assessed. RESULTS: A total of 255 ovarian lesions (123 lesions with torsion and 132 lesions without torsion) were evaluated. Multivariable regression analysis showed that whirl sign (odds ratio [OR] 11.000; p < 0.001), tubal thickening (OR 4.621; p = 0.001), unusual location of ovarian lesion (OR 2.712; p = 0.020), and hemorrhagic component within adnexal lesion (OR 2.537; p = 0.028) were independent significant parameters predicting ovarian torsion. Tubal thickening showed the highest sensitivity (91.1%) and whirl sign showed the highest specificity (94.7%). When probabilities of ovarian torsion of 0.5 or more in the nomogram were diagnosed as ovarian torsion, sensitivity, specificity, and accuracy of the nomogram were 78.1%, 91.7%, and 85.1%, respectively. CONCLUSION: The whirl sign, tubal thickening, unusual location of ovarian lesion, and hemorrhagic component within adnexal lesion, and an integrated nomogram derived from these significant findings can be useful for predicting ovarian torsion.

Intraoperative use of cortical step sign and diameter difference sign: Accuracy, inter-rater agreement and influence of surgical experience in subtrochanteric transverse fractures.

BACKGROUND: The cortical step sign (CSS) and diameter difference sign (DDS) are radiographic tools for torsional alignment control in intramedullary nailing. They have been found to be highly relevant in objective radiographic measurements, but for intraoperative visual identification they lack sufficient evidence yet. The aim of this experimental study was to evaluate their (1) accuracy, (2) inter-rater agreement, (3) predictors of correct identification for clinically relevant maltorsion (CRM: ≥15°), and (4) positive and negative predictive values. HYPOTHESIS: Sensitivity and specificity of CSS and DDS in visual identification of CRM are comparable to those in objective measurement. MATERIAL AND METHODS: Six observers of three different levels of surgical experience evaluated 50 a.p. and 50 lateral views of subtrochanteric fractures of cadaveric specimens with internal/external maltorsion from 0° to 30° to assess for CSS, DDS, and CRM. (1) Sensitivity and specificity were evaluated. Percentage agreement and Cohen's Kappa were used to evaluate accuracy as agreement with measured/true values and (2) inter-rater agreement. To determine (3) significant predictors of correct identification of the CSS, DDS, and CRM, a mixed-effects logistic model was constructed, and (4) predictive values were calculated. RESULTS: (1) Sensitivities of CSS and DDS for CRM (0.99±0.03 and 0.88±0.06) were close to those in objective measurement (1.00 and 0.90). So were specificities (0.25±0.08 and 0.47±0.17 vs. 0.32 and 0.47). Agreement percentage for CSS was high (90-94%, kappa 0.40-0.69), for DDS and CRM it was slightly lower (74-82%, kappa 0.34-0.57 and 62-76%, kappa 0.26-0.49). (2) Inter-rater agreement also showed the highest values for CSS (88-96%, kappa 0.51-0.73) with slightly lower values for DDS (74-84%, kappa 0.36-0.63) and CRM (62-84%, kappa 0.21-0.68). (3) Training level and the magnitude of maltorsion were found the most relevant predictors of a correct identification of CSS/DDS/CRM. (4) DDS showed a higher positive predictive value (73.1%), CSS a higher negative predictive value (93.5%). DISCUSSION: We found visual identification of CSS and DDS to be almost as accurate as objective measurement in the detection of CRM. Estimation of maltorsion is not sufficiently reliable, but a negative CSS excludes a CRM with high probability. Both signs should be applied by experienced surgeons. LEVEL OF EVIDENCE: Level III, experimental setting, non-randomised experimental trial.

Isolated tubal torsion in the third trimester of pregnancy managed with simultaneous salpingectomy and cesarean section.

Isolated tubal torsion is an uncommon cause of acute abdomen in pregnancy. Tubal torsion may occur in the absence of adnexal disease. Diagnosing tubal torsion is especially difficult in pregnancy because no precise preoperative radiological and biochemical investigations have been conducted. Most patients are diagnosed during surgery. Here, I present a case of isolated tubal torsion in a pregnant woman at 35 weeks and 6 days of gestation that was managed with salpingectomy and cesarean section simultaneously.

Twist and shout: magnetic resonance imaging findings in ovarian torsion.

Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic "whirlpool sign". The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.

Spontaneous middle lobe torsion in a patient with multicentric Castleman disease: A case report.

We describe a rare case of middle lobe lung torsion in a patient with a tension hydrothorax secondary to multicentric Castleman disease. The case demonstrates the difficulty of diagnosing torsion prospectively, and the possible sequelae of delayed detection. Although imaging features can be confusing, an awareness of this condition and careful image interpretation by radiologists could facilitate early recognition and management of a torted lobe.

A New Instrument for Measuring Tibial Torsion in Pediatric Patients.

