We study a cohomology theory \H^{\bullet }_{\varphi }\, which we call the \{\mathcal {L}}_B\-cohomology, on compact torsion-free \\mathrm {G}_2\ manifolds. We show that \H^k_{\varphi } \cong ...H^k_{\mathrm {dR}}\ for \k \ne 3, 4\, but that \H^k_{\varphi }\ is infinite-dimensional for \k = 3,4\. Nevertheless, there is a canonical injection \H^k_{\mathrm {dR}} \rightarrow H^k_{\varphi }\. The \{\mathcal {L}}_B\-cohomology also satisfies a Poincaré duality induced by the Hodge star. The establishment of these results requires a delicate analysis of the interplay between the exterior derivative \\mathrm {d}\ and the derivation \{\mathcal {L}}_B\ and uses both Hodge theory and the special properties of \\mathrm {G}_2\-structures in an essential way. As an application of our results, we prove that compact torsion-free \\mathrm {G}_2\ manifolds are ‘almost formal’ in the sense that most of the Massey triple products necessarily must vanish.
Perinatal or neonatal testicular torsion (PTT) is defined as testicular torsion within the first 30 days of life. PTT is a rare event, and bilateral PTT is even rarer. However, recent articles have ...advocated emergency bilateral exploration to exclude the catastrophic possibility of asymptomatic contralateral testicular torsion leading to anorchia. The aim of this study is to evaluate PTT in Northern Ireland (NI) using a nationwide population-based retrospective observational study.
All boys in NI who underwent emergency scrotal exploration within their first 30 days of life for possible testicular torsion over a 10-year period (January 2010-December 2019 inclusive) were included. Intraoperative findings primarily evaluated included diagnosis and presence of synchronous or asynchronous (metachronous) contralateral testicular torsion. Secondary outcomes included correlation between intraoperative findings and any preoperative ultrasound scan (USS), and scrotal examination findings during postoperative outpatient follow-up.
A total of 19 patients who underwent emergency scrotal exploration in the study period were included. An intraoperative finding confirming the diagnosis of PTT was reported in 14 (73.7%) patients. The incidence of PTT was calculated as 11.3 per 100,000 per male live births in NI, with bilateral PTT accounting for two patients (14.2% of all PTTs), divided equally between synchronous and asynchronous PTTs. Of two affected testes where preservation was felt appropriate intraoperatively, only one was still palpable at follow-up, producing a testicular salvage rate after PTT of only 7.1%. Testicular findings on preoperative USS were confirmed intraoperatively in five out of six patients, producing a concordance rate of 83.3%.
This is the first nationwide population-based study to calculate more accurately the incidence of PTT, and bilateral synchronous and asynchronous bilateral PTTs, all of which seem to be significantly higher than previously estimated. However, in keeping with previous reports, this study confirms the poor salvage rate of testes undergoing perinatal torsion, and suboptimal concordance between preoperative USS findings and intraoperative diagnosis.
