Rupture

To investigate the physiopathologic mechanisms of the rupture of the corpora cavernosa by means of a histologic study of the tunica albuginea. In 6 patients (age range 28 to 49 years, mean 38) with traumatic penile rupture, samples of the tunica albuginea were taken during corrective surgery far from the site of the lesion. These specimens were analyzed with light microscopy by the same pathologist and compared with other samples of tunica albuginea taken from 7 patients who underwent penile surgery for other reasons. Five of the 6 patients with traumatic penile rupture had histologic anomalies of the tunica albuginea (fibrosclerosis in all 5 patients [83%] and phlogistic cellular infiltrations composed of lymphocytes or histiocytes in 3 patients [50%]). Only 1 patient (17%) with traumatic rupture of the corpus cavernosum had a completely healthy tunica albuginea. None of the control specimens revealed any histologic alterations. Structural anomalies could alter the mechanical prope...

This is a longitudinal study of the identity process through times of dramatic social change. Using a narrative psychological approach this research follows the life stories of five Egyptian bloggers as they write their stories on online blogs over the course of the three years following the 2011 revolution, at which time Egypt has witnessed major social and political changes. The aim is to understand the identity process of individuals as they develop and adapt through changing social contexts and how they create alternative social relations as they engage in prefigurative politics. The findings shed light on how ruptures trigger a process of reflexivity, adaptive learning, and sense-making that facilitates coping and the reconstruction of a positive identity after ruptures. It also suggests that the narration of the experience of rupture through storytelling creates a heightened sense of agency in individuals' ability to create new meanings of their world in spite of the socio-cultural and political constraints. This study presents narratives as an informing methodological resource that connects identity process with social representations and emphasizes the value of storytelling as an integral part of the adaptation process.

The purpose of our study was to clarify the events that take place during anterior cruciate ligament (ACL) failure, focusing on the behavior of the ACL as a composition of multiple fibers, during uniaxial tension along the ligament.Ten fresh-frozen human cadaveric knee specimens were fixed in an Instron machine (Instron, Norwood, MA), and load was applied parallel to the ACL axis. Two cameras were used to detect the failure mode of the ACL and its different groups of fibers. The distinct bundles of fibers were marked in each specimen before testing. The macroscopic findings during the experiment were used for comparison with the biomechanical results.The ACL showed a non-monotonic response during testing. The load-elongation curve showed a plateau or a second peak after the initial drop in load. Macroscopically, some fibers were failing initially, whereas the intact fibers had a remaining load potential. In our setting, 3 different failure patterns were recognized, specifically, a midsubstance tear of the anteromedial or the posterolateral bundle with a subsequent failure of the intact bundle or an initial avulsion of the anteromedial attachment. Analysis of the video frames showed a direct connection between the failure patterns in the load-elongation curves and the macroscopic sequence of events during ACL failure.The ACL ligament acts as a multifiber construction. In our setting, rupture follows 3 specific patterns where a complete or partial tear of the fiber bundles occurs first and the remaining intact fiber bundles have a potential load resistance.Our study allows a better understanding of the mechanical properties of the ACL. An update on the biomechanics of ACL failure during uniaxial tension after the “double-bundle revolution” could provide data helpful for ACL reconstruction.

Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with four-strand gracilis and semitendinosus tendon (N = 37) or with patellar tendon-bone (N = 35) from the ipsilateral side. The groups were similar in terms of age, sex, level of activity, degree of laxity, meniscal lesions found surgically, and rehabilitation program. The follow-up was performed at another hospital by independent observers after 6, 12, and 24 months. Sixty-one patients (32 with hamstring tendon grafts and 29 with patellar tendon grafts) complied with the follow-up routine for the full 24 months. No differences were found between the groups with respect to Cincinnati functional score, KT-1000 arthrometer measurements, or stairs hopple test results. The subjective result and the single-legged hop test result were better for the hamstring tendon group after 6 and 12 months, but no differences were found after 24 months. The hamst...

John Barth‟s “Lost in the Funhouse ” is a prime example of a postmodernist short fiction. The poetics of the work is mainly concerned with questions of ontology and frequently seeks to foreground this notion in different ways so much so that the reader gets lost in a funhouse of reading. Accordingly, the story has been divided into separate worlds, each trying to call into attention its own ontological existence and significance. Barth‟s story self-consciously implements certain techniques at different levels of his work to foreground world formation and draw the reader‟s attention towards the worlds of the text. His story foregrounds different planes, each of which stands independently as an ontological world: the world of language and text, the metafictional level, the projected world level, and the external world of the author. However, the resultant ontological ruptures, which are intentionally induced, cause various complications in the narrative. Ontologies are presented as un...

Objective To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). Methods In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. Results Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). Conclusions MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant.