Isolated torsion of the fallopian tube. A case report

BACKGROUND: While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone remains a rare occurrence. Diagnosis and surgical intervention are often delayed. CASE: A 38-year-old woman presented with acute lower right abdominal pain initially managed as renal colic. She returned to the emergency department three days later. After surgical consultation, a computed tomography scan and ultrasound showed a cystic pelvic mass with normal ovarian flow studies. Ultimately, the gynecology team performed laparoscopy with the suspicion of intermittent adnexal torsion. A 6 x 8-cm, twisted, dusky purple right fallopian tube was noted. A laparoscopic salpingectomy was performed. CONCLUSION: In the differential diagnosis of acute lower abdominal pain, isolated torsion of the fallopian tube should be considered. A timely diagnosis and surgical intervention may allow preservation of the tube. Even when irreversible damage has occurred, laparoscopic management is recommended.     

Diagnosing ovarian torsion with computed tomography. A case report

BACKGROUND: The diagnosis of adnexal torsion is difficult to make on the basis of symptoms, physical findings or radiologic techniques. Unfortunately, delayed intervention can lead to irreversible damage and loss of the adnexa. This report describes a finding seen on computed tomography (CT) that may increase suspicion of the diagnosis of ovarian torsion. CASE: A 21-year-old woman was admitted with constant abdominal pain and a tender retrouterine mass. Ultrasound failed to provide a definitive diagnosis. CT showed a central, hypodense area consistent with fat and surrounded by a shell of intermediate density. At laparotomy the patient was found to have a necrotic left adnexa due to torsion. Bisection of the adnexal mass confirmed a dermoid cyst with overlying edematous ovarian cortex. CONCLUSION: The observation of a round, hypodense central lesion (dermoid cyst) surrounded by thickened, edematous ovarian cortex on CT is a finding that may aid in the diagnosis of adnexal torsion. The finding is a thickened shell of ovarian cortex surrounding a central mass that has caused the torsion; in this case it was a dermoid cyst.     

Effects of different types of anticholinesterase agents on in vivo hippocampal population spikes in rats

Laparoscopic oophoropexy may prevent recurrent (repeat torsion of the same ovary) or sequential (subsequent torsion of the contralateral ovary) ovarian torsion. Two adolescent girls with sequential ovarian torsion underwent laparoscopic plication of utero-ovarian ligaments. Neither patient has had recurrence in the 6. 5 and 2 years, respectively, since surgery. Sequential ovarian torsion has been described,1-8 and in almost every instance the authors raised the question of whether or not oophoropexy should have been done at the time of the initial episode of torsion. In virtually every instance the second ovary was removed and the patient rendered menopausal. In two patients with sequential ovarian torsion the ovary was saved and oophoropexy performed laparoscopically in an effort to prevent recurrence.     

Length and torsion of the lower limb

Corrective osteotomies are often planned and performed on the basis of normal anatomical proportions. We have evaluated the length and torsion of the segments of the lower limb in normal individuals, to analyse the differences between left and right sides, and to provide tolerance figures for both length and torsion. We used CT on 355 adult patients and measured length and torsion by the Ulm method. We excluded all patients with evidence of trauma, infection, tumour or any congenital disorder. The mean length of 511 femora was 46.3 +/- 6.4 cm (+/-2SD) and of 513 tibiae 36.9 +/- 5.6 cm; the mean total length of 378 lower limbs was 83.2 +/- 11.4 cm with a tibiofemoral ratio of 1 to 1.26 +/- 0.1. The 99th percentile level for length difference in 178 paired femora was 1.2 cm, in 171 paired tibiae 1.0 cm and in 60 paired lower limbs 1.4 cm. In 505 femora the mean internal torsion was 24.1 +/- 17.4 degrees, and in 504 tibiae the mean external torsion was 34.9 +/- 15.9 degrees. For 352 lower limbs the mean external torsion was 9.8 +/- 11.4 degrees. The mean torsion angle of right and left femora in individuals did not differ significantly, but mean tibial torsion showed a significant difference between right (36.46 degrees of external torsion) and left sides (33.07 degrees of external torsion). For the whole legs torsion on the left was 7.5 +/- 18.2 degrees and 11.8 +/- 18.8 degrees, respectively (p < 0.001). There was a trend to greater internal torsion in femora in association with an increased external torsion in tibiae, but we found no correlation. The 99th percentile value for the difference in 172 paired femora was 13 degrees; in 176 pairs of tibiae it was 14.3 degrees and for 60 paired lower limbs 15.6 degrees. These results will help to plan corrective osteotomies in the lower limbs, and we have re-evaluated the mathematical limits of differences in length and torsion.     

