BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of r...Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.展开更多
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.展开更多
Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture pr...Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture presents significant risks,including dyspnea,respiratory failure,and potentially fatal airway obstruction,and is often overlooked or diagnosed late in clinical settings.Prompt diagnosis and intervention are prognostically crucial.[1,2]Between January 2013 and December 2023,four children(two male and two female)with bronchial rupture were admitted to the Pediatric Surgical Intensive CareUnit(ICU)at Children’s Hospital,Zhejiang University School of Medicine.Here,we share our experience of patient management.展开更多
A spontaneous splenic rupture is one of the rarest encounters in our field. It is a potentially fatal condition if not diagnosed early and treated promptly. Moreover, several preexisting diseases contribute to the occ...A spontaneous splenic rupture is one of the rarest encounters in our field. It is a potentially fatal condition if not diagnosed early and treated promptly. Moreover, several preexisting diseases contribute to the occurrence of spontaneous splenic rupture, which includes hematological disease, infectious, malignancy, and immune-compromised disease. In our case, we report a 37-year-old male with a known case of diabetes mellitus who presented with generalized abdominal pain and was diagnosed with spontaneous splenic rupture. He was treated with splenic artery embolization and discharged with a good outcome. Despite the rarity of the disease, it is important to keep it in mind when a patient presents to you with abdominal pain.展开更多
In this study,the vertical components of broadband teleseismic P wave data recorded by China Earthquake Network are used to image the rupture processes of the February 6th,2023 Turkish earthquake doublet via back proj...In this study,the vertical components of broadband teleseismic P wave data recorded by China Earthquake Network are used to image the rupture processes of the February 6th,2023 Turkish earthquake doublet via back projection analysis.Data in two frequency bands(0.5-2 Hz and 1-3 Hz)are used in the imaging processes.The results show that the rupture of the first event extends about 200 km to the northeast and about 150 km to the southwest,lasting~90 s in total.The southwestern rupture is triggered by the northeastern rupture,demonstrating a sequential bidirectional unilateral rupture pattern.The rupture of the second event extends approximately 80 km in both northeast and west directions,lasting~35 s in total and demonstrates a typical bilateral rupture feature.The cascading ruptures on both sides also reflect the occurrence of selective rupture behaviors on bifurcated faults.In addition,we observe super-shear ruptures on certain fault sections with relatively straight fault structures and sparse aftershocks.展开更多
On December 18, 2023, the M_(S)6.2 Jishishan earthquake occurred in the northeastern region of the QinghaiXizang Plateau, causing heavy casualties and property damage in Gansu and Qinghai Provinces. In this study,we i...On December 18, 2023, the M_(S)6.2 Jishishan earthquake occurred in the northeastern region of the QinghaiXizang Plateau, causing heavy casualties and property damage in Gansu and Qinghai Provinces. In this study,we integrate space imaging geodesy, finite fault inversion, and back-projection methods to decipher its rupture property, including fault geometry, coseismic slip distribution, rupture direction, and propagation speed. The results reveal that the seismogenic fault dips to the southwest at an angle of 29°. The major slip asperity is dominated by reverse slip and is concentrated within a depth range of 7–16 km, which explains the significant uplift near the epicenter observed by both the Sentinel-1 ascending and descending In SAR data. Moreover, the teleseismic array waveforms indicate a northwest propagating rupture with an overall slow rupture velocity of~1.91 km/s(AK array) or 1.01 km/s(AU array).展开更多
Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel...Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel insights into physical criteria for delineating surface fault-rupture hazard zones(SRHZs)along ruptured strike-slip faults.To achieve this objective,three trench studies across the surface rupture were conducted on the Pazarcık segment of the EAFZ to collect field data,and earthquake recurrence intervals were interpreted using Bayesian statistics from previously conducted paleoseismological trenchings.The results of the proposed model indicate that the Pazarcık segment produced five significant surface-rupturing earthquakes in the last∼11 kyr:E1:11.13±1.74 kyr,E2:7.62±1.20 kyr,E3:5.34±1.05 kyr,E4:1.82±0.93 kyr,and E5:0.35±0.11 kyr.In addition,the recurrence intervals of destructive earthquakes on the subject in question range from 0.6 kyr to 4.8 kyr.Considering that the last significant earthquake occurred in 1513,the longest time since the most recent surface fault rupturing earthquake on this particular segment was 511 years.These results indicate that,in terms of the theoretical recurrence interval of earthquakes that can create surface ruptures on the Pazarcık segment,the period in which the February 6,2023,earthquake occurred was within the end of the expected return period.As a result,the potential for a devastating earthquake in the near future is not foreseen on the same fault.Finally,the SRHZ proposed for the Pazarcık section of Gölbaşıvillage was calculated as a 61-meter-wide offset on the fault lineament to reduce the negativities that may occur in the ruptured area in the future.It is recommended to take into account this width in the settlement of this area and nearby areas.展开更多
Hypertensive disorders of pregnancy,including chronic hypertension,gestational hypertension,and preeclampsia,are the most common complications in pregnant women,affecting approximately 15%of pregnancies.[1,2]Hemolysis...Hypertensive disorders of pregnancy,including chronic hypertension,gestational hypertension,and preeclampsia,are the most common complications in pregnant women,affecting approximately 15%of pregnancies.[1,2]Hemolysis,elevated liver enzymes,and low platelet count(HELLP syndrome)can occur in 0.2%-0.6%of all pregnancies,and 10%-15%of patients are diagnosed with preeclampsia.[3,4]Among its severe complications,liver hematoma is remarkable and may lead to liver rupture.Prompt identification of HELLP syndrome is crucial for proper therapeutic management and to avoid fatal outcomes[4,5]since when a hepatic hematoma occurs,the risk of rupture increases to 12%.[3,5]展开更多
AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repai...AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.展开更多
Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due t...Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.展开更多
The subsurface fluid injection can cause pressure increase within faults,leading to earthquake occurrences.However,the factors controlling earthquake rupture due to pressure perturbation remain poorly understood.To re...The subsurface fluid injection can cause pressure increase within faults,leading to earthquake occurrences.However,the factors controlling earthquake rupture due to pressure perturbation remain poorly understood.To resolve this problem,we simulate the physical processes of earthquake nucleation and rupture on strike-slip faults perturbated by pressure migration based on the slip-weakening law.Multiple kinds of factors,including background stress,fluid injection rates,the area of the pressurized region,fault geometry,and fault friction coefficients,are considered in our simulations.Our simulation results reveal that the ratio of shear stress to normal stress rather than their absolute values controls the rupture behavior.With the large stress ratios,high injection rates,and large pressurized areas,earthquakes are prone to propagate as runaway ruptures.Additionally,faults with large aspect ratios of length to width are also favorable for causing runaway ruptures.In contrast,the factors of fault strike,dip angles and friction coefficients have minor influence on rupture behavior.展开更多
BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who compl...BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.展开更多
BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency...BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.展开更多
BACKGROUND Severe bleeding as a result of a major vascular injury is a potentially fatal event commonly observed in the emergency department.Bowel necrosis and gastric ulcers secondary to ischemia are rare due to thei...BACKGROUND Severe bleeding as a result of a major vascular injury is a potentially fatal event commonly observed in the emergency department.Bowel necrosis and gastric ulcers secondary to ischemia are rare due to their rich blood supply.In this case,we present the case of a patient who was treated successfully following rupture of his femoral artery resulting in bowel necrosis and an unusually large gastric ulcer.CASE SUMMARY A 28-year-old male patient sustained a knife stab wound to the right thigh,causing rupture of his femoral artery and leading to massive bleeding.He underwent cardiopulmonary resuscitation and received a large blood transfusion.Abdominal surgeries confirmed bowel necrosis,and jejunostomy was performed.The necrotic intestine was removed,the remaining intestine was anastomosed,and the right thigh was amputated.After three surgeries,the patient's overall condition gradually improved,and the patient was discharged from the hospital.However,one day after discharge,the patient was admitted again due to dizziness and melena,and a gastroduodenoscopy revealed a giant banded ulcer.After 2 weeks of treatment,the ulcer had decreased in size without bleeding.Six months after the last surgery,enterostomy and reintroduction surgery were completed.The patient was fitted with a right lower limb prosthesis one year after surgery.After 3 years of follow-up,the patient did not complain of discomfort.CONCLUSION Trauma department physicians need to be aware of the possible serious complications involving the abdomen of trauma patients with massive bleeding.展开更多
BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis.Such perforation is a rare but life-threatening situation that can lead to the formation and rupture of liver hematomas.Here,we repor...BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis.Such perforation is a rare but life-threatening situation that can lead to the formation and rupture of liver hematomas.Here,we report a case of a ruptured intrahepatic hematoma caused by intrahepatic gallbladder perforation,and we present a literature review.CASE SUMMARY A 70-year-old male was admitted to the hospital with a complaint of right upper quadrant abdominal pain,flustering and dizziness.The preoperative diagnosis was a ruptured malignant liver tumor,and the patient’s medical images and increased level of carbohydrate antigen-199 suggested that the gallbladder had been invaded.However,the tumor was proven to be a liver hematoma secondary to gallbladder perforation after surgery.The patient was discharged uneventfully on the fifteenth postoperative day.CONCLUSION Intrahepatic gallbladder perforation is difficult to diagnose preoperatively.Radiological examinations play a crucial role in the diagnosis but only for partial cases.Early diagnosis and appropriate surgery are key to managing this rare condition.展开更多
BACKGROUND Achilles tendon rupture is a common orthopedic injury,with an annual incidence of 11-37 per 100000 people,significantly impacting daily life.Minimally invasive surgery,increasingly favored for its reduced r...BACKGROUND Achilles tendon rupture is a common orthopedic injury,with an annual incidence of 11-37 per 100000 people,significantly impacting daily life.Minimally invasive surgery,increasingly favored for its reduced risks and comparable fixation strength to open surgery,addresses these challenges.Despite advantages like accelerated recovery,perioperative care poses emotional support,pain management,and rehabilitation challenges,impacting treatment efficacy and patient experience.To address these gaps,this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery,aiming to develop personalized,standardized care guidelines for broader implementation.AIM To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery,providing evidence-based early recovery indicators.METHODS This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups.The experimental group received perioperative rapid rehabilitation nursing care,while the control group received standard care.The primary outcome measure was the Oswestry disability index score,with secondary outcomes including quality of life,Barthel index,patient satisfaction with nursing,incidence of complications,and rehabilitation adherence.Statistical analysis included appropriate methods to compare outcomes between groups.The study was conducted in a specific setting,utilizing a randomized controlled trial design.RESULTS All 160 patients completed the follow-up.The experimental group showed significantly greater improvements in key efficacy indicators:Postoperative Oswestry disability index score(8.688 vs 18.88,P<0.0001),quality of life score(53.25 vs 38.99,P<0.0001),and Barthel index(70.44 vs 51.63,P<0.0001).The experimental group had a lower incidence of deep vein thrombosis(1.25%vs 10.00%,P=0.0339)with a relative risk of 0.1250(95%confidence interval:0.02050-0.7421).Infection rates were lower in the experimental group(2.50%vs 11.25%,P=0.0564).Hospital stay(5.40 days vs 7.26 days,P<0.0001)and postoperative bed rest(3.34 days vs 5.42 days,P<0.0001)were significantly shorter.Patient satisfaction was 100%in the experimental group vs 87.50%in the control group(P=0.0031).CONCLUSION The rapid rehabilitation intervention significantly reduced pain,shortened hospital stays,and lowered complication rates,improving joint function and patient satisfaction.展开更多
Both M_(W) 7.8 and M_(W) 7.5 earthquakes occurred in southeastern Türkiye on February 6,2023,resulting in numerous buildings collapsing and serious casualties.Understanding the distribution of coseismic surface r...Both M_(W) 7.8 and M_(W) 7.5 earthquakes occurred in southeastern Türkiye on February 6,2023,resulting in numerous buildings collapsing and serious casualties.Understanding the distribution of coseismic surface ruptures and secondary disasters surrounding the epicentral area is important for post-earthquake emergency and disaster assessments.High-resolution Maxar and GF-2 satellite data were used after the events to extract the location of the rupture surrounding the first epicentral area.The results show that the length of the interpreted surface rupture zone(part of)is approximately 75 km,with a coseismic sinistral dislocation of 2-3 m near the epicenter;however,this reduced to zero at the tip of the southwest section of the East Anatolia Fault Zone.Moreover,dense soil liquefaction pits were triggered along the rupture trace.These events are in the western region of the Eurasian Seismic Belt and result from the subduction and collision of the Arabian and African Plates toward the Eurasian Plate.The western region of the Chinese mainland and its adjacent areas are in the eastern section of the Eurasian Seismic Belt,where seismic activity is controlled by the collision of the Indian and Eurasian Plates.Both China and Türkiye have independent tectonic histories.展开更多
BACKGROUND Splenic rupture associated with Behçet’s syndrome(BS)is extremely rare,and there is no consensus on its management.In this case report,a patient with BSassociated splenic rupture was successfully trea...BACKGROUND Splenic rupture associated with Behçet’s syndrome(BS)is extremely rare,and there is no consensus on its management.In this case report,a patient with BSassociated splenic rupture was successfully treated with splenic artery embolization(SAE)and had a good prognosis after the intervention.CASE SUMMARY The patient was admitted for pain in the left upper abdominal quadrant.He was diagnosed with splenic rupture.Multiple oral and genital aphthous ulcers were observed,and acne scars were found on his back.He had a 2-year history of BS diagnosis,with symptoms of oral and genital ulcers.At that time,he was treated with oral corticosteroids for 1 month,but the symptoms did not alleviate.He underwent SAE to treat the rupture.On the first day after SAE,the patient reported a complete resolution of abdominal pain and was discharged 5 d later.Three months after the intervention,a computed tomography examination showed that the splenic hematoma had formed a stable cystic effusion,suggesting a good prognosis.CONCLUSION SAE might be a good choice for BS-associated splenic rupture based on good surgical practice and material selection.展开更多
Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging mo...Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.展开更多
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
文摘Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
文摘Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture presents significant risks,including dyspnea,respiratory failure,and potentially fatal airway obstruction,and is often overlooked or diagnosed late in clinical settings.Prompt diagnosis and intervention are prognostically crucial.[1,2]Between January 2013 and December 2023,four children(two male and two female)with bronchial rupture were admitted to the Pediatric Surgical Intensive CareUnit(ICU)at Children’s Hospital,Zhejiang University School of Medicine.Here,we share our experience of patient management.
文摘A spontaneous splenic rupture is one of the rarest encounters in our field. It is a potentially fatal condition if not diagnosed early and treated promptly. Moreover, several preexisting diseases contribute to the occurrence of spontaneous splenic rupture, which includes hematological disease, infectious, malignancy, and immune-compromised disease. In our case, we report a 37-year-old male with a known case of diabetes mellitus who presented with generalized abdominal pain and was diagnosed with spontaneous splenic rupture. He was treated with splenic artery embolization and discharged with a good outcome. Despite the rarity of the disease, it is important to keep it in mind when a patient presents to you with abdominal pain.
基金supported by the National Key R&D Program of China(No.2022YFF0800601)National Scientific Foundation of China(Nos.41930103 and 41774047).
文摘In this study,the vertical components of broadband teleseismic P wave data recorded by China Earthquake Network are used to image the rupture processes of the February 6th,2023 Turkish earthquake doublet via back projection analysis.Data in two frequency bands(0.5-2 Hz and 1-3 Hz)are used in the imaging processes.The results show that the rupture of the first event extends about 200 km to the northeast and about 150 km to the southwest,lasting~90 s in total.The southwestern rupture is triggered by the northeastern rupture,demonstrating a sequential bidirectional unilateral rupture pattern.The rupture of the second event extends approximately 80 km in both northeast and west directions,lasting~35 s in total and demonstrates a typical bilateral rupture feature.The cascading ruptures on both sides also reflect the occurrence of selective rupture behaviors on bifurcated faults.In addition,we observe super-shear ruptures on certain fault sections with relatively straight fault structures and sparse aftershocks.