ZielTätigkeiten in erzwungenen Körperhaltungen, wie Arbeiten in gebeugter oder gedrehter Haltung sowie dauerhaftes Stehen oder repetitive Tätigkeiten, können als hoch belastend für das ...muskuloskeletale System eingestuft werden. Daher konzentriert sich diese Arbeit auf die körperliche Arbeitsbelastung von Großküchenmitarbeitern auf Basis einer objektiven Tätigkeitsanalyse.Material und MethodenEs wird der Arbeitsalltag von 15 (9 w/6 m) Mitarbeitern (Spülküche: 6 2 w/4 m, Band: 7 5 w/2 m, Kommissionierung: 2 w) in einer Krankenhausgroßküche an drei verschiedenen Arbeitstagen über den Zeitraum einer gesamten Schicht mittels objektiver Tätigkeitsanalyse analysiert. Diese erfolgt durch eine externe Beobachtungsperson, die die jeweiligen Körperhaltungen in einer speziellen Software sekundengenau erfasst.ErgebnisseIn allen Tätigkeitsbereichen entfällt der größte Anteil mit >3,5 h auf das „Stehen“. „Gehen“ folgt mit >1,25 h und „Sitzen“ mit >0,75 h. „Bücken“, „Tragen“, „Beugen“, „Torsion“, „Heben“ und „Hocken“ dauern jeweils <0,5 h. Die überwiegenden Tätigkeiten am „Band“ und in der „Spülküche“ werden zu deren Hauptanteil in stehender Körperhaltung ausgeführt. Hinsichtlich der Intersubjektreliabilität liegen in der Spülküche beim „Stehen“ (p ≤ 0,03), „Gehen“ (p ≤ 0,01) und der „Torsion“ (p ≤ 0,01) Signifikanzen vor. Am Band weist die Körperhaltung „Bücken“ eine Signifikanz von p ≤ 0,01 auf.SchlussfolgerungArbeitnehmer der Krankenhausgroßküche arbeiten hauptsächlich in stehender Körperhaltung. Da eine andauernde Stehbelastung insbesondere zu einer erhöhten Beanspruchung von Wirbelsäulenstrukturen sowie von Bändern und Gelenken im Hüft‑, Knie- und Fußbereich führt, ist es anzuraten, die Stehbelastung in der Krankenhausgroßküche zu reduzieren.
The time window for possible salvage and survival of a torsed testicle is commonly thought to be 6 to 8 hours. However, survival of torsed testicles with or without subsequent atrophy is known to ...occur outside that critical time window. In this article, we performed a systematic review of the English literature to provide a more accurate understanding of reported time frames of testicle survival after a torsion event.
The primary research question was to determine the relationship between time to treatment and the rate of survival for testicles of male patients presenting with testicular torsion (TT).
A systematic review of the literature was performed and structured according to PRISMA guidelines. An exhaustive library search was performed after search strategies were developed for multiple databases that included PubMed, Cochrane library, Ovid MEDLINE, Web of Science, and ProQuest Theses and Dissertations. Two different searches were developed including "testicular torsion" and TT with the search term "time" added. Articles specifically reporting TT case series, testicle outcomes, and time to surgical or manual treatment were selected for review. In addition to and preceding the systematic review, an exhaustive manual search of the literature was also performed by the authors. As a result of these searches, a total of 30 studies with data considered relevant to the research question were included. The information extracted from the articles was tabulated with regard to time intervals to treatment and survival outcome.
The systematic review process and protocol are reported in this article. A total of 30 studies were found that reported case series of TT patients and their outcomes as well as time to treatment reported in useful time frames. From these reports, a total of 2116 TT patients were culled, and their outcomes and time to treatment are reported. Because the time to treatment was reported variously in different case series, the 3 most common formats for reporting time to treatment and outcome were used. When overlap between the tables existed, the data were tallied and reported cumulatively. When reported in 6-hour intervals (1,283 patients), survival at 0 to 6 hours was 97.2%; 7 to 12 hours, 79.3%; 13 to 18 hours, 61.3%; 19 to 24 hours, 42.5%; 25 to 48 hours, 24.4%; and greater than 48 hours, 7.4%. Moreover, we reported cumulative survival data based on reporting for all 3 groups of patients. Testicular salvage in the first 12 hours is 90.4%, from 13 to 24 hours survival is 54.0%, and beyond 24 hours survival is 18.1%. Testicle survival after TT was significant beyond the commonly held 6 to 8 hour time frame and even after more than 24 hours of ischemia.
Survival of the testicle irrespective of subsequent atrophy, decreased spermatogenesis or impaired endocrine function after TT can be much longer than the 6 to 8 hours that is commonly taught. Our systematic review of the literature demonstrates that survival percentages are significant even past 24 hours of torsion. This information should encourage aggressive management of patients presenting with TT pain that has been ongoing for many hours.
