جستجوی مقالات مرتبط با کلیدواژه "پارگی" در نشریات گروه "پزشکی"

Isolated Flexor Digitorum Longus (FDL) muscle tear is extremely rare and so far, a handful of cases have been reported in the literature. Proper diagnosis and treatment will reduce the complications caused by this tear and helps to reduce the burden of the injury to the athlete and team.

A 38-year-old professional athletics male, presented with medial tibial pain that started while running. He did not have any history of diabetes, infectious and inflammatory joint diseases, and the use of drugs such as fluoroquinolone and corticosteroids and supplements containing it, statins, and other drugs that damaged the tendons was not reported. He presented with right leg claudication, despite normal lower limb alignment. Ultrasonography revealed evidence of a grade 3 strain of the FDL muscle with extensive hematoma. MRI confirmed the diagnosis of a grade 3 FDL strain. Treatment included hematoma aspiration, injection of Platelet rich plasma (PRP) in the train side under ultrasound guidance, physiotherapy and specific rehabilitation protocol. The patient adhered to the rehabilitation program and reported significant improvement in pain and function.

So far, only a few case reports have reported the rupture of this muscle spontaneously or after ankle dislocation or malleolus and talus fracture. The treatment was effective based on the patient’s response. Careful attention should be given to similar cases to ensure accurate diagnosis and appropriate treatment.

Single superficial femoral artery (SFA) aneurysm is rare and occurs in approximately 5 per 100,000 patients. Rupture is a rare complication in this aneurysm. In this case report, we present the diagnostic and therapeutic work up of a ruptured SFA aneurysm of the right lower limb in a 75-year-old diabetic man with ischemic heart disease. Pre-surgical diagnosis was through physical examination findings and color Doppler flow imaging. The defective part of the artery was resected and then reconstructed through autologous saphenous vein grafting harvested from the opposite limb. No early post-surgical complication was observed. If a pulsatile mass is found in the thigh, the SFA aneurysm should be considered as a differential diagnosis to prevent premature death and lower limb amputation by timely surgery.

Perineal injury is a common complication of vaginal delivery that can affect women's physical, mental and social health. This study was performed with aim to determine the prevalence of third and fourth degree of perineal laceration during delivery and some related factors.

In this retrospective analytical -descriptive study, information was extracted from the records of mothers who gave birth during 2015-2017. The control group consisted of 129 mothers who did not have severe rupture and were selected by systematic randomization among vaginal deliveries performed during the mentioned years. After collecting information about the factors related to the perineal laceration, data were analyzed by SPSS software (version 18) and Chi-square and Fisher Exact and independent t tests. P<0.05 was considered statistically significant.

Among 8814 vaginal deliveries performed during the relevant years, there were 32 cases of third and fourth degree of perineal laceration (0.363%), of these, 22 cases were noli par (68.8%). In comparison between the case (n=32) and control (n=129) groups, the work experience of the delivery agent (p<0.02), instrumental delivery (p<0.023) and the duration of the second stage of labour (p<0.0001) were more in the case group.

Third and fourth degree of perineal lacerations are associated with the second stage of longer labour and instrumental labour that requires the presence of a labour agent with a longer work experience.

Retroperitoneal hematomas, as a rare but significant quantity in patients with history of recent operation, should be suspected in all patients who demonstrate signs of hypovolemia without apparent blood loss. Here, we have presented a rare case of postpartum hematoma to aware about this diagnosis in similar cases.

Case Report:

A 24-year-old gravid 1 woman with term pregnancy had tachycardia and oliguria after delivery with large episiotomy extended up to right fornix. After volume resuscitation, a tense tender swelling in the upper part and posterior lateral of vagina in vaginal exam was suspicious to retroperitoneal hematoma, and emergent laparotomy confirmed the diagnosis.

Post-vaginal delivery laceration extending from posterior vaginal wall to uterosacral ligament and rarely to para-vesical space can be a life-threatening emergency and a cause of maternal mortality. Careful examination and repair of extended episiotomy or laceration is the key factor to prevent retroperitoneal hematoma.

Recently, the surgical methods are used in patients with anterior cruciate ligament rupture and have been associated with successful results. There are different results in the term of using of the surgical methods for anterior cruciate ligament that often is associated with some complications such as infection, static laxity, remaining the pain, need to recurrence surgery, and limitation in the range of motion. Therefore, in this study, we aimed to compare outcomes of anterior cruciate ligament reconstruction with the fixed loop and the adjustable loop.