OBJECTIVE: To develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait. METHODS: The new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured. RESULTS: Less experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner's inter-test and the inter-personal reliabilities increased. CONCLUSION: TFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.

Right iliac fossa pain from a grossly enlarged and torted appendix in a patient with known colitis.

A 27-year-old man with a background of well controlled colitis presented with a 12-hour history of central abdominal pain, nausea, vomiting and fever. A diagnostic laparoscopy revealed an extremely large, gangrenous appendix, which had descended into the pelvis posterior to adhesions in the right iliac fossa and was torted 720°. The decision was taken to convert to a lower midline laparotomy and as the base appeared healthy, a standard appendicectomy was performed. The patient recovered well and was discharged after two days. The appendix measured 104mm x 53mm x 51mm. Histology revealed acute haemorrhagic and necrotising appendicitis with foci of impending perforation. There was no malignancy or mucocoele. Acute torsion (or volvulus) of the appendix is an unusual cause of this common general surgical emergency.

Clinical analysis of umbilical artery embolism in 18 cases / 中华围产医学杂志

Objective:To investigate the clinical characteristics and pregnancy outcomes of fetal umbilical artery embolism.Methods:This retrospective case series recruited 18 cases of fetal umbilical artery embolism delivered at Xiamen Maternal and Child Healthcare Hospital from January 2018 to February 2020. Maternal age, complications, umbilical artery condition revealed by prenatal ultrasound, delivery mode, perinatal outcomes, and placental pathological examinations were analyzed using descriptive statistical methods.Results:(1) The total prenatal detection rate of umbilical artery embolism was 0.062% (18/29 130). The average maternal age was (30.1±6.1) years old. Four of the 18 cases aged other 35 and one was younger than 18 years old; 17 cases were singleton pregnancy, and the other one was a dichorionic diamniotic twin pregnancy. The mean gestational age was (35.1±2.6) weeks when an abnormal umbilical artery was first indicated by ultrasound, including 16 with a single umbilical artery shown in the third trimester and two with suspected umbilical artery embolism. The main complications were followed as gestational diabetes mellitus (8/18), fetal growth restriction (4/18), and abnormal umbilical cord insertion (3/18). (2) Cesarean section was performed for 16 cases, resulting in live births, while the other two cases had intrauterine death. Among the 16 neonates, nine were premature infants, and seven were full-term infants, with an average birth weight of (2 434±816) g; four were small for gestational age, and neonatal asphyxia occurred in three cases. Eleven were admitted to the neonatal intensive care unit, including five with brain injury. (3) Placental pathological examinations showed embolism in one of the two umbilical arteries in 17 cases and the umbilical vein in one case. Excessive torsion of the umbilical cord was observed in 11 cases and the umbilical cord's abnormal insertion in three cases. One case refused placental pathological examination.Conclusions:Umbilical artery embolism should be considered when a single umbilical artery is indicated by ultrasound in the third trimester. The time of delivery should be based on the risk of premature birth and unexpected adverse events. A cesarean section is suggested.

Inferior oblique weakening surgery on ocular torsion in congenital superior oblique palsy.

AIM: To investigate changes in fundus excyclotorsion after inferior oblique myectomy or myotomy. METHODS: The records of 21 patients undergoing strabismus surgery by a single surgeon between 2009 and 2012 were examined. Only patients who had undergone an inferior oblique myectomy or myotomy, with or without horizontal rectus muscle surgery, were evaluated. Digital fundus photographs were obtained, and the angle formed by a horizontal line passing through the optic disc center and a reference line connecting the foveola and optic disc center was measured. Associated clinical factors examined include age at the time of surgery, presence or absence of a head tilt, degree of preoperative vertical deviation, torsional angle, inferior oblique muscle overaction/superior oblique muscle underaction, and surgery laterality. Whether the procedure was performed alone or in combination with a horizontal rectus muscle surgery was also examined. RESULTS: Mean preoperative torsional angle was 12.0±6.4°, which decreased to 6.9±5.7° after surgery (P<0.001, paired t-test). Torsional angle also decreased from 15.1±7.0° to 6.2±4.3° in the myectomy group (P<0.001, paired t-test) but there were no significant changes in the myotomy group (P=0.093, Wilcoxon signed rank test). Multivariable linear regression analysis showed that preoperative torsional angle, degree of inferior oblique overaction, and age at surgery independently and significantly affected postoperative torsional angle. CONCLUSION: Mean torsional angle decreased after inferior oblique myectomy. Degree of preoperative torsional angle, inferior oblique overaction, and age at surgery influence postoperative torsional angle.

Uniportal thoracoscopic management of middle lobe torsion after upper lobectomy.