Side-chains in native and random coil protein conformations. Analysis of NMR coupling constants and chi1 torsion angle preferences

The behaviour of amino acid side-chains in proteins in solution has been characterised by analysing NMR 3JHalphaH beta coupling constants and crystallographic chi1 torsion angles. Side-chains both in the core of native folded proteins and in situations where there is an absence of close packing including the random coil state have been considered. An analysis of experimental 3JHalphaH beta coupling constant data for ten proteins shows that in the core of native proteins a very close similarity is observed between the chi1 conformations adopted in solution and in crystals. There is clear evidence, however, for significant motional averaging about the chi1 torsion angles in solution. Using a model of a Gaussian distribution about the average torsion angles the extent of these fluctuations has been quantified; the standard deviation for the motion is 26 degrees, the fluctuations about chi1 in the protein core being similar in size to those found for main-chain phi torsion angles in solution. From the distribution of chi1 torsion angles in a data base of protein crystal structures, torsion angle populations and coupling constants have been predicted for a random coil polypeptide. Significant variations in the chi1 distributions for different amino acids give differences in the predicted coupling constants; for 3JHalphaH beta, for example, values of 5.1 and 5.7 Hz are predicted for serine compared with 4.9 and 9.9 Hz for leucine. Experimental data for short unstructured peptides show an excellent agreement with the predictions, indicating that the overall chi1 distributions in protein crystals reflect the local preferences of the amino acids. Predictions from the protein data base therefore provide an important framework for interpreting experimental data for non-native protein conformations and for residues on the surface of folded proteins.     

The effect of tibial torsion of the pathology of the knee

Measurements of tibial torsion using a tropometer were made in more than 1200 consecutive patients attending an adult knee clinic. In total 1672 readings from 836 patients in 11 diagnostic categories were analysed. Patients with either patellofemoral instability or Osgood-Schlatter disease had a significant increase in lateral tibial torsion. The most important finding was a significant reduction in this torsion in patients with panarticular disease.     

Segmented gene conversion as a mechanism of correction of 18S rRNA pseudogene located outside of rDNA cluster in D. melanogaster

INTRODUCTION: Acute scrotum in the pediatric age is mainly related to surgical causes. Spermatic cord torsion and inguinoscrotal hernia must be ruled out first, because of the possible ischemic damage to gonadal tissue and therefore surgery is sometimes performed directly, thus representing also a diagnostic tool. Spermatic cord torsion is found in two age ranges, namely: the neonatal period, where it usually represents the evolution of an intrauterine process, and the peripubertal period, which is more frequent. An unquestionable and prompt diagnosis is particularly needed because of the extreme sensitivity of gonadal tissue to ischemia. In this particular field, color and power Doppler US, depicting gonadal flow, have greatly increased diagnostic imaging capabilities, which were previously limited to B-mode US. MATERIAL AND METHODS: We examined 19 peripubertal patients with the diagnosis of spermatic cord torsion made on the basis of B-mode US and then confirmed with color Doppler. RESULTS: We found two signs which can be considered highly suggestive of spermatic cord torsion: the spiral twist of spermatic vessels and the peculiar extent of reactive hydrocele, caused by the bell clapper anomaly of the vaginal sac. CONCLUSIONS: The above US patterns are very helpful to diagnose spermatic cord torsion.     