This cross-sectional study was done on 60 patients undergoing anterior cruciate ligament reconstruction referred to Kashani Hospital of Isfahan, Iran, from March 2017 to February 2019. Also, this study was approved in the Isfahan University of Medical Sciences, Isfahan, Iran. 30 patients were assigned to a fixed loop and 30 patients under the adjustable loop method. Postoperative outcomes were compared with the fixed loop group and the adjustable loop group.

The frequency of static laxity below 8 mm in the fixed loop group was 83.3% and the frequency of static laxity below 8 mm in the adjustable loop was 76.7%. There was no significant difference between the fixed loop group and the adjustable loop group based on static laxity. Also, no infection was seen in the fixed loop group and the adjustable loop group. There was no significant difference between the fixed loop group and the adjustable loop group in terms of range of motion and knee score before and after surgery. After surgery, 96.7% of the fixed loop group and 86.7% of the adjustable loop group returned to normal activity. There was no significant difference between the fixed loop group and the adjustable loop group in terms of return to normal activity and satisfaction.

Using the fixed loop is effective, useful, and with low-complication for the patients with anterior cruciate ligament and also using the adjustable loop grafts is effective, useful, and with low-complication for the patients with the anterior cruciate ligament rupture.

The study of shoulder pathologies as one of the most common orthopedic injuries due to the lack of sensitivity of clinical findings is one of the topics discussed in radiology papers. Traditionally, MRI is a selective diagnostic modality of choice. However, due to its limitations, such as high cost and unavailability, simple and cheaper methods seems to be valuable. Sonography can be a good alternative in this field that examines soft tissue pathologies. This study evaluated the magnitude of ultrasound and MRI matching in cases of partial and complete tear of cuff muscles and accompanying findings such as subacromial bursal effusion and degenerative changes of shoulder joint. In this study 85 patients who referred to the radiology department of Hazrat-e-Rasool Akram Hospital were asked for simultaneous sonographic examination of the shoulder. The degree of ultrasound and MRI correlation in localizing the tear as well as the severity of tear based on complete or partial was evaluated for each rotator cuff muscle individually. Also the degree of subacromial bursa effusion and acromioclavicular join hypertrophy were also compared. A total of 85 patients (30 males and 55 females) with different injuries in supraspinatus, infraspinatus, subscapularis and long head of biceps tendon, sonography was in acceptable agreement with the findings of MRI in the diagnosis of complete and partial tear and in determining their location. However, the tendency of tendon retraction is less than predicted by MRI. Shoulder ultrasound can be used as an alternative modality to MRI, especially in cases where it is not available, to examine the rupture of cuff tendons, as well as the extent and severity of subacromial bursa effusion and acromioclavicular joint hypertrophy.

  Severe perineal tears during delivery decrease maternal health and satisfaction. This is a challenge for promotion and acceptance of normal vaginal birth. Therefore, this study was performed with aim to identify the risk factors associated with severe perineal tears during normal vaginal delivery. This was a case-series study which was performed by reviewing medical records and interviewing with women who gave birth from 20th April to 25th December 2016 at Omolbanin Hospital, Mashhad, Iran and had third and fourth degree perineal lacerations. Data extracted from patients’ medical records included demographic and childbirth-related data (number of parity, the length of the first and second stage of labour, frequency and duration of uterine contractions, prescribed medications in labour, birth attendant, mode of delivery, degree of perineal tear, method of perineal repair and neonatal weight) that was recorded in related forms. Interviews were conducted within the first year after childbirth following telephone invitation, focusing on women’s chief complains. Descriptive statistics were used for data analysis. Out of the seven Iranian patients studied, four cases (57.2%) were multiparous and three cases were primiparous. The most risk factors associated with perineal lacerations included 6 cases of induction by oxytocin (85.7%), 3 cases of gestational diabetes (42.8%), 3 cases of postdate pregnancy (42.8%) and 2 cases of macrosomia (28.50%). The delivery of only one case was done by the skilled stuff of labor and the others were accomplished by medical and midwifery students. In 6 cases (%85.7), more than one risk factor was seen. The most common postpartum complication was gas incontinence. Labor induction with oxytocin, gestational diabetes, and postdate pregnancy are the most common risk factors associated with severe perineal tears during normal delivery. The majority of women suffer of gas incontinence, even after successful repair of perineal lacerations

The Achilles tendon rupture occurs more often than any other tendon، and if the diagnosis is delayed for more than four weeks، it is called chronic rupture. In this case، due to gastrocnemius muscle contractile effect، a distance is created between the two ends of the rupture. As the result، chronic rupture''s healing method is different and more difficult than that of acute rupture. Most cases of chronic Achilles tendon rupture have been reported، previously، in adults. Only one case has been reported in children with chronic ruptured، and that was healed by plantaris gracilis tendon augmentation treatment. The authors of the present study report a case of successful treatment of the traumatic rupture of the Achilles tendon، with 7 cm distance between the two ends of the rupture، in a 9-year-old boy، six weeks after the injury، using end to end treatment method.

