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Yu Z, Choy KT, Ong F, Williams E, Naidu S, Smithers BM, Gurung A, Lutton N. Massive mixed epithelial-stromal tumour of seminal vesicle requiring challenging abdominoperineal resection: a case report and review of literature. J Surg Case Rep 2023; 2023:rjad490. [PMID: 37662445 PMCID: PMC10471484 DOI: 10.1093/jscr/rjad490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023] Open
Abstract
Mixed epithelial-stromal tumours (MESTs) are a rare biphasic tumour that frequently arise in women from the renal and urogenital tract. They are also seen in men but are exceptionally uncommon with only few cases reported to originate from the seminal vesicles. Malignant transformation of its epithelial or stromal components is possible; however, by in large, these tumours are benign in nature. We report the case of a 48-year-old man with no remarkable medical or surgical history who presented with a huge expanding pelvic and intra-abdominal mass that required extensive surgical management including a pelvic exenteration. Histopathological analysis concluded the diagnosis of benign MEST originating from the seminal vesicles with no malignant features. No further systemic therapy was recommended for our patient. Given the technical intricacy in the operative resection of this tumour, we aim to present our findings and surgical management of this complex MEST.
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Affiliation(s)
- Zirong Yu
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Kay Tai Choy
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Ferdinand Ong
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Evan Williams
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Sanjeev Naidu
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Bernard M Smithers
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Anjan Gurung
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
- Department of Anatomical Pathology at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
| | - Nicholas Lutton
- Department of General Surgery at Princess Alexandra Hospital-199 Ipswich Rd, Woolloongabba, QLD 4102, Australia
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Sheth MM, Shah AA. Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. Orthop J Sports Med 2023; 11:23259671231154452. [PMID: 37197034 PMCID: PMC10184227 DOI: 10.1177/23259671231154452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 05/19/2023] Open
Abstract
Background While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient. Purpose To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs. Study Design Narrative review. Methods A search of the PubMed database was performed to conduct a comprehensive literature review on MIRCTs. A total of 97 studies were included. Results Recent literature reflects added attention to clarifying the definitions of "massive, "irreparable," and "pseudoparalysis." In addition, numerous recent studies have added to the understanding of what generates pain and dysfunction from this condition and have reported on new techniques for addressing them. Conclusion The current literature provides a nuanced set of definitions and conceptual foundations on MIRCTs. These can be used to better define these complex conditions in patients when comparing current surgical techniques to address MIRCTs, as well as when interpreting the results of new techniques. While the number of effective treatment options has increased, high-quality and comparative evidence on treatments for MIRCTs is lacking.
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Affiliation(s)
- Mihir M. Sheth
- Baylor College of Medicine, Houston, Texas, USA
- Mihir M. Sheth, MD, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030, USA () (Twitter: @mihirmsheth)
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Arredondo Montero J, Bronte Anaut M, Bardají Pascual C. Extensive Keloid and Hypertrophic Mixed Scarring Pattern in Ear Lobes of a 14-Year-Old African Female: A Case Report. Fetal Pediatr Pathol 2023; 42:270-274. [PMID: 35620898 DOI: 10.1080/15513815.2022.2080310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Massive earlobe scarring/keloid formation can occur after ear piercing in individuals of African descent. Case report: A 14-year-old African girl with pierced ears in childhood presented with two progressively growing and disfiguring tumors on both earlobes. The maximum diameter of each lesion was 5.5 centimeters, and the weight of each lesion was approximately 20 grams. Histologically, there was a mixed pattern of keloid and hypertrophic scarring. Discussion: Massive keloids can occur after ear piercing in childhood. It is unclear why some individuals develop these massive keloids.
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Affiliation(s)
| | - Mónica Bronte Anaut
- Pathology Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Carlos Bardají Pascual
- Pediatric Surgery Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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Ó Conaire E, Delaney R, Lädermann A, Schwank A, Struyf F. Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review. Int J Environ Res Public Health 2023; 20:5242. [PMID: 37047860 PMCID: PMC10094518 DOI: 10.3390/ijerph20075242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Massive irreparable rotator cuff tears can cause significant shoulder pain, disability and reduction in quality of life. Treatment approaches can be operative or non-operative. Operative approaches include reverse total shoulder arthroplasty, arthroscopic debridement, partial rotator cuff repair, subacromial balloon spacers, superior capsule reconstruction, and tendon transfer procedures. Non-operative approaches include physiotherapy exercise programs and corticosteroid injections. There are no randomized controlled trials comparing the different treatment approaches. It is therefore challenging for clinicians to advise patients on what is their best treatment pathway. Physiotherapy exercise programs are less expensive and have lower risks for patients than surgical approaches. However, the success of physiotherapy in patients with massive irreparable rotator cuff tears is highly variable with published success rates of 32-96%. Several cohort studies have sought to identify if certain factors are predictive of success with physiotherapy. Several biomechanical factors were identified as possibly being related to a successful or unsuccessful outcome following physiotherapy, with complete tear of subscapularis demonstrating the strongest evidence. However, there were no appropriately designed prognostic studies. There has been a strong emphasis on biomechanical factors. Other domains such as psychosocial factors, which are important in similar patient populations, have not been explored. We recommend that further research is needed in this area and should include randomized controlled trials comparing treatment approaches and longitudinal prospective prognostic studies to identify predictors of treatment success.
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Affiliation(s)
- Eoin Ó Conaire
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (A.S.); (F.S.)
- Evidence-Based Therapy Centre, First Floor Geata na Cathrach, Fairgreen Road, H91 W26K Galway, Ireland
| | - Ruth Delaney
- Dublin Shoulder Institute, Sports Surgery Clinic, Santry, D09 C523 Dublin, Ireland;
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland;
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Ariane Schwank
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (A.S.); (F.S.)
- Institute for Therapy and Rehabilitation, Canton Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (A.S.); (F.S.)
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Marshall C, Josephson CD, Leonard JC, Wisniewski SR, Leeper CM, Luther JF, Spinella PC. Blood component ratios in children with non-traumatic life-threatening bleeding. Vox Sang 2023; 118:68-75. [PMID: 36427061 DOI: 10.1111/vox.13382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In paediatric trauma patients, there are limited prospective data regarding blood components and mortality, with some literature suggesting decreased mortality with high ratios of plasma and platelets to red blood cells (RBCs) in massive transfusions; however, most paediatric massive transfusions occur for non-traumatic aetiologies and few studies assess blood product ratios in these children. This study's objective was to evaluate whether high blood product ratios or low deficits conferred a survival benefit in children with non-traumatic life-threatening bleeding. MATERIALS AND METHODS This is a secondary analysis of the five-year, multicentre, prospective, observational massive transfusion epidemiology and outcomes in children study of children with life-threatening bleeding from US, Canadian and Italian medical centres. Primary interventions were plasma:RBC and platelets:RBC (high ratio ≥1:2 ml/kg) and plasma and platelet deficits. The primary outcome was mortality at 6 h, 24 h and 28 days. Multivariate logistic regression models were used to determine independent associations with mortality. RESULTS A total of 222 children were included from 24 medical centres: 145 children (median [interquartile range] age 2.1 years [0.3-11.8]) with operative bleeding and 77 (8.0 years [1.2-14.7]) with medical bleeding. In adjusted analyses, neither blood product ratios nor deficits were associated with mortality at 6 h, 24 h or 28 days. CONCLUSION This paper addresses a lack of prospective data in children regarding optimal empiric massive transfusion strategies in non-traumatic massive haemorrhage and in finding no decrease in mortality with high plasma or platelet to RBC ratios or lower deficits supports an exploratory analysis for mortality.