基金supported by the Open Fund of Hubei Luojia Laboratory(230100015)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB41000000)the Knowledge Innovation Program of Wuhan-Shuguang Project(2023010201020281).
文摘On December 18, 2023, the M_(S)6.2 Jishishan earthquake occurred in the northeastern region of the QinghaiXizang Plateau, causing heavy casualties and property damage in Gansu and Qinghai Provinces. In this study,we integrate space imaging geodesy, finite fault inversion, and back-projection methods to decipher its rupture property, including fault geometry, coseismic slip distribution, rupture direction, and propagation speed. The results reveal that the seismogenic fault dips to the southwest at an angle of 29°. The major slip asperity is dominated by reverse slip and is concentrated within a depth range of 7–16 km, which explains the significant uplift near the epicenter observed by both the Sentinel-1 ascending and descending In SAR data. Moreover, the teleseismic array waveforms indicate a northwest propagating rupture with an overall slow rupture velocity of~1.91 km/s(AK array) or 1.01 km/s(AU array).
基金This contribution was partially supported by the Turkish government through the 1002-C project in Natural Disasters Focused Fieldwork Emergency Support Program managed by the TUBITAK.I am grateful to F.Koçbulut and S.Koşaroğlu for helping me with the trenching studies.I also gratefully acknowledge H.Sözbilir,M.Nas,and E.Akgün for comments and suggestions.Furthermore,I extend my gratitude to the anonymous referees for their constructive criticisms and insightful feedback during the evaluation phase of this manuscript.
文摘Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel insights into physical criteria for delineating surface fault-rupture hazard zones(SRHZs)along ruptured strike-slip faults.To achieve this objective,three trench studies across the surface rupture were conducted on the Pazarcık segment of the EAFZ to collect field data,and earthquake recurrence intervals were interpreted using Bayesian statistics from previously conducted paleoseismological trenchings.The results of the proposed model indicate that the Pazarcık segment produced five significant surface-rupturing earthquakes in the last∼11 kyr:E1:11.13±1.74 kyr,E2:7.62±1.20 kyr,E3:5.34±1.05 kyr,E4:1.82±0.93 kyr,and E5:0.35±0.11 kyr.In addition,the recurrence intervals of destructive earthquakes on the subject in question range from 0.6 kyr to 4.8 kyr.Considering that the last significant earthquake occurred in 1513,the longest time since the most recent surface fault rupturing earthquake on this particular segment was 511 years.These results indicate that,in terms of the theoretical recurrence interval of earthquakes that can create surface ruptures on the Pazarcık segment,the period in which the February 6,2023,earthquake occurred was within the end of the expected return period.As a result,the potential for a devastating earthquake in the near future is not foreseen on the same fault.Finally,the SRHZ proposed for the Pazarcık section of Gölbaşıvillage was calculated as a 61-meter-wide offset on the fault lineament to reduce the negativities that may occur in the ruptured area in the future.It is recommended to take into account this width in the settlement of this area and nearby areas.
文摘Hypertensive disorders of pregnancy,including chronic hypertension,gestational hypertension,and preeclampsia,are the most common complications in pregnant women,affecting approximately 15%of pregnancies.[1,2]Hemolysis,elevated liver enzymes,and low platelet count(HELLP syndrome)can occur in 0.2%-0.6%of all pregnancies,and 10%-15%of patients are diagnosed with preeclampsia.[3,4]Among its severe complications,liver hematoma is remarkable and may lead to liver rupture.Prompt identification of HELLP syndrome is crucial for proper therapeutic management and to avoid fatal outcomes[4,5]since when a hepatic hematoma occurs,the risk of rupture increases to 12%.[3,5]
基金Supported by the Joint Construction Project of Henan Medical Science and Technology(No.LHGJ20220370)the Natural Science Foundation of Henan Province(No.232300420237).