Adnexal torsion: review of the literature Sasaki, Kirsten J; Miller, Charles E
Journal of minimally invasive gynecology,
03/2014, Letnik:
21, Številka:
2
Journal Article
Recenzirano
Adnexal torsion is one of a few gynecologic surgical emergencies. Misdiagnosis or delay in treatment can have permanent sequelae including loss of an ovary with effect on future fertility, ...peritonitis, and even death. A PubMed search was performed between 1985 and 2012 for reviews, comparative studies, and case reports to provide a review of the epidemiology, risk factors, clinical presentation, common laboratory and imaging findings, and treatments of adnexal torsion. Common symptoms of torsion include pain, nausea, and vomiting, with associated abdominal or pelvic tenderness, and may differ in premenarchal and pregnant patients. Laboratory and imaging findings including ultrasound with Doppler analysis, computed tomography, and magnetic resonance imaging can assist in making the diagnosis but should not trump clinical judgment; normal Doppler flow can be observed in up to 60% of adnexal torsion cases. Treatment depends on the individual patient but commonly includes detorsion, even if the adnexae initially seem necrotic, with removal of any associated cysts or salpingo-oophorectomy, because recurrence rates are higher with detorsion alone or detorsion with only cyst aspiration.
This meta-analysis seeks to discern the optimal management strategy in neonatal testicular torsion (NTT).
Reviewed all English-language articles published between 2005 and 2015 in Medline/Pubmed that ...had a defined diagnosis of NTT within the first thirty days of life, and discussed specific surgical and nonsurgical management. Exclusion criteria were non-English literature, case reports, case studies, and failure to clearly describe the management of NTT. Data from 9 studies were analyzed, individually and together as pooled data, using a random effect model with a random intercept to estimate the pooled proportions of interest. Results are presented with 95% confidence interval. All analyses were done in SAS 9.4®.
9 publications met criteria for this analysis with a total of 196 patients. Bilateral testicular torsions (n = 14) were less common as compared to right/left testicular torsion (n = 85/97). Asynchronous NTTs (n = 9) were more common than synchronous NTTs (n = 2). There was a higher incidence of NTT in neonates delivered by vaginal delivery (n = 110) as compared to those delivered by c-section (n = 25). Extravaginal torsion (n = 54) is far more common than intravaginal torsion (n = 2). Full-term neonates (n = 122) have a higher incidence of NTT as compared to preterm neonates (n = 9). A total of 15 testicles were salvaged. Of the salvaged testicles 2 were documented as prenatal, 10 postnatal and 3 were undocumented. A strategy of bilateral exploration allows for salvage of about 7% of ipsilateral testicles and prevent asynchronous torsion in about 4% of neonates.
Based on our population, between 8–12% of patients would benefit from bilateral exploration at the time of diagnosis. We recommend urgent bilateral exploration with orchiopexy of the contralateral testicle in order to avert anorchia.
Systematic review.
Level 5 meta-synthesis (Evidence from systematic reviews of qualitative and descriptive studies).
Abstract Purpose The treatment of ovarian torsion (OT) is often delayed because of diagnostic uncertainty and dependence on radiologic confirmation. In contrast, when testicular torsion (TT) is ...suspected, diagnosis and management are expedited despite lack of certainty, and operative exploration is not delayed by radiologic investigations. We compared the management of torsion in both sexes to define a better clinical pathway for suspected OT. Methods A 2.5-year review of the Pediatric Health Information System database was performed to determine the incidence of TT and OT at large children's hospitals. A 10-year retrospective review of children (0-19 years) diagnosed with TT or OT at a single academic center was performed to identify differences in diagnosis and management and determine the impact on gonadal salvage rates. Results The incidence of TT was comparable with OT in the Pediatric Health Information System database (0.03% vs 0.02%). A total of 158 patients with TT and 90 patients with OT were managed at our center with a median age of 12 years in both groups. Boys presented earlier after the onset of pain (36 vs 72 hours, P < .0001) and were imaged more quickly (0.77 vs 1.86 hours, P < .0001). Time to operating room (OR) was also shorter for TT (2.3 vs 6.3 hours, P < .0001). The salvage rate for TT was 30.3% vs 14.4% for OT ( P < .01). Conclusions Girls with suspected OT waited 2.5 times as long for diagnostic imaging and 2.7 times as long to be taken to the operating room. In addition, the gonadal salvage rate was significantly worse for girls compared with boys with TT. More urgent intervention for OT, with liberal use of diagnostic laparoscopy and without reliance on a definitive diagnosis by imaging, should be considered in girls with lower abdominal pain.