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Affiliation(s)
- Callie Marshall
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Cassandra D Josephson
- Department of Oncology and Cancer and Blood Disorders Institute, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Julie C Leonard
- Department of Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Christine M Leeper
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James F Luther
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | | | - Philip C Spinella
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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6
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Kim MS, Hasan LK, Fathi A, Hasan SK, Haratian A, Bolia IK, Petrigliano FA, Weber AE, Gamradt SC, Liu JN. Evaluation of spin in systematic reviews and meta-analyses of superior capsular reconstruction. J Shoulder Elbow Surg 2022; 31:1743-1750. [PMID: 35472573 DOI: 10.1016/j.jse.2022.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Small, preliminary studies and the systematic reviews on superior capsular reconstruction (SCR) that collate data are at increased risk spin. This study's primary objective was to identify, describe, and account for the incidence of spin in systematic reviews of SCR. This study's secondary objective was to characterize the studies in which spin was identified to determine whether identifiable patterns of characteristics exist among studies with spin. METHODS This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a predetermined protocol. A search was conducted on the PubMed and Embase databases for systematic reviews and meta-analyses on SCR. Screening and data extraction were conducted independently by 2 authors. Each included study's abstract was assessed for the presence of the 15 most common types of spin, with full texts reviewed during cases of disagreement or for clarification. General data that were extracted included study title, authors, publication year, journal, level of evidence, study design, funding source, reported adherence to PRISMA guidelines, preregistration of the study protocol, and primary and secondary outcome measures. Full texts were used in the assessment of study quality per AMSTAR 2. RESULTS We identified 53 studies during our search, of which 17 met the inclusion criteria. At least 1 form of spin was observed in all 17 studies. The most common types of spin were type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") and type 9 ("Conclusion claims the beneficial effect of the experimental treatment despite reporting bias"), both of which were observed in 11 studies (11 of 17, 65%). A statistically significant association between lower level of evidence and type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") was observed (P = .0175). A statistically significant association was also found between more recent year of publication and the spin category misleading interpretation (P = .0398), and between lower AMSTAR 2 score and type 13 ("Failure to specify the direction of the effect when it favors the control intervention") (P = .0260). No other statistical associations between other study characteristics were observed. CONCLUSION Spin is highly prevalent in abstracts of SCR systematic reviews and meta-analyses. An association was found between the presence of spin and lower level of evidence, year of publication, and AMSTAR 2 ratings.
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Affiliation(s)
- Michael S Kim
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Amir Fathi
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Shurooq K Hasan
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA, USA.
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7
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Ozbeyaz NB, Gokalp G, Gezer AE, Algul E, Sahan HF, Aydinyilmaz F, Guliyev I, Kalkan K. Novel marker for predicting the severity and prognosis of acute pulmonary embolism: platelet-to-hemoglobin ratio. Biomark Med 2022; 16:915-924. [PMID: 35833861 DOI: 10.2217/bmm-2022-0201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: We investigated the ability of the platelet-to-hemoglobin ratio (PHR) to predict mortality and disease severity in patients with acute pulmonary embolism (APE). Materials & methods: The severity of APE was classified as massive (high risk), submassive (intermediate risk) or nonmassive (low risk). PHR is defined as platelet count/hemoglobin count. Results: PHR was significantly higher in patients with massive APE, and this elevation showed a gradual increase from the nonmassive group to the massive group (p < 0.001). In-hospital and 1-month mortality were higher in patients with high PHR values. PHR was an independent risk factor for the development of massive APE (odds ratio: 1.014; 95% CI: 1.011-1.017; p = 0.009). Conclusion: PHR values predicted massive APE and were an independent predictor of mortality in APE.
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Affiliation(s)
- Nail B Ozbeyaz
- Department of Cardiology, Pursaklar State Hospital, Ankara, 06145, Turkey
| | - Gokhan Gokalp
- Department of Cardiology, Pursaklar State Hospital, Ankara, 06145, Turkey
| | - Adil E Gezer
- Department of Emergency Medicine, Pursaklar State Hospital, Ankara, 06145, Turkey
| | - Engin Algul
- Department of Cardiology, Diskapi Yildirim Beyazit Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
| | - Haluk F Sahan
- Department of Cardiology, Diskapi Yildirim Beyazit Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
| | - Faruk Aydinyilmaz
- Department of Cardiology, Erzurum Education & Research Hospital, Erzurum, 25030, Turkey
| | - Ilkin Guliyev
- Department of Cardiology, Medical Park Hospital, Tokat, 60235, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Diskapi Yildirim Beyazit Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
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Liu B, Xu J, Jin Y, Su W, Zhang X, Qiao Y, Yu W, Cheng L, Zhao J, Li Y. Advantages of 3-dimensional Measurements for Supraspinatus Intramuscular Fatty Evaluation in Patients With Medium to Massive Rotator Cuff Tears: Comparison With a Single Sagittal Slice. Am J Sports Med 2022; 50:699-707. [PMID: 35044262 DOI: 10.1177/03635465211068854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fatty infiltration of the rotator cuff muscles is highly related to poor outcomes after rotator cuff tears. Fat fraction (FF) based on traditional 2-dimensional measurements (2D-FF) from a single sagittal Y-view slice cannot determine intramuscular FF in the rotator cuff muscles; the newly developed 3-dimensional method (3D-FF) is supposed to precede 2D measurements for intramuscular FF evaluation in accuracy and reliability. PURPOSE (1) To measure 3D-FF and (2) to compare 3D-FF and 2D-FF in terms of quantitative values and intra- and interobserver agreement. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Six-point Dixon magnetic resonance imaging was performed in patients with full-thickness supraspinatus tears. 2D-FF was calculated on a single sagittal Y-view. Semiautomatic segmentation software (ITK-SNAP) was used to reconstruct 3D volumes of the supraspinatus muscle and fat. 3D-FF was obtained by dividing the fat volume by the total volume of the supraspinatus muscle. A paired t test was used to compare the individual differences between 2D-FF and 3D-FF results. Linear regression and Bland-Altman analyses were performed to determine the agreement between 2D-FF and 3D-FF. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver agreement. RESULTS The 3D muscular and fatty models presented an inhomogeneous distribution of intramuscular fat in the supraspinatus, indicating the superiority of 3D-FF over 2D-FF in capturing all muscle morphologic information. 2D-FF was significantly higher than 3D-FF in the supraspinatus with large (19.5% ± 5.9% vs 16.2% ± 3.7%; P = .002) and massive (34.8% ± 13.3% vs 26.2% ± 9.4%; P < .001) rotator cuff tears. 2D-FF overestimated the FF compared with 3D-FF by >50% in 14.7% of all patients and by >15% in 67.6% of patients with large or massive RCTs. The discrepancy between 2D-FF and 3D-FF increased with increasing mean FF. The intra- and interobserver agreement of 3D-FF (ICCs, 0.89-0.99 and 0.89-0.95) was superior to that of 2D-FF (ICCs, 0.71-0.95 and 0.64-0.79). CONCLUSION 3D-FF indicated an inhomogeneous distribution of intramuscular fat by capturing all muscle and fat morphologic information. In patients with large and massive rotator cuff tears, 2D-FF of the supraspinatus was significantly higher than 3D-FF. 3D-FF was more reliable than 2D-FF for estimating fatty infiltration in the supraspinatus, with better intra- and interobserver agreement.
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Affiliation(s)
- Beibei Liu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuchen Jin
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Human Oncology and Pathogenesis, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiuyuan Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weibin Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lude Cheng
- Siemens Medical Systems Co, Ltd, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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9
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de Bruin S, Eggermont D, van Bruggen R, de Korte D, Scheeren TWL, Bakker J, Vlaar APJ. Transfusion practice in the bleeding critically ill: An international online survey-The TRACE-2 survey. Transfusion 2021; 62:324-335. [PMID: 34971005 PMCID: PMC9305497 DOI: 10.1111/trf.16789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Transfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non-bleeding critically ill patients practices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients. STUDY DESIGN AND METHODS An international online survey was performed among physicians working in the ICU. Transfusion practice in massively and non-massively bleeding patients was examined, including transfusion ratios, thresholds, and the presence of transfusion guidelines. RESULTS Six hundred eleven respondents filled in the survey of which 401 could be analyzed, representing 64 countries. Among the respondents, 52% had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell [RBC] concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratios (p < .001). For RBC transfusion in the general non-massively bleeding ICU population, a hemoglobin (Hb) threshold of 7.0[7.0-7.3] g/dl was reported. In the general ICU population, a platelet count threshold of 50[26-50] × 109 /L was applied. DISCUSSION Half of the centers had no massive transfusion protocol available. Transfusion practice in massively bleeding critically ill patients is highly variable and driven by the presence of an MTP. In the general non-massively bleeding ICU population restrictive transfusion triggers were chosen.
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Affiliation(s)
- Sanne de Bruin
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Dorus Eggermont
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk de Korte
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands.,Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Bakker
- Department of Intensive Care Medicine, Erasmus MC University Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care Medicine, New York University Medical Center and Columbia University Medical Center New York, New York, New York, USA.,Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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10
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Misir A, Uzun E, Kizkapan TB, Ozcamdalli M, Sekban H, Guney A. Factors associated with the development of early- to mid-term cuff-tear arthropathy following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2021; 30:1572-1580. [PMID: 33038498 DOI: 10.1016/j.jse.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have specifically evaluated the development of cuff-tear arthropathy (CTA) after a rotator cuff repair in the postoperative early to mid-term. This study aimed to identify the factors associated with the development of CTA, to evaluate the effect of arthropathy on functional outcomes, and to evaluate the incidence of CTA 3-10 years after an arthroscopic rotator cuff repair. METHODS A total of 312 patients who underwent an arthroscopic repair of a large or massive full-thickness rotator cuff tear with a minimum follow-up of 3 years were retrospectively divided into 2 groups for analysis: those with postrepair CTA (arthritic glenohumeral changes due to rotator cuff insufficiency) and those without. CTA was assessed using the Seebauer and modified Hamada-Fukuda classification systems. Pre-, intra-, and postoperative patient characteristics; characteristics of the rotator cuff tear; clinical and radiological parameters; and pre- and postoperative functional scores were compared. RESULTS The rate of development of CTA was 11.5% (36 of 312 patients, 13 centric and 23 eccentric arthropathy). CTA was more frequently associated with the poor integrity of the supraspinatus tendon after repair (P < .001) and massive tears (P = .006). Postoperative pseudoparalysis (P < .001), symptomatic retear (P < .001), tear size (P = .026), critical shoulder angle (P = .001), preoperative acromiohumeral interval (P = .046), and the humeral head superior migration (P = .001) were found to be associated with the development of CTA. However, only postoperative pseudoparalysis was found to be an independent risk factor (P < .001, odds ratio: 2.965). Patients with postrepair CTA had significantly worse functional outcome scores. CONCLUSION The postoperative development of pseudoparalysis may be a marker of CTA in the future and that closer follow-up may be necessary.
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Affiliation(s)
- Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Health Sciences University, Gaziosmanpasa Training and Research Hospital, Gaziosmanpasa, Istanbul, Turkey.
| | - Erdal Uzun
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Melikgazi, Kayseri, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Osmangazi, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University School of Medicine, Kirsehir Merkez, Kirsehir, Turkey
| | - Hazim Sekban
- Department of Orthopaedics and Traumatology, Health Sciences University, Kayseri City Hospital, Kocasinan, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Melikgazi, Kayseri, Turkey
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Sachinis NP, Papagiannopoulos S, Sarris I, Papadopoulos P. Outcomes of Arthroscopic Nerve Release in Patients Treated for Large or Massive Rotator Cuff Tears and Associated Suprascapular Neuropathy: A Prospective, Randomized, Double-Blinded Clinical Trial. Am J Sports Med 2021; 49:2301-2308. [PMID: 34156877 DOI: 10.1177/03635465211021834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Suprascapular neuropathy has been observed in the setting of rotator cuff tears (RCTs), but its association with these tears and their treatment are unclear. HYPOTHESIS Arthroscopic suprascapular nerve release during rotator cuff repair will not alter the outcomes of neuropathy. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 42 patients with large/massive reparable RCTs and suprascapular neuropathy were recruited and followed up at 6 and 12 months. Electrophysiological results as well as Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), and Constant scores were evaluated at selected time periods. Patients were randomly assigned to 2 groups. Patients in the control group underwent arthroscopic repair of the rotator cuff without combined arthroscopic release of the superior transverse scapular ligament; in the second group, the superior transverse ligament was released. The primary outcome was to examine full suprascapular nerve recovery through electrophysiological changes between groups. The secondary/tertiary outcomes were analysis of clinical outcomes and assessment of the relation between RCT size and the degree of suprascapular nerve recovery. Patients, clinical staff members, and the neurologist were blinded to the type of surgical procedure. RESULTS Of 42 patients, 37 completed the follow-up at 12 months (median age, 64 years [range, 50-75 years]). Overall, 17 of 19 (89.5%) patients in the control group and 15 of 18 (83.3%) patients in the nerve release group had full nerve recovery, with no significant difference between the 2 groups. Clinically, all patients in both groups showed a significant improvement (P < .001), but no significant difference was observed between the 2 groups in terms of 12-month postoperative scores (control group: DASH: median, 5 [range, 0-21]; ASES: median, 88 [range, 83-98]; Constant: median, 86 [range, 70-98]) (nerve release group: DASH: median, 6 [range, 0-25]; ASES: median, 90 [range, 83-98]; Constant: median, 88 [range, 75-98]). Also, no significant difference was found between the 2 groups regarding other secondary and tertiary outcomes. CONCLUSION Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone. REGISTRATION NCT02318381 (ClinicalTrials.gov identifier).
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Affiliation(s)
| | | | - Ioannis Sarris
- Third Orthopaedic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- Second Orthopaedic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chetana Shanmukhappa S, Lokeshwaran S, Kumar K S, Doraiswamy P. "Peanut saves the day": an innovative solution to massive, cryptogenic haemoptysis-a case study. Respirol Case Rep 2021; 9:e00754. [PMID: 33976883 PMCID: PMC8103091 DOI: 10.1002/rcr2.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Massive (or life-threatening) haemoptysis is a time-sensitive emergency encountered by a physician that requires an interdisciplinary, collaborative effort to arrest the bleeding in a prompt and timely manner. Placement of an endobronchial Watanabe spigot (EWS) to halt haemoptysis is a relatively recent technique finding its wide application in airway pathology, with the current extension of its use to bronchial bleeding. However, the lack of immediate access to EWS gives rise to the need to innovate with day-to-day materials used in routine surgical practice and available in resource-limited settings, which may serve the purpose of a spigot. In this report, we bring to light a case of life-threatening, cryptogenic haemoptysis that was managed by a novel technique of using peanut gauze as a spigot resulting in a successful endobronchial tamponade.
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Affiliation(s)
| | | | - Sunil Kumar K
- Department of PulmonologyAster CMI HospitalBengaluruIndia
| | - Prakash Doraiswamy
- Department of Anaesthesia and Critical CareAster CMI HospitalBengaluruIndia
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13
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Hacibey I, Sahin Y, Serifoglu I, Muslumanoglu AY. Idiopathic bilateral massive perirenal subcapsular effusion: The first case in the literature. Urologia 2021; 89:481-483. [PMID: 33730943 DOI: 10.1177/03915603211001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bilateral perirenal subcapsular effusion is a rare clinical condition and is associated with several underlying etiologies. We present a 33 years old male patient with idiopathic bilateral massive subcapsular effusion. CASE PRESENTATION A 33-year-old male patient presented to our outpatient clinic with bilateral flank pain and fever for 2 weeks. Bilateral perirenal subcapsular effusion was detected in intravenous contrast-enhanced CT and dynamic MRI. TREATMENT Bilateral ultrasound-guided percutaneous drainage was performed by an expert uroradiologist to reduce the parenchymal pressure, Control CT imaging after 6 weeks demonstrate that bilateral normal kidneys. DISCUSSION It has been reported that subcapsular and perirenal effusion is a rare clinical condition that may develop secondary to causes such as Nephrotic syndrome, Eisenmenger Syndrome, Lymphangiomatosis, and Page Kidney Disease. In our case, the clinical symptoms of the patient regressed after the whole effusion fluid was drained. No underlying pathology was found in further examinations. Therefore, we present the first case of Idiopathic Bilateral Massive Perirenal Subcapsular Effusion in the literature.
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Affiliation(s)
- Ibrahim Hacibey
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Sahin
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ismail Serifoglu
- Bagcilar Training and Research Hospital, Department of Radyology, Istanbul, Turkey
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14
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Downs JW, Cumpston KL, Kershner EK, Troendle MM, Rose SR, Wills BK. Clinical outcome of massive acetaminophen overdose treated with standard-dose N-acetylcysteine. Clin Toxicol (Phila) 2021; 59:932-936. [PMID: 33620007 DOI: 10.1080/15563650.2021.1887493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent recognition of "massive" acetaminophen (APAP) overdoses has led to the question of whether standard dosing of N-acetylcysteine (NAC) is adequate to prevent hepatoxicity in these patients. The primary aim of this study was to evaluate the clinical outcome for patients with massive APAP overdose who received standard intravenous NAC dosing of 300 mg/kg over 21 h. METHODS This was a single-center retrospective cohort study conducted by chart review of APAP overdoses reported to a regional poison center from 1 January 2010 to 31 December 2019. Massive APAP overdose was defined by single, acute overdose resulting in an APAP concentration exceeding 300 mcg/mL at 4 h post-ingestion. Standard univariate statistical analysis was conducted to describe the cohort, and a multivariate logistic model was utilized to calculate adjusted odds ratios for risk of hepatoxicity. RESULTS 1425 cases of APAP overdose were reviewed. 104 cases met the inclusion criteria of massive APAP overdose. Overall, 79 cases (76%) had no acute liver injury or hepatotoxicity, and 25 (24%) developed hepatoxicity. Nine percent (n = 4) of cases receiving NAC within 8 h developed hepatotoxicity. Crude odds for hepatoxicity was 5.5-fold higher for cases who received NAC after 8 h. CONCLUSIONS Standard NAC dosing received within 8 h prevented hepatoxicity in 91% (n = 40) of cases in our series of massive APAP overdoses. Additional data is needed to determine the clinical outcomes of massive APAP overdose using current intravenous NAC dosing.
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Affiliation(s)
- John W Downs
- Department of Emergency Medicine, Division of Medical Toxicology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Kirk L Cumpston
- Department of Emergency Medicine, Division of Medical Toxicology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Emily K Kershner
- Department of Emergency Medicine, Division of Medical Toxicology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Michelle M Troendle
- Department of Emergency Medicine, Division of Medical Toxicology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - S Rutherfoord Rose
- Department of Emergency Medicine, Division of Medical Toxicology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Brandon K Wills
- Department of Emergency Medicine, Division of Medical Toxicology, Virginia Commonwealth University Health System, Richmond, VA, USA
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15
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D'Ambrosio MM, Klein DS, Feldman JJ. Superior capsular reconstruction-Where we are now? Musculoskeletal Care 2020; 19:375-379. [PMID: 33225625 DOI: 10.1002/msc.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew M D'Ambrosio
- Jersey City Medical Center, Robert Wood Johnson Barnabas Health, Jersey CIty, New Jersey, USA
| | - David S Klein
- Jersey City Medical Center, Robert Wood Johnson Barnabas Health, Jersey CIty, New Jersey, USA
| | - John J Feldman
- Jersey City Medical Center, Robert Wood Johnson Barnabas Health, Jersey CIty, New Jersey, USA
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16
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Tiwari C, Nagdeve N, Saoji R, Hatwar G, Sinha S, Thatte S. Congenital Hepatic Arteriovenous Malformation Presenting as Isolated Massive Hepatomegaly in an Otherwise Healthy Neonate: A Case Report. J Mother Child 2020; 24:67-70. [PMID: 33074180 PMCID: PMC8518103 DOI: 10.34763/jmotherandchild.2020241.2002.000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Congenital hepatic arteriovenous malformations (HAVMs), though rare, carry high morbidity and mortality rates if left undiagnosed. The usual clinical presentation is in infancy with congestive heart failure, anaemia and hepatomegaly. There are reports of presentation as persistent pulmonary hypertension in newborns and reports of their spontaneous regression as well. We describe a healthy full-term neonate with HAVM who was presented with isolated massive hepatomegaly and underwent surgical ligation.