文摘AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.
文摘Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart failure.Concomitant pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae rupture.Trauma patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute hypoxemia.The possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.
基金co-supported by the National Natural Science Foundation of China under Grants(42130101,42074007)the Fundamental Research Funds for the Central Universities under Grants 2042023kf1035。
文摘The subsurface fluid injection can cause pressure increase within faults,leading to earthquake occurrences.However,the factors controlling earthquake rupture due to pressure perturbation remain poorly understood.To resolve this problem,we simulate the physical processes of earthquake nucleation and rupture on strike-slip faults perturbated by pressure migration based on the slip-weakening law.Multiple kinds of factors,including background stress,fluid injection rates,the area of the pressurized region,fault geometry,and fault friction coefficients,are considered in our simulations.Our simulation results reveal that the ratio of shear stress to normal stress rather than their absolute values controls the rupture behavior.With the large stress ratios,high injection rates,and large pressurized areas,earthquakes are prone to propagate as runaway ruptures.Additionally,faults with large aspect ratios of length to width are also favorable for causing runaway ruptures.In contrast,the factors of fault strike,dip angles and friction coefficients have minor influence on rupture behavior.
文摘BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.
文摘BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.
文摘BACKGROUND Severe bleeding as a result of a major vascular injury is a potentially fatal event commonly observed in the emergency department.Bowel necrosis and gastric ulcers secondary to ischemia are rare due to their rich blood supply.In this case,we present the case of a patient who was treated successfully following rupture of his femoral artery resulting in bowel necrosis and an unusually large gastric ulcer.CASE SUMMARY A 28-year-old male patient sustained a knife stab wound to the right thigh,causing rupture of his femoral artery and leading to massive bleeding.He underwent cardiopulmonary resuscitation and received a large blood transfusion.Abdominal surgeries confirmed bowel necrosis,and jejunostomy was performed.The necrotic intestine was removed,the remaining intestine was anastomosed,and the right thigh was amputated.After three surgeries,the patient's overall condition gradually improved,and the patient was discharged from the hospital.However,one day after discharge,the patient was admitted again due to dizziness and melena,and a gastroduodenoscopy revealed a giant banded ulcer.After 2 weeks of treatment,the ulcer had decreased in size without bleeding.Six months after the last surgery,enterostomy and reintroduction surgery were completed.The patient was fitted with a right lower limb prosthesis one year after surgery.After 3 years of follow-up,the patient did not complain of discomfort.CONCLUSION Trauma department physicians need to be aware of the possible serious complications involving the abdomen of trauma patients with massive bleeding.
文摘BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis.Such perforation is a rare but life-threatening situation that can lead to the formation and rupture of liver hematomas.Here,we report a case of a ruptured intrahepatic hematoma caused by intrahepatic gallbladder perforation,and we present a literature review.CASE SUMMARY A 70-year-old male was admitted to the hospital with a complaint of right upper quadrant abdominal pain,flustering and dizziness.The preoperative diagnosis was a ruptured malignant liver tumor,and the patient’s medical images and increased level of carbohydrate antigen-199 suggested that the gallbladder had been invaded.However,the tumor was proven to be a liver hematoma secondary to gallbladder perforation after surgery.The patient was discharged uneventfully on the fifteenth postoperative day.CONCLUSION Intrahepatic gallbladder perforation is difficult to diagnose preoperatively.Radiological examinations play a crucial role in the diagnosis but only for partial cases.Early diagnosis and appropriate surgery are key to managing this rare condition.