The significance of arterial chemotherapy for multiple hepatic metastases from colorectal carcinoma

Controversy persists with regard to the diagnosis and treatment of the acute scrotum in children. The differential diagnosis includes torsion of the testis, torsion of one of the appendices testis and epididymo-orchitis. Clinical differentiation is notoriously difficult and our policy has been to explore the scrotum of all who present with signs of an acute scrotum. The medical records of 199 boys aged less than 13 years who presented with an acute scrotum at Red Cross War Memorial Children's Hospital in Cape Town during the period 1970-1996 were retrospectively reviewed. Diagnosis was made clinically in all cases. Sixty-two boys (31%) were found on exploration to have torsion of the testis (mean age 6.3 years), the left side being affecting 2.5 times more frequently than the right (1 neonate had bilateral torsion), 62 (31%) had torsion of testicular appendages and 56 (28%) had epididymo-orchitis. Nineteen were grouped separately and 13 (6.5%) of these were treated conservatively. Boys needing an orchidectomy (N = 38) for testicular torsion presented three times later than those who did not (48 v. 16.5 hours). Successful conservation of the testis was directly related to the time interval of symptom development and surgical derotation. Boys with torsion of a testicular appendage presented later (mean 51 hours) and were older (mean 10 years) than boys in the other two groups. Those with epididymo-orchitis were younger (mean 3.3 years) and 40% were younger than 1 year. Only in one-third was there any clinical supportive evidence of the diagnosis. Surgical complications were infrequent. We advocate expedient surgical exploration and derotation with contralateral orchidopexy, since clinical differentiation between torsion of the testis, testicular appendages and epididymo-orchitis is inexact, even with highly specialised investigation such as Doppler ultrasound and radionuclide scanning, which may not be widely available, may delay definitive treatment and suggest a lack of urgency where time is of the essence.     

Suppression of sympathetic nervous system during fasting

We describe 3 patients within whom ocular torsion could be induced by application of positive air pressure to one external ear canal. In all cases, the superior pole of the eye rotated away from the stimulated ear when positive pressure was applied. The amplitude of torsion ranged from 3 degrees to 16 degrees. Exploratory tympanotomy was performed in all 3 patients. In 2 patients, round-window fistulas were found and repaired. In the third patient, no fistula was noted but the oval- and round-window areas were patched. There was no resolution of symptoms after surgery in any patient. Based on these cases, patients presenting with pressure-induced ocular torsion are unlikely to have resolution of their symptoms, even when a perilymphatic fistula is confirmed and repaired. We hypothesize that pressure-induced ocular torsion is caused by an irreversible juxtaposition of the utricle and stapes footplate.     

Effect of osseous torsions of the lower limb on the development of lateral femorotibial knee arthrosis

PURPOSE OF THE STUDY: Frontal deformation of the knee is certainly not the only factor involved in the occurrence of lateralised tibio-femoral arthrosis. The aim of the study was to analyze if any kind of tibial torsion or femoral torsion could be able to induce lateralized arthrosis. MATERIAL AND METHODS: Femoral torsion, tibial torsion and tibio-femoral index (tibial torsion minus femoral torsion) have been measured on 59 knees with lateral arthrosis (8 knees) or with medial arthrosis (51 knees). For each knee, two frontal deformations were measured: 1) the actual arthrosis deformation was calculated on a hip knee ankle radiograph, 2) the pre arthrosis deformation is the arthrosis deformation minus the angle made by the femoral condyle tangent and the tibial plateau tangent. A knee has no frontal deformation if the angle between the mechanical axis of the femur and the mechanical axis of the tibia is between 178 degrees and 182 degrees; there is a varus deformity if the angle is inferior to 178 degrees; there is a valgus deformation if the angle is superior to 182 degrees. RESULTS: Out of the 8 knees with lateral arthrosis, 2 showed initially no frontal deformation and 6 had a valgus deformation; out of the 51 knees with medial arthrosis, 34 showed initially no frontal deformation, 6 had a valgus deformity and 11 a varus deformity. The tibio-femoral index in lateral FT arthrosis was statistically different from those in medial FT arthrosis (p 0.0001). When a lateral arthrosis appeared whatever the pre arthrosis deformation was the index was always negative (tibial torsion lower than femoral torsion); when a medial FT arthrosis appeared, whatever the pre arthrosis deformation was, the index (except for two cases) was always positive (tibial torsion higher than femoral torsion). CONCLUSION: Femoral and tibial torsions play a part in lateralised arthrosis occurrence together with frontal mechanical factors. Perhaps troubles in torsion explain some spontaneous or post-therapeutic evolutions not explained by frontal mechanical factors.     