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Affiliation(s)
- Charu Tiwari
- Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra 440003, India
| | - Nilesh Nagdeve
- Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra 440003, India
| | - Rajendra Saoji
- Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra 440003, India
| | - Ghanshyam Hatwar
- Department of General Surgery, GMCH, Nagpur, Maharashtra 440003, India
| | - Sanskriti Sinha
- Department of General Surgery, GMCH, Nagpur, Maharashtra 440003, India
| | - Sharvil Thatte
- Department of General Surgery, GMCH, Nagpur, Maharashtra 440003, India
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17
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Torres-Loaiza JW, Velasco A, Villegas R, Salazar G, Escobar G. [ Massive rotator cuff injury: arthroscopic treatment with upper capsular reconstruction]. Acta Ortop Mex 2020; 34:228-233. [PMID: 33535280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Massive rotator cuff injuries (LMMRs) are those breaks of more than 5 cm either the anteroposterior plane, or lateromedial plane. Some authors consider them to be complete ruptures of at least two rotator cuff tendons. The clinical case of a 63-year-old man with this type of injury that was resolved by the superior capsule reconstruction technique is presented, technical details and some of the literature review to carry out the procedure are shown.
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Affiliation(s)
- J W Torres-Loaiza
- Traumatología Artroscopía. Hospital General «Pablo Arturo Suárez», Quito, Ecuador
| | - A Velasco
- Traumatología Artroscopía. Hospital General «Pablo Arturo Suárez», Quito, Ecuador
| | - R Villegas
- Hospital General «Pablo Arturo Suárez», Quito, Ecuador
| | - G Salazar
- Traumatología Artroscopía. Hospital General «Pablo Arturo Suárez», Quito, Ecuador
| | - G Escobar
- Traumatología Artroscopía. Hospital General «Pablo Arturo Suárez», Quito, Ecuador
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18
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Rodrigues A, Carrilho A, Almeida N, Baldaia C, Alves Â, Gomes M, Gonçalves L, Nunes AR, Pereira CL, Silva MJ, Aguiar J, Orfão R, Duarte P, Marinho RT. Interventional Algorithm in Gastrointestinal Bleeding-An Expert Consensus Multimodal Approach Based on a Multidisciplinary Team. Clin Appl Thromb Hemost 2020; 26:1076029620931943. [PMID: 32584602 PMCID: PMC7427045 DOI: 10.1177/1076029620931943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The approach to the patient with gastrointestinal bleeding (GIB) can be very complex. A multidisciplinary panel of physicians with expertise in Gastroenterology, Anesthesiology, and Transfusion Medicine worked together to provide the best knowledge and guide clinical practitioners in the real setting of health institutions, characterized by disparate availability of human and technical resources. The authors propose a global and personalized approach according to different clinical scenarios to improve the outcomes of patients with GIB, for whom the reduction of inappropriate transfusions is crucial. The goal of this document is to provide clear and objective guidance through interventional algorithms toward a goal-directed approach according to the clinical situation and supported by the latest available scientific data on GIB management in different settings.
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Affiliation(s)
- Anabela Rodrigues
- Transfusion Medicine Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Alexandre Carrilho
- Anesthesiology Department, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Nuno Almeida
- Gastroenterology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Cilénia Baldaia
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ângela Alves
- Anesthesiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Manuela Gomes
- Transfusion Medicine Department, Hemovida, Lisbon, Portugal
| | - Luciana Gonçalves
- Transfusion Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Carla Leal Pereira
- Transfusion Medicine Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Mário Jorge Silva
- Gastroenterology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - José Aguiar
- Anesthesiology Department, Hospital Lusíadas, Porto, Portugal
| | - Rosário Orfão
- Anesthesiology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Duarte
- Gastroenterology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Rui Tato Marinho
- Gastroenterology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Rijnhout TWH, Noorman F, Bek A, Zoodsma M, Hoencamp R. Massive transfusion in The Netherlands. Emerg Med J 2019; 37:65-72. [PMID: 31831587 DOI: 10.1136/emermed-2019-208665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Massive transfusion protocols (MTPs) may improve survival in patients with uncontrolled haemorrhage. An MTP was introduced into the Dutch transfusion guidelines in 2011, the ninth edition of the advanced trauma life support course in 2012 and the third version of the European guideline in 2013. This is the first survey of MTPs in Dutch trauma centres. METHODS The aim of the study was to compare MTP strategies in level 1 trauma centres in The Netherlands, and with (inter)national guidelines. A contact in each government assigned level 1 trauma centre in The Netherlands and the Dutch Ministry of Defence was approached to share their MTPs and elucidate their protocol in a survey and oral follow-up interview. RESULTS All 11 level 1 trauma centres responded. The content of the packages and transfusion ratios (red blood cells/plasma/platelets) were 3:3:1, 5:5:1, 5:3:1, 2:3:1, 4:4:1, 5:2:1, 2:2:1 and 4:3:1. Tranexamic acid was used in all centres and an additional dose was administered in eight centres. Fibrinogen was given directly (n=4), with persistent bleeding (n=3), based on Clauss fibrinogen (n=3) or rotational thromboelastometry (n=1). All centres used additional medication in patients in the form of anticoagulants, but their use was ambiguous. CONCLUSION MTPs differed between institutes and guidelines. The discrepancies in transfusion ratios can be explained by (inter)national differences in preparation and volume of blood components and/or interpretation of the '1:1:1' guideline. We recommend updating MTPs every year using the latest guidelines and evaluating the level of evidence for treatment during massive transfusion.
