Effect of Compressive Shoulder Draping With Adhesive Incise Drape on Soft Tissue Swelling in Shoulder Arthroscopy: A Prospective Randomized Trial

Background

Soft tissue swelling in shoulder arthroscopy is common and may lead to complications. Measures aimed at reducing this phenomenon are routinely used with limited efficacy.

Purpose/Hypothesis

The purpose of the study was to assess (1) soft tissue swelling of the shoulder (the operated site) and (2) soft tissue swelling of the neck, chest, and arm (the surrounding tissue) in patients with versus without compressive draping during shoulder arthroscopy. It was hypothesized that compressive draping of the shoulder with adhesive incise drape would reduce soft tissue swelling during shoulder arthroscopy.

Study Design

Randomized controlled trial; Level of evidence, 1.

Methods

A total of 50 patients undergoing arthroscopic rotator cuff repair were prospectively randomized to either the study group (in which the shoulder was draped with adhesive incise drape tightened around the shoulder) or the control group (in which a standard shoulder arthroscopy drape was used). The circumferences of the shoulder, arm, chest, and neck were measured preoperatively and postoperatively and compared between the groups.

Results

The shoulder circumference in the standard draping group increased by 16% during the procedure (from 21.2 ± 1.5 cm preoperatively to 24.5 ± 1.7 cm postoperatively) compared with only 6% in the compressive draping group (from 21.0 ± 1.3 cm preoperatively to 22.3 ± 1.1 cm postoperatively) (P < .01). No serious postoperative complications were observed in either group.

Conclusion

Compressive shoulder draping with adhesive incise drape was effective in reducing soft tissue swelling around the shoulder in arthroscopic rotator cuff repair compared with standard arthroscopic draping and was not associated with any adverse reactions.

Registration

NCT03216590 (ClinicalTrials.gov identifier).

Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques

BACKGROUND

Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis.

METHODS

This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups.

RESULTS

Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003).

CONCLUSION

The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.

Age-related Differences in Clinical Outcomes of Lumbar Discectomy

Introduction

Lumbar discectomy is a common and effective treatment for symptomatic disk herniation. It has been suggested that lumbar discectomy in older patients may result in poorer clinical outcomes and lesser satisfaction. The purpose of this study was to assess age-related difference in patient reported outcomes of patients undergoing lumbar discectomy for chronic low back and radicular pain.

Materials and methods

Patients with chronic lumbar radiculopathy without neurological deficit underwent non-urgent single level lumbar discectomy in our institution between 2014 and 2017. Pain level (using VAS score), Oswestry Disability Index, and SF-12 scores were retrospectively reviewed and compared between younger patients (<60 years, group 1) and older patients (>60 years, group 2).

Results

Seventy-three patients, aged between 34–76 years participated in this study. VAS, ODI, and SF-12 scores improved significantly after the surgery for each group (P < .01). When comparing between the groups, no significant differences in the outcomes measured were found after the surgery in both early post-operative follow-up and late post-operative follow-up (P > .05).

Discussion

Elderly patients undergoing lumbar discectomy report a significant reduction in VAS, ODI, and SF-12 scores justifying the procedure.

Conclusion

Lumbar discectomy improved function and decreased pain level to similar extent in both younger and older patients suffering from radicular symptoms related to lumbar disc herniation.

SAT-425 Characteristics of Hypothyroid Patients Achieving Long Term Euthyroidism on Levothyroxine Treatment

Background

Studies have shown that hypothyroid patients treated with Levothyroxine replacement therapy often experience fluctuations in TSH levels, while others remain well controlled over time.

Aim

To assess the association between pre-treatment TSH and other biochemical and clinical characteristics and long-term maintenance of normal TSH under Levothyroxine treatment.

Methods

This is a retrospective nested case-control study. Study population included patients above age 18 insured by Clalit Health Service (CHS) in the South of Israel between the years 2002-2017, diagnosed with hypothyroidism (ICD 9 code 244.9) and who had at least one TSH measurement before initiating levothyroxine therapy, purchased this medication for at least 5 consecutive years with one annual TSH measurement while on treatment. Patients with surgical, post iodine ablation or congenital hypothyroidism were excluded. Patients with a TSH level within the normal range for 5 consecutive years were defined as cases while the others served as controls. Demographic, laboratory, pregnancy status and pharmacy purchase were extracted from the computerized medical records of CHS and compared between the groups.

Results

Out of 5472 patients included in the study, 644 had a normal TSH for 5 consecutive years (11.8%, cases). Mean age at first levothyroxine purchase was 55.8±13.7 in cases and 54.10±16.2 in controls (p=0.003) and females comprised 84.8% and 81.4% respectively (p=0.035). Mean pretreatment TSH was 5.15±9.6 in cases and 10.02±29 in controls (p<0.001). Thyroid autoantibodies (anti TPO or anti thyroglobulin) were available in 40.8% and 44.8% of cases and controls respectively (P=0.63) and were positive in 36.5% and 56.7% (p<0.01). Subclinical hypothyroidism was diagnosed in 44.4% of cases and 54.6% of controls with prior to treatment. The odds ratio (OR) for having normal TSH for at least 5 consecutive years, using multivariable logistic regression was 0.99 for pretreatment mean TSH (p=0.89), 0.48 for positive thyroid antibodies (p<0.001), 0.72 for pretreatment diagnosis of subclinical hypothyroidism (p=0.032), 0.69 for use of iron supplements and 1.01 for age at first levothyroxine purchase (per year, p=0.02).

Conclusions

In our study population of adults with hypothyroidism treated with levothyroxine, only 11.8% were controlled for at least 5 consecutive years. Positive thyroid autoantibodies, pretreatment subclinical hypothyroidism and use of iron supplements lowered probability of long term TSH normalization, while age was associated with the increased rate. Further research should test whether TSH control for 5 consecutive years signals simply “good contol”, or perhaps the possibility of transient forms of hypothyroidism for which treatment discontinuation is recommended.

Differential network analysis of multiple human tissue interactomes highlights tissue-selective processes and genetic disorder genes

Motivation

Differential network analysis, designed to highlight network changes between conditions, is an important paradigm in network biology. However, differential network analysis methods have been typically designed to compare between two conditions and were rarely applied to multiple protein interaction networks (interactomes). Importantly, large-scale benchmarks for their evaluation have been lacking.

Results

Here, we present a framework for assessing the ability of differential network analysis of multiple human tissue interactomes to highlight tissue-selective processes and disorders. For this, we created a benchmark of 6499 curated tissue-specific Gene Ontology biological processes. We applied five methods, including four differential network analysis methods, to construct weighted interactomes for 34 tissues. Rigorous assessment of this benchmark revealed that differential analysis methods perform well in revealing tissue-selective processes (AUCs of 0.82–0.9). Next, we applied differential network analysis to illuminate the genes underlying tissue-selective hereditary disorders. For this, we curated a dataset of 1305 tissue-specific hereditary disorders and their manifesting tissues. Focusing on subnetworks containing the top 1% differential interactions in disease-relevant tissue interactomes revealed significant enrichment for disorder-causing genes in 18.6% of the cases, with a significantly high success rate for blood, nerve, muscle and heart diseases.

Summary

Altogether, we offer a framework that includes expansive manually curated datasets of tissue-selective processes and disorders to be used as benchmarks or to illuminate tissue-selective processes and genes. Our results demonstrate that differential analysis of multiple human tissue interactomes is a powerful tool for highlighting processes and genes with tissue-selective functionality and clinical impact.

Availability and implementation

Datasets are available as part of the Supplementary data.

Supplementary information

Supplementary data are available at Bioinformatics online.