The effect of specimen geometry on the accuracy of the constitutive equation derived from the hot torsion test

A rigid-viscoplastic FE code has been used to simulate the isothermal hot torsion of specimens used in tests designed for determining the relationship governing constitutive behaviour. For a given constitutive equation, the torque-rotation data were derived from the FE analysis of specimens of various geometries. Subsequently, based on these data, the constitutive equation was regenerated using an existing analytical relationship relating torque and twist in a cylindrical specimen. The effect of geometry of hot torsion specimens on the accuracy of the constitutive equation derived from the analytical relationship was investigated. Recommendations on the preferred geometry of hot torsion specimens for high deformations were made.     

Ocular torsion quantification with video images

The present paper describes a technique to quantify eye rotations about the visual axis (ocular torsion). Two digitized polar transformed images of the iris are displayed on a video monitor in order to facilitate a visual comparison and manual interaction. Emphasis is placed on error analysis and the method's simplicity when applied to static ocular torsion measurement. The implementation, applying averaging over ocular torsion determined in partitioned iris images, yields a theoretical resolution of 5' of arc. In a control experiment with an artificial eye, the accuracy showed to be better than 14' of arc. In practice, the measuring device was validated with the data from the literature by means of an experiment about ocular torsion in humans during tilt and hypergravity conditions (up to 3 g).     

Gallbladder torsion. A case report

INTRODUCTION: The unusual anatomical position of the organ, generally suspended by a mesentery, allows the rare possibility of its torsion with necrosis and even perforation. CASE REPORT: A woman, aged 78, who presented signs and symptoms similar to those of severe acute cholecystitis: abrupt onset of pain and a large palpable mass below the right costal margin. Immediate laparotomy with detorsion and easy cholecystectomy was performed. CONCLUSIONS: Should a greatly enlarged mass be palpable below the right costal margin within a few hours from the abrupt onset of unremittant abdominal pain the possibility of torsion should come to mind not to delay operation in the supposition of acute cholecystitis.     

Torsion of an intra-abdominal testicle in a neonate. Case report and review of the literature

The thirty-ninth reported case of torsion of an intra-abdominal testicle is described in a neonate. The gonad was excised as is recommended because of the high incidence of malignancy (60% of 37 cases). Torsion of an intra-abdominal testicle should be considered where an abdominal mass with calcification is found in an infant with undescended testis. Ultrasonography improves the diagnostic accuracy in infants because of the cystic nature of these masses in this age group.     

An inverse computational method for determining the constitutive parameters using the hot torsion test results

Recently a number of inverse computational methods were presented for determining constitutive parameters from the results of mechanical tests. These are based on minimization of the least square errors of the measured and calculated load-displacement results of the given test. Uniqueness of the minimum obtained from these methods has not been investigated properly. This paper presents an approximate solution for the minimum error in the inverse computational determination of constitutive parameters using the hot torsion test. The approximation is based on an analytical solution for the torsion test. It shows that for the hot torsion test, the existing inverse computational methods based on a load-displacement objective function fail to predict a unique set of constitutive parameters for an assumed rigid-viscoplastic constitutive relationship. A new objective function was developed to ensure the uniqueness of the solution for the constitutive parameters. An algorithm is presented for applying the new method to the hot torsion test results.     