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Affiliation(s)
- Tim W H Rijnhout
- Department of Surgery, Alrijne Hospital Leiderdorp, Leiderdorp, The Netherlands .,Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Femke Noorman
- Military Blood Bank, Dutch Ministry of Defence, Utrecht, The Netherlands
| | - Annemarije Bek
- Military Blood Bank, Dutch Ministry of Defence, Utrecht, The Netherlands
| | - Margreet Zoodsma
- Military Blood Bank, Dutch Ministry of Defence, Utrecht, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital Leiderdorp, Leiderdorp, The Netherlands.,Trauma Research Unit Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Defence Healthcare Organization, Ministry of Defence, Utrecht, The Netherlands
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20
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Abstract
RATIONALE The improvement of microneurosurgery and neuroimaging, as well as neuronavigation and neurophysiological monitoring, enables neurosurgeons to safely and accurately resect lesions on the brainstem. PATIENT CONCERNS A 54-year-old man, with 2-year history of hypertension, presented with sudden loss of consciousness for 1.5 hours. DIAGNOSES Spontaneous brainstem hemorrhage. INTERVENTIONS We performed posterior fossa decompression together with hematoma evacuation in the super early stage for the patient. OUTCOMES The patient regained normal spontaneous breathing function after surgery. And he needed help for daily activities with hemiplegia of right limb at three-month follow-up. LESSONS The hematoma evacuation together with posterior fossa decompression in the super early stage maybe a good treatment for patients in a deep coma with a large hematoma at the dorsal side.
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Prat D, Tenenbaum S, Pritsch M, Oran A, Vogel G. Sub-acromial balloon spacer for irreparable rotator cuff tears: Is it an appropriate salvage procedure? J Orthop Surg (Hong Kong) 2019; 26:2309499018770887. [PMID: 29665765 DOI: 10.1177/2309499018770887] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Irreparable rotator cuff tear (RCT) presents a difficult treatment challenge for the orthopaedic surgeon. Many treatment strategies with varying degrees of success have been performed over the years. One of the suggested surgical treatment options is the use of a biodegradable sub-acromial balloon spacer. METHODS A retrospective study of patients treated with sub-acromial balloon spacer between the years 2011 and 2016 was conducted. Mean follow-up time was 14.4 months. Patient charts were reviewed to evaluate the early clinical results and complications of sub-acromial spacer for irreparable RCTs. RESULTS The study cohort included 24 shoulders in 22 patients. The average postoperative Disability of the Arm, Shoulder and Hand score was 62.4. The average preoperative University of California at Los-Angeles Shoulder score was 10.9 and improved to 15.9 ( p = 0.001). Forty-six per cent of patients were satisfied with their clinical postoperative outcome. We found moderate-strong positive correlation ( r = 0.64) between preoperative range of motion (ROM) and general satisfaction. None of the postoperative radiographs showed an improvement regarding the proximal migration of the humeral head. In total, four (16.7%) patients experienced postoperative complications, and two (8.3%) patients required an additional surgery as a consequence of a postoperative complication. CONCLUSION Our results show unsatisfactory improvement in patients with irreparable RCT treated with the sub-acromial balloon spacer. Careful patient selection with attention to preoperative ROM should be considered. LEVEL OF EVIDENCE Therapeutic level IV.
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Affiliation(s)
- Dan Prat
- 1 Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Tenenbaum
- 1 Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Pritsch
- 1 Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Oran
- 1 Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Vogel
- 1 Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Machairas N, Paspala A, Syllaios A, Schizas D. Massive subcutaneous emphysema after traumatic pneumothorax. Clin Case Rep 2019; 7:1789-1790. [PMID: 31534751 PMCID: PMC6745444 DOI: 10.1002/ccr3.2311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/16/2019] [Accepted: 06/27/2019] [Indexed: 11/22/2022] Open
Abstract
A simple case/asymptomatic pneumothorax not deemed to necessitate drainage can quickly change, and patient safety can be compromised. Chest tube insertion with increased suction is considered a safe and efficient strategy in patients with extensive subcutaneous emphysema following traumatic pneumothorax.
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Affiliation(s)
- Nikolaos Machairas
- Third Department of Surgery, Attikon University HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Anna Paspala
- Third Department of Surgery, Attikon University HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Athanasios Syllaios
- First Department of Surgery, Laikon HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon HospitalNational and Kapodistrian University of AthensAthensGreece
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23
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Ernstbrunner L, Andronic O, Grubhofer F, Camenzind RS, Wieser K, Gerber C. Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: a systematic review of longitudinal outcomes. J Shoulder Elbow Surg 2019; 28:774-781. [PMID: 30674426 DOI: 10.1016/j.jse.2018.10.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this systematic review was to evaluate the longitudinal evolution of midterm to long-term results of reverse total shoulder arthroplasty (RTSA) for patients with massive irreparable rotator cuff tears (miRCT). METHODS Databases were scanned for studies of RTSA for miRCT. Studies with a minimum Level IV of evidence were considered eligible. Studies were included if they reported a minimum of 5 years of follow-up and excluded if they reported RTSA combined with tendon transfers or as revision arthroplasty. Data were grouped based on results after 5 to 7 years, 7 to 10 years, and 10 to 20 years of follow-up. RESULTS Eight studies with a total of 365 shoulders were included. After a mean follow-up of 9.5 years (range, 5-20 years), the preoperative absolute and relative Constant scores were significantly improved from 24 to 59 points (P = .004) and from 33% to 74% (P = .009). The preoperative Subjective Shoulder Value improved from 23% to 72% (P = .049). Active anterior elevation and abduction also improved significantly (P = .004 and P = .014, respectively), but active external rotation remained unchanged (P = .855). None of the clinical scores or active ranges of motion significantly deteriorated up to 20 years after the operation (P > .05). After 10 years, 42% of the RTSAs showed grade III or IV inferior scapular notching. CONCLUSION Pooled long-term results of RTSA for miRCT show significant improvement of overhead function and of objective and subjective outcome scores up to 20 years after surgery. Shoulder function and outcome scores also showed no significant deterioration between 5 and 20 years of follow-up. Longer follow-up will be needed to determine ultimate longevity.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Roland S Camenzind
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Henseler JF, Kolk A, Zondag B, Nagels J, de Groot JH, Nelissen RGHH. Three-dimensional shoulder motion after teres major or latissimus dorsi tendon transfer for posterosuperior rotator cuff tears. J Shoulder Elbow Surg 2017; 26:1955-1963. [PMID: 28606637 DOI: 10.1016/j.jse.2017.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Teres major (TM) transfer and latissimus dorsi (LD) transfer are essential treatment options in patients with posterosuperior rotator cuff (RC) tears. The purpose of this study was to quantify shoulder kinematics before and after TM transfer and LD transfer in posterosuperior RC tear patients. METHODS In this prospective cohort study, we quantitatively measured shoulder movements using an electromagnetic tracking device (Flock of Birds) preoperatively and 1 year after either TM (n = 13) or LD (n = 9) tendon transfer. Additional outcome measures included the Constant score (CS), patient-reported pain, and quantitative range of motion. Scapular kinematics were evaluated during arm abduction. RESULTS By use of a quantitative assessment, forward flexion (from 87° to 106°, P = .007), abduction (from 86° to 106°, P = .010), and external rotation in abduction (from 52° to 70°, P = .019) improved. Both transfers reduced pain (from 50 to 10 mm, P < .001), and the CS improved (from 37 to 62 points, P < .001). No significant differences in postoperative improvement in pain and function were found between TM and LD tendon transfers. The TM transfer group showed increased scapular lateral rotation compared with the LD transfer group (13°; 95% confidence interval [CI], 4.8° to 21.7°; P = .003). We were unable to detect differences between TM transfer and LD transfer in the change in protraction (3.2°; 95% CI, -6.3° to 12.8°; P = .489) and posterior tilt (3.5°; 95% CI, -3.5° to 10.5°; P = .313). CONCLUSION Tendon transfer surgery resulted in an overall improvement in CS, pain relief, and quantitative range of motion in the treatment of an irreparable posterosuperior RC tear. Scapular lateral rotation gradually increased after TM transfer, reminiscent of RC function, whereas such an increase was not observed after LD transfer.