文摘BACKGROUND Achilles tendon rupture is a common orthopedic injury,with an annual incidence of 11-37 per 100000 people,significantly impacting daily life.Minimally invasive surgery,increasingly favored for its reduced risks and comparable fixation strength to open surgery,addresses these challenges.Despite advantages like accelerated recovery,perioperative care poses emotional support,pain management,and rehabilitation challenges,impacting treatment efficacy and patient experience.To address these gaps,this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery,aiming to develop personalized,standardized care guidelines for broader implementation.AIM To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery,providing evidence-based early recovery indicators.METHODS This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups.The experimental group received perioperative rapid rehabilitation nursing care,while the control group received standard care.The primary outcome measure was the Oswestry disability index score,with secondary outcomes including quality of life,Barthel index,patient satisfaction with nursing,incidence of complications,and rehabilitation adherence.Statistical analysis included appropriate methods to compare outcomes between groups.The study was conducted in a specific setting,utilizing a randomized controlled trial design.RESULTS All 160 patients completed the follow-up.The experimental group showed significantly greater improvements in key efficacy indicators:Postoperative Oswestry disability index score(8.688 vs 18.88,P<0.0001),quality of life score(53.25 vs 38.99,P<0.0001),and Barthel index(70.44 vs 51.63,P<0.0001).The experimental group had a lower incidence of deep vein thrombosis(1.25%vs 10.00%,P=0.0339)with a relative risk of 0.1250(95%confidence interval:0.02050-0.7421).Infection rates were lower in the experimental group(2.50%vs 11.25%,P=0.0564).Hospital stay(5.40 days vs 7.26 days,P<0.0001)and postoperative bed rest(3.34 days vs 5.42 days,P<0.0001)were significantly shorter.Patient satisfaction was 100%in the experimental group vs 87.50%in the control group(P=0.0031).CONCLUSION The rapid rehabilitation intervention significantly reduced pain,shortened hospital stays,and lowered complication rates,improving joint function and patient satisfaction.
基金funded by the Basic Research Program of the Institute of Earthquake Forecasting,China Earthquake Administration(Grant Nos.CEAIEF20220102,2021IEF0505,and CEAIEF2022050502)the National Natural Science Foundation of China(Grant Nos.42072248 and 42041006)the National Key Research and Development Program of China(Grant Nos.2021YFC3000601-3 and 2019YFE0108900)。
文摘Both M_(W) 7.8 and M_(W) 7.5 earthquakes occurred in southeastern Türkiye on February 6,2023,resulting in numerous buildings collapsing and serious casualties.Understanding the distribution of coseismic surface ruptures and secondary disasters surrounding the epicentral area is important for post-earthquake emergency and disaster assessments.High-resolution Maxar and GF-2 satellite data were used after the events to extract the location of the rupture surrounding the first epicentral area.The results show that the length of the interpreted surface rupture zone(part of)is approximately 75 km,with a coseismic sinistral dislocation of 2-3 m near the epicenter;however,this reduced to zero at the tip of the southwest section of the East Anatolia Fault Zone.Moreover,dense soil liquefaction pits were triggered along the rupture trace.These events are in the western region of the Eurasian Seismic Belt and result from the subduction and collision of the Arabian and African Plates toward the Eurasian Plate.The western region of the Chinese mainland and its adjacent areas are in the eastern section of the Eurasian Seismic Belt,where seismic activity is controlled by the collision of the Indian and Eurasian Plates.Both China and Türkiye have independent tectonic histories.
文摘BACKGROUND Splenic rupture associated with Behçet’s syndrome(BS)is extremely rare,and there is no consensus on its management.In this case report,a patient with BSassociated splenic rupture was successfully treated with splenic artery embolization(SAE)and had a good prognosis after the intervention.CASE SUMMARY The patient was admitted for pain in the left upper abdominal quadrant.He was diagnosed with splenic rupture.Multiple oral and genital aphthous ulcers were observed,and acne scars were found on his back.He had a 2-year history of BS diagnosis,with symptoms of oral and genital ulcers.At that time,he was treated with oral corticosteroids for 1 month,but the symptoms did not alleviate.He underwent SAE to treat the rupture.On the first day after SAE,the patient reported a complete resolution of abdominal pain and was discharged 5 d later.Three months after the intervention,a computed tomography examination showed that the splenic hematoma had formed a stable cystic effusion,suggesting a good prognosis.CONCLUSION SAE might be a good choice for BS-associated splenic rupture based on good surgical practice and material selection.
基金Supported by Natural Science Foundation Project of Chongqing,No.CSTB2024NSCQ-MSX1265.
文摘Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.