Torsion of a malignant undescended testis

Cryptorchid testis have a greater risk of malignant change than do normally descended testis. The undescended testis would also be susceptible to torsion by the mechanism of increase in testicular size. A 36-year-old man of torsion of malignant undescended testis is presented. He was diagnosed as having incarcerated inguinal hernia on his first visit to general surgeon due to acute left lower abdominal pain. At laparotomy, a 7.5 x 5.5 x 3.0 cm3, greyish tan color mass was found. The pathological diagnosis is choricarcinoma and teratoma, mixed germ cell tumor. We would emphasise that in any patient presenting with acute abdominal symptoms and an absent scrotal testis, the possibility of a complication of torsion of undescended testis should be considered.     

Twinning and multiaxial cyclic plasticity of a low stacking-fault-energy f.c.c. alloy

Out-of-phase cyclic tension and torsion tests followed by metallographic measurements are carried out on Co33Ni specimens. It appears that, even for small strain ranges, nonproportional loadings induce profuse mechanical twinning and a strong kinematic hardening in this low stacking-fault-energy f.c.c. alloy. These results are analysed and an attempt to incorporate twinning into micromechanical simulations of f.c.c. polycrystals elastoplastic behaviour is described.     

Model for Reinforced Concrete Members under Torsion, Bending, and Shear. II: Model Application and Validation

A model was recently proposed for predicting the load-deformation response of a reinforced concrete member under torsion combined with bending and shear to spalling or ultimate. This paper shows the application of the model to create interaction surfaces to predict the failure of a member subjected to different ratios of applied torsion, bending, and shear. The model was validated by comparing the predicted and experimental behavior of 28 members from three experimental studies available in the literature. The members were loaded under torsion combined with different ratios of bending, and shear. The torque-twist behavior, reinforcement stress, and concrete surface strain predicted by the model were in close agreement with the experiments. This paper also describes how the model can be applied to create interaction surfaces. The interaction curves predicted by the model were validated by comparing the predicted and experimental capacities of 17 specimens available in the literature.     

Severe rhabdomyolysis with renal failure after intranasal cocaine use

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).     

Conventional color Doppler velocity sonography versus color Doppler energy sonography for the diagnosis of acute experimental torsion of the spermatic cord

OBJECTIVE: We compared color Doppler velocity sonography and color Doppler energy sonography for the diagnosis of spermatic cord torsion in a canine model and determined the degree of torsion necessary to acutely halt testicular blood flow. MATERIALS AND METHODS: Spermatic cord torsion was created in five dogs by exposing and rotating the ipsilateral testis 0 degree, 180 degrees, 270 degrees, 360 degrees, 450 degrees, and 540 degrees. Detorsion followed. The testicles were scanned at each torsion stop using both color Doppler velocity sonography and color Doppler energy sonography. Doppler parameters were optimized (by phantom and test scans) and maintained at a tolerable noise level throughout the experiment. Readers who were unaware of the degree of torsion compared flow in the rotated and contralateral control testes. RESULTS: Flow became undetectable by color Doppler velocity sonography and color Doppler energy sonography at 450 degrees in four of five cases and at 540 degrees in one of five cases. We found no significant difference between the velocity and the energy techniques for detecting this absence of flow (p > .05, Wilcoxon test). We found a significant difference in degree of flow for both techniques when comparing controls and all degrees of torsion combined (p < .006, Mann-Whitney test), but significance was achieved at lesser degrees of torsion with the velocity technique than with the energy technique (180 degrees and 360 degrees, respectively, Wilcoxon test). CONCLUSION: Color Doppler energy sonography was not significantly more sensitive than color Doppler velocity sonography for the diagnosis of spermatic cord torsion in this model. Complete occlusion of arterial inflow occurred at 450-540 degrees of torsion.