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Affiliation(s)
- Jan Ferdinand Henseler
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, The Netherlands; Upper Extremity Unit, Maja Clinic Leiden, Leiden, The Netherlands.
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, The Netherlands
| | - Bob Zondag
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurriaan H de Groot
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Olaoye IO, Adesina MD. Solitary massive lipoma in the planter aspect of great toe presenting as two masses. SAGE Open Med Case Rep 2017; 5:2050313X17730265. [PMID: 28959448 PMCID: PMC5593210 DOI: 10.1177/2050313x17730265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/16/2017] [Indexed: 12/04/2022] Open
Abstract
Lipoma is rare in the planter aspect of the toes, and only few cases of massive lipoma have been reported in this site. The differential diagnosis of masses in the foot and toes is wide, and clinical diagnosis may be challenging. Access to magnetic resonance imaging, a standard diagnostic investigation for such soft tissue masses of the foot and toes, may be limited in some practice, requiring a reliance on clinical signs. We report a solitary massive lipoma in the planter aspect of the right great toe that appeared as two masses and with modification of typical clinical signs of lipoma.
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Pulgar J, Escudero M, Carcuro G, Schiff A, Pellegrini M. Cement Casting to Optimize Reconstruction of Chronic Osteochondral Lesions of the Talus. Foot Ankle Spec 2017; 10:333-336. [PMID: 28719779 DOI: 10.1177/1938640017692414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Few surgical techniques have been described for reconstruction in massive osteochondral lesions of the talus, and there is limited evidence of techniques for accurately reproducing native talar anatomy with bone auto/allograft techniques. In this article, we present a novel technique, which is highly reproducible, using bone cement to restore the congruence and anatomy of the ankle joint. LEVELS OF EVIDENCE Level V: Technical tip.
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Affiliation(s)
- Jorge Pulgar
- Department of Orthopaedic Surgery, Universidad de Chile, Santiago, Chile (JP).,Department of Orthopaedic Surgery, Foot and Ankle Unit. Hospital Clínico Universidad de Chile, Santiago Chile (ME, GC, MP).,Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois (AS)
| | - Mario Escudero
- Department of Orthopaedic Surgery, Universidad de Chile, Santiago, Chile (JP).,Department of Orthopaedic Surgery, Foot and Ankle Unit. Hospital Clínico Universidad de Chile, Santiago Chile (ME, GC, MP).,Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois (AS)
| | - Giovanni Carcuro
- Department of Orthopaedic Surgery, Universidad de Chile, Santiago, Chile (JP).,Department of Orthopaedic Surgery, Foot and Ankle Unit. Hospital Clínico Universidad de Chile, Santiago Chile (ME, GC, MP).,Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois (AS)
| | - Adam Schiff
- Department of Orthopaedic Surgery, Universidad de Chile, Santiago, Chile (JP).,Department of Orthopaedic Surgery, Foot and Ankle Unit. Hospital Clínico Universidad de Chile, Santiago Chile (ME, GC, MP).,Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois (AS)
| | - Manuel Pellegrini
- Department of Orthopaedic Surgery, Universidad de Chile, Santiago, Chile (JP).,Department of Orthopaedic Surgery, Foot and Ankle Unit. Hospital Clínico Universidad de Chile, Santiago Chile (ME, GC, MP).,Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois (AS)
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Park JG, Cho NS, Song JH, Baek JH, Rhee YG. Long-term outcome of tuberoplasty for irreparable massive rotator cuff tears: is tuberoplasty really applicable? J Shoulder Elbow Surg 2016; 25:224-31. [PMID: 26443106 DOI: 10.1016/j.jse.2015.07.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tuberoplasty is a therapeutic option for irreparable massive rotator cuff tear (RCT). However, no study has reported long-term outcomes after arthroscopic tuberoplasty. METHODS We evaluated 16 patients who underwent arthroscopic tuberoplasty for symptomatic irreparable massive RCT without pseudoparalysis. Patients were a mean age of 64 years (range, 43-80 years) at the time of the operation, and the mean duration of follow-up was 98 months (range, 84-126 months). RESULTS At the last follow-up, the visual analog scale score for pain during motion had decreased to 2.3 from a preoperative mean of 6.9 (P < .001). The mean University of California at Los Angeles and Constant scores improved from 10.3 and 37.9 preoperatively to 27.2 and 59.2, respectively, at the last follow-up (P < .001 for both). The best University of California at Los Angeles (UCLA) and Constant scores during the follow-up duration were 28.3 and 60.3, respectively, at 5 years. The mean acromiohumeral interval changed from 5 mm preoperatively to 4 mm at the last follow-up. The rate of continuity in the inferior scapulohumeral line decreased significantly from 69% (11 shoulders) preoperatively to 19% (3 shoulders) at the last follow-up (P = .011). Only 1 patient underwent revision surgery. CONCLUSIONS Arthroscopic tuberoplasty yielded satisfactory outcomes during a mean 8-year follow-up period. Although superior migration of the humeral head progressed with time, the clinical outcomes were not affected. Arthroscopic tuberoplasty is a good option for relieving pain and improving functionality in nonpseudoparalytic patients with painful irreparable massive RCT.
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Affiliation(s)
- Jung Gwan Park
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Nam Su Cho
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jong Hoon Song
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jong Hun Baek
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea.
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Bernadette NN, Kamgaing N, Monebenimp F, Simeu C. Human immunodeficiency virus infection in a child revealed by a massive purulent pericarditis mistaken for a liver abscess due to Staphylococcus aureus. Afr J Paediatr Surg 2015; 12:71-3. [PMID: 25659555 PMCID: PMC4955492 DOI: 10.4103/0189-6725.150988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Massive purulent andacute pericarditis in children is a life-threatening disease associated with high mortality. It has been described tocomplicate usuallya bronchopulmonary infectionbut is currently uncommon in the era of antibiotics. Acute and massive purulent pericarditis has been rarely reported in children in association with human immunodeficiency virus (HIV) infection. This is a case of a10-year-old boy who presented with signs of sepsis and cardiac tamponade due to a massive staphylococcal purulent pericarditis complicating an unknown HIV infection.The child underwent pericardiectomy, intensive treatment, and survived this life-threatening disease.