Perineal trauma during natural vaginal delivery is associated with short and long term morbidity for women. Interventions to increase the possibility for an intact perineum are needed. This study aimed to determine the effect of perineal massage with a sterile lubricant on episiotomy and laceration. This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating massage with lubricant (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretch the perineum with lubricant 5up to 10 minute, in and between mother’s pushing in second stage of labor. In control group just Ritgen Maneuver was applied. At last we compared the rate of intact perineum, episiotomy and laceration, mean duration of second stage of labor and Apgar score in 1 and 5 minute between two groups. In case group, intact perineum, episiotomy and laceration were: 22.2% (10), 44.4% (20), 33.3 (15) respectively. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statistically significant. In massage group, first degree laceration was 33.3% (15). In control group, first degree laceration was 28.3% (28).This difference was not statistically significant. In massaged control groups, Second, third and fourth degree laceration have not occurred. The results showed that massage with a sterile lubricant provides no apparent advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labor criteria and women’s preference during delivery.

As a retroperitoneal organ, duodenal injuries following blunt abdominal trauma is rare and constitutes only 22% of all duodenal injuries (3%-5%). It often occurs after severe and suddenly blows to the upper abdomen or abdominal compression from high-riding seat belts. It is difficult to have a primary and proper diagnosis despite advances in the laboratory and imaging techniques. Here, we present a case of isolated rupture of the third part of the duodenum due to blunt abdominal trauma, resulting from motorcycle accident. The rupture was diagnosed and repaired while the patient underwent laparotomy surgery only according to physical examination (guarding, tenderness, rebound tenderness), whereas all of the laboratory and imaging findings were normal. After seven days and patient’s ability to eat meal, the patient was discharged without any complication.

Perineal trauma particularly from routine episiotomy that is associated with short and long term morbidity for women. The aim of this study was to determine the effect of perineal massage with lavender essence on episiotomy and laceration. This clinical trial study was performed on 176 nulliparous women who referred to Arak Talghani teaching center for normal delivery. They were randomly participating in massage with lavender essence oil (91 cases) or control group (85 cases). In lavender group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretch the perineum with lavender essence oil 5 up to 10 minute, in and between mother’s pushing in second stage of labor. In control group just Ritgen Maneuver was applied. At last we compared the rate of intact perineum, episiotomy and laceration, mean duration of second stage of labour and Apgar score in 1st and 5th minute between two groups. In case group, intact perineum, episiotomy and laceration were: 60.2% (53), 8% (7), and 31.8% (31) respectively. In control group, intact perineum, episiotomy and laceration were: 2.4% (2), 80% (68) and 17.6% (15) respectively. This difference was statistically significant (p=0.0001). In Lavender essence group, first and second degree laceration were 27.3 % (27) and 4.5% (4) respectively. Third and fourth degree laceration were not occurred. In control group, first, second and third degree laceration were 4.6 % (4), 7.1% (6) and 5.9% (5) respectively, fourth degree laceration was not occurred. Difference was statistically significant. (p=0.0001) The results showed that perineal massage with Lavender essence in second stage of labour decreases incidence of episiotomy and degree of laceration. Lavender essence may be increase blood flow, elasticity, softness and relaxation of perineal tissue.

Hydatid cyst, a parasite disease, can involve liver more than other organs. The most serious complication of the cyst is rupture which may spread out to biliary duct, hollow organ, or abdominal cavity directly. Elective treatment is emergent surgery. Case: A 28 rural woman referring with abdominal pain, nausea and vomiting due to car accident. Abnormal findings consisted of: abdominal distention, reduction of bowel sounds, tenderness and generalized guarding and hive lesions in the anterior chest wall, upper abdomen, and both forearms. In sonography, a lot of free liquid in abdominal and pelvic cavity, and three hetroechoic masses in the right lobe of the liver were reported. Four days after abdominal surgery the patient was discharged with Albendazole order. Intra-abdominal rupture of hydatid cyst is the most serious that due to trauma complication and elective treatment is emergency surgery.