To analyze characteristics of acute and chronic ovarian torsion, review treatment recommendations, and present possible surgical techniques for fertility preservation in young women.
Literature ...review and demonstration of perioperative management of ovarian torsion using radiologic images and intraoperative video footage. Ovarian torsion is mostly mentioned in context of gynecologic emergencies, where acute ovarian torsion with arterial obstruction leads to ovarian ischemia and necrosis. However, ovarian torsion can also occur as a partial or intermittent torsion with venous and lymphatic obstruction, followed by ovarian swelling. In both cases, surgical management of ovarian torsion commonly includes oophorectomy, although leading guidelines recommend preservation of the ovary. We here aimed to raise awareness for the clinical features of ovarian torsion and demonstrate adequate perioperative management, thereby avoiding surgical overtreatment in young women.
Medical University of Vienna, Department of Obstetrics and Gynecology.
We present a case of acute ovarian torsion with a consequently ischemic ovary as well as a case of chronic ovarian torsion with related massive ovarian edema. The patients included in this video gave consent for publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.), and other applicable sites.
Laparoscopic management with detorsion of the torquated ovaries, cystectomy on an ischemic ovary and oophoropexy to the pelvic side wall and utero-ovarian ligament to prevent recurrence.
Postoperative relief of pain and normalization of ovarian size and morphology on ultrasound imaging.
The current cases show successful conservative surgical management of ovarian torsion, hence preserving hormonal function and fertility in young women.
Although it is recommended to preserve fertility in young women affected by ovarian torsion, surgical overtreatment by means of oophorectomy is still common in clinical routine. Increasing awareness for the clinical characteristics of acute and chronic ovarian torsion, as well as for the importance of preservation of the ovary, is crucial. We therefore believe that ovarian torsion and its surgical management deserve increased attention in the future.
Isolated fallopian tube torsion is a rare cause of acute abdominal pain in adolescent females. It is known to be a surgical emergency as it may lead to ischemia of the fallopian tube which can result ...in necrosis, infertility or infection. Presenting symptoms and radiographic findings are vague making diagnosis difficult, often requiring direct visualization in the operating room to make the definitive diagnosis. There has been an increase in this diagnosis at our institution in the previous year prompting compilation of cases and a literature review.
Although total oophorectomy (TO) was historically performed in cases of nonviable-appearing ovaries, considerable evidence has demonstrated equivalent outcomes after ovarian sparing surgery (OSS) as ...well as long-term fertility preservation benefits. This study sought to compare outcomes of OSS and TO for patients with ovarian torsion.
Females <21 years old admitted for ovarian torsion were identified from the Nationwide Readmissions Database (2016–2018) and stratified by OSS or TO. Propensity score-matched analysis (PSMA) utilizing >50 covariates (demographics, medical comorbidities, ovarian diagnoses, etc.) was constructed between those receiving TO and OSS.
There were 3,161 females (median 15 12–18 years) with ovarian torsion, and concomitant pathologies included cysts (42%), benign masses (25%), and malignant masses (<1%). Open approaches were more common (52% vs. 48% laparoscopic), and ovarian resection (OSS or TO) was performed in 87% (39% OSS and 48% TO). OSS was more commonly performed with laparoscopic detorsions (60% vs. 40% TO), while TO was more frequent in open operations (59% vs. 41% TO; both p < 0.001). No differences in overall readmissions (7% OSS vs. 8% TO) or readmissions for recurrent torsion (<1% overall) and ovarian masses (<1%) were observed (both groups <1%; p = 0.612). After PSMA, laparoscopy was still utilized less frequently with TO (39% vs. 53%; p < 0.001) despite similar rates of malignant masses.
Overall, these data offer additional support for the current practice guidelines that give preference to OSS as the primary method of treatment for pediatric ovarian torsion in the majority of cases.
III.
Retrospective Comparative Study.
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