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Abstract
Paediatric patients undergoing surgical procedures commonly require some volume of blood or blood component replacement in the perioperative period. Paediatric patients undergoing major surgery associated with substantial blood loss should be evaluated pre-operatively. Pre-operative correction of anaemia may be done considering the age, plasma volume status, clinical status and comorbidities. Maximum allowable blood loss (MABL) for surgery must be calculated, and appropriate quantity of blood and blood components should be arranged. Intraoperative monitoring of blood loss should be done, and volume of transfusion should be calculated in a protocol based manner considering the volemia and the trigger threshold for transfusion for the patient and the MABL. Early haemostasis should be achieved by judicious administration of red blood cells, blood components and pharmacological agents.
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Affiliation(s)
- Avnish Bharadwaj
- Department of Anesthesiology, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
| | - Mamta Khandelwal
- Department of Anesthesiology, SMS Medical College, Jaipur, Rajasthan, India
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Sardana D, Goyal A, Gauba K. Sinus histiocytosis with massive lymphadenopathy: a "massive" misnomer. Diagn Cytopathol 2014; 43:315-9. [PMID: 25088489 DOI: 10.1002/dc.23198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/07/2014] [Accepted: 07/17/2014] [Indexed: 12/26/2022]
Abstract
Sinus histiocytosis with massive lymphadenopathy also known as Rosai-Dorfman disease is a rare, benign, histiocytic disorder of unknown origin characterized by lymphadenopathy. Since its original description by Rosai and Dorfman in 1969, small number of cases has been reported; hence no specific diagnostic criteria and treatment guidelines have been suggested. The purpose of this article is to present and discuss a case of Rosai Dorfman Syndrome in 4-year-old child diagnosed with the help of Fine Needle Aspiration Cytology. The swelling resolved over a period of 18 months without any recurrence in 2-year follow-up period. This case report highlights the role of Fine Needle Aspiration Cytology in the diagnosis of Rosai-Dorfman disease and the importance of regular follow ups using a careful wait and watch approach in its management. The report also briefly discusses the various dilemmas associated with its diagnosis and treatment.
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Affiliation(s)
- Divesh Sardana
- Unit of Pedodontics and Preventive Dentistry, Oral Health Sciences Center, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
A massive rotator cuff tear is not necessarily irreparable. Number of tendons involved, muscle-tendon unit quality, and decreased acromionhumeral distance (AHD) are as important as tear size in determining reparability of lesion. Massive and irreparable rotator cuff tears cannot be anatomically repaired to the bone and are a common source of pain and disability even in middle-aged patients. In these patients when conservative management has failed, it is possible to perform different surgical techniques. A functional repair can help to restore the horizontal force couple of the cuff on the humeral head and to increase the AHD. Debridement of irreparable tears and biceps tenotomy or tenodesis can have a role in low functional demand patients but results deteriorate over time. Recently, several commercially available tissue-engineered biological and synthetic scaffolds have been developed to augment rotator cuff repairs. The aim is to provide a mechanical improvement in case of poor quality tissue at time zero and give a support to have a better cuff healing. In selected cases, the scaffold can be used also to bridge tendon defect. Patients who not have pseudoparalysis, cuff tear arthropathy and with intact deltoid function can benefit from tendon transfers with satisfactory outcomes. These different procedures should be chosen for each patient with selected criteria and after a satisfactory explanation about the really possible expectation after surgery.
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Affiliation(s)
- Alessandro Castagna
- Alessandro Castagna, Via Antonio Locatelli 6, 20124,
Milan, Italy. Tel: +39 02/86995349 Fax: +39
02/86912884
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Davidoss N, Ha J, Banga R, Rajan G. Delayed Presentation of a Congenital Cholesteatoma in a 64-year-old Man: Case Report and Review of the Literature. J Neurol Surg Rep 2014; 75:e113-6. [PMID: 25083369 PMCID: PMC4110127 DOI: 10.1055/s-0034-1376200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/15/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Congenital cholesteatomas of the temporal bone are epidermoid cysts of embryologic origin that result in progressive desquamation and trapping of squamous epithelium behind an intact tympanic membrane. They are benign, slowly progressive lesions that can be found in various areas of the temporal bone. We report a case of a patient with a massive cholesteatoma first detected at the age of 64 years, causing significant destruction of the mastoid and petrous temporal bones, and adjacent occipital bone. Methods We reviewed the literature and a case report of a patient seen in our institution recently. The Medline database was used to search multiple terms including “congenital” and “cholesteatoma.” Results The patient's congenital cholesteatoma was detected incidentally on a computed tomography scan when the patient's only symptoms were unilateral conductive hearing loss with a family history of hearing loss. It was subsequently successfully operated on with minimal postoperative complications. Conclusions Congenital cholesteatomas of mastoid origin can often exist for many years in a subclinical state and develop into a massive size before causing symptoms. A high index of suspicion is necessary to detect congenital cholesteatomas in patients with unilateral conductive hearing loss who are otherwise asymptomatic and have a normal tympanic membrane.
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Affiliation(s)
- Nishant Davidoss
- Department of Ear, Nose and Throat, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jennifer Ha
- Department of Otolaryngology, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Rupan Banga
- Department of Otolaryngology, Head and Neck Surgery, Fremantle Hospital, Perth, Western Australia, Australia
| | - Gunesh Rajan
- Department of Otolaryngology, University of Western Australia, Crawley, Western Australia, Australia
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Günbatar H, Sertogullarindan B, Ekin S, Arisoy A, Ozkol HU. Yellow nail syndrome presenting with postpartum massive pleural effusion. Clin Respir J 2014; 8:369-71. [PMID: 24279775 DOI: 10.1111/crj.12077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/30/2013] [Accepted: 11/20/2013] [Indexed: 01/17/2023]
Abstract
Yellow nail syndrome (YNS) is an uncommon clinical syndrome characterized by yellow-green discoloration of nails and recurrent respiratory tract lesions, pleural effusions and lymphedema. A 38-year-old woman was referred to the emergency complaining of chronic cough and increasing dyspnea within last 2 weeks. She had given birth 1 month ago. On examination, the patient exhibited dystrophic yellowish nails and mild peripheral lymphedema. A chest roentgenogram revealed a large right pleural effusion and a small left pleural effusion. YNS is a rare clinical entity but should be taken into consideration in patients with massive pleural effusions and persistent lymphedemas on the postpartum period.
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Affiliation(s)
- Hülya Günbatar
- Department of Pulmonary and Critical Care, Yuzuncu Yil University Medical Faculty, Van, Turkey
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