Lobar torsion is a rare but potentially life-threatening complication following pulmonary resection. Surgical management usually entails an exploratory thoracotomy and resection of the involved lobe if nonviable. We present the case of a 67-year-old woman diagnosed with right middle lobe torsion 5 days after thoracotomy and right upper lobectomy for squamous carcinoma of the lung. A thoracoscopic right middle lobectomy was successfully performed utilizing a single 4-cm port placed along the midaxillary line in the 5th intercostal space.

Left common basal pyramid torsion following left upper lobectomy/segmentectomy.

Lobar or segmental lung torsion is a severe complication of lung resection. To the best of our knowledge, common basal pyramid torsion has never been reported. We describe a case of left basal pyramid torsion after left upper lobectomy and superior segmentectomy, which was successfully treated by thoracoscopic surgery.

The impact of tibial torsion measurements on gait analysis kinematics.

OBJECTIVE: To measure and compare tibial torsion values as assessed by goniometry and three-dimensional kinematics. In addition, the impact of each one of these measurements on kinematic and kinetic results for normal gait was determined. METHODS: Twenty-three healthy and fully ambulatory patients were assessed, 11 women and 12 men, from 20 to 40 years old. Data were collected at a laboratory for the three-dimensional analysis of movement with 10 cameras and two force plates. Tibial torsion measurements were obtained using goniometry and three-dimensional kinematics based on the Plug-in Gait model. Afterwards, both procedures were compared, and the impact of each result was assessed on the kinematic and kinetic modeling of the knee and ankle. RESULTS: Pearson's linear correlation coefficient (r=0,504) showed a moderate correlation between the three-dimensional kinematics and goniometry, and between the changes in the measurements. Regarding the processed kinematic and kinetic results for every torsion position, no significant differences were noticed among any of the studied variables (p>0.05). CONCLUSION: Although statistical correlation among tibial torsion angles by goniometry and three-dimensional kinematic were moderate, kinematic and kinetic analysis of the joints did not reveal any significant changes. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.

Isolated tubal torsion in the third trimester of pregnancy managed with simultaneous salpingectomy and cesarean section / 영남의대학술지

Isolated tubal torsion is an uncommon cause of acute abdomen in pregnancy. Tubal torsion may occur in the absence of adnexal disease. Diagnosing tubal torsion is especially difficult in pregnancy because no precise preoperative radiological and biochemical investigations have been conducted. Most patients are diagnosed during surgery. Here, I present a case of isolated tubal torsion in a pregnant woman at 35 weeks and 6 days of gestation that was managed with salpingectomy and cesarean section simultaneously.

Quiste de ovario torcido: a propósito de dos nuevos casos / Ovarian torsion cyst: about two new cases

RESUMEN Fundamento: se expresan los conceptos torsión quística de ovario, del ovario y de los anejos, coincidentes porque provocan déficit tisular y hemático, lo que constituye una urgencia médico quirúrgica. Aparece a cualquier edad, de preferencia en la pre menopáusica y en los años fértiles, es infrecuente en anejos normales, se mencionan además otros factores de riesgo. El diagnóstico clínico es muy importante; entre los medios diagnósticos, se incluyen el ultrasonido diagnóstico convencional o el Doppler color y la laparoscopía habitual o la video asistida. El tratamiento está encaminado a salvar el órgano afectado; la destorción es válida y puede realizarse. Objetivo: presentar dos casos de quistes de ovario torcido y actualizar sobre este tema. Presentación de casos: se presentan dos pacientes tratadas en un grupo básico de trabajo y en un mismo mes, febrero de 2017, ambas en periodo post menopáusico; el diagnóstico y el tratamiento fueron demorados y esto conllevó a la cirugía exerética con buena evolución posterior. Conclusiones: ambos casos tuvieron demora diagnóstica y el tratamiento por tanto, no fue oportuno aunque la evolución postoperatoria fue buena. Se enfatiza que ante una mujer con masa palpable y dolorosa pélvica, debe descartarse con rapidez esta posibilidad.

ABTRACT Background: the concepts of cystic torsion of the ovary, ovary and adnexa are presented. Those are coincident because they provoke hematological tissue deficit, constituting a medical surgery urgency. It appears at any age, preferably premenopausal and in the period of fertile years. It is very infrequent in normal extensions. Also, some risk factors are presented. The clinic diagnosis is very important. Among the diagnosis means are included the conventional ultrasound, the Doppler color, and the usual laparoscopy or video assisted laparoscopy. The treatment is aimed at saving the affected organ; to remove the torsion is valid and can be made. Objective: to present two cases of torsion ovary cyst and update about the matter. Case presentations: two sick women are treated in a basic workgroup and in a same month, February 2017, both in post-menopausal period. The diagnoses and treatment were delayed and this caused a surgery with good posterior evolution. Conclusions: both cases had diagnostic delay, and the treatment wasn't timely, the post operatory evolution was good though. It is emphasized that when a woman with pelvic pain mass is presented, this possibility should be discarded quickly.