Arthroscopic Stabilisation in Anterior Shoulder Instability: An Analysis of Mid-term Outcome

OBJECTIVE

To assess the clinical outcome of arthroscopic stabilisation for recurrent anterior glenohumeral joint dislocations.

STUDY DESIGN

Case series. Place and Duration of the Study: Ghurki Trust Teaching Hospital, Lahore, from May 2018 to December 2022.

METHODOLOGY

Fifty-two patients who underwent arthroscopic repair of Bankart lesion were studied. Those who had concomitant fractures, neurological injury or underwent any surgery on the same shoulder were excluded. The outcome was assessed in terms of improvement in pain, constant and Rowe scores, postoperatively.

RESULTS

The mean delay in the procedure after the first dislocation was 65.15+38.23 months, and the mean follow-up period was 26.61+7.55 months. On final follow-up, improvement in pain was statistically significant (p<0.05): (VAS: 2.17+1.77 to 0.69+0.64 at rest and from 4.5+2.24 to 1.58+1.85 at motion). On subjective assessment, 50% of the sample was very satisfied, and an objective assessment showed statistically significant (p<0.05) improvement in Constant score from 65.4 to 78.6. Rowe score not only showed a significant improvement (from 31.6 to 80.3 with p<0.05), but 69.2% of the follow-up scores lied in the good and excellent results range as well. Recurrence was noted in 8 cases (15.3%).

CONCLUSION

Significant clinical improvement was seen after arthroscopic stabilisation in anterior shoulder instability. However, further research is required regarding the recurrence rate and restriction in the range of motion.

KEY WORDS

Glenohumeral joint, Dislocation, Stabilisation, Shoulder arthroscopy.

In vitro fertilization exacerbates stroke size and neurological disability in wildtype mice

BACKGROUND AND PURPOSE

Assisted reproductive technologies (ART) induce premature vascular aging in human offspring. The related alterations are well-established risk factors for stroke and predictors of adverse stroke outcome. However, given the young age of the human ART population there is no information on the incidence and outcome of cerebrovascular complications in humans. In mice, ART alters the cardiovascular phenotype similarly to humans, thereby offering the possibility to study this problem.

METHODS

We investigated the morphological and clinical outcome after ischemia/reperfusion brain injury induced by transient (45 min) middle cerebral artery occlusion in ART and control mice.

RESULTS

We found that stroke volumes were almost 3-fold larger in ART than in control mice (P < 0.001). In line with these morphological differences, neurological performance assessed by the Bederson and RotaRod tests 24 and 48 h after artery occlusion was significantly worse in ART compared with control mice. Plasma levels of TNF-alpha, were also significantly increased in ART vs. control mice after stroke (P < 0.05). As potential underlying mechanisms, we identified increased blood-brain barrier permeability evidenced by increased IgG extravasation associated with decreased tight junctional protein claudin-5 and occludin expression, increased oxidative stress and decreased NO-bioactivity in ART compared with control mice.

CONCLUSIONS

In wildtype mice, ART predisposes to significantly worse morphological and functional stroke outcomes, related at least in part to altered blood-brain barrier permeability. These findings demonstrate that ART, by inducing premature vascular aging, not only is a likely risk factor for stroke-occurrence, but also a mediator of adverse stroke-outcome.

TRANSLATIONAL PERSPECTIVE

This study highlights that ART not only is a likely risk factor for stroke-occurrence, but also a mediator of adverse stroke-outcome. The findings should raise awareness in the ever-growing human ART population in whom these techniques cause similar alterations of the cardiovascular phenotype and encourage early preventive and diagnostic efforts.

Per-Cutaneous Trans-splenic Vein Thrombolysis of Acute Major Portal Vein Thrombosis in Post-Liver Transplant Recipient: A Unique Experience

Portal venous thrombosis (PVT) is an uncommon complication in post-liver transplant recipients. The reported incidence is 1-4%. It may occur within a month, called early or after one month of transplantation, known as late PVT. Early PVT has a poor prognosis, leading to graft failure in most cases. Treatment of such cases is quite challenging because of difficult alternative portal inflow establishment. We performed successful thrombolysis of acute major PVT with a unique technique using ultrasound-guided percutaneous trans-splenic vein access in a post-liver transplant recipient. The per-cutaneous trans- splenic vein approach-based thrombolysis described here in this report might be very helpful in similar cases. This technique minimizes the potential risk of graft loss, avoids re-exploration, has a low risk of bleeding, and is cost-effective.

One Stage Bilateral Knee And Hip Arthroplasties In 42 Years Old Female

Knee and hip joint replacement surgeries are the mainstay of treatment in patients having grade 3 or grade 4 arthritis either due to degenerative process, rheumatoid disease or due to some other disease process. The main aims of these surgeries are to decrease the morbidity, early rehabilitation and decrease management costs of such patients. We report the first case in which bilateral total knee and total hip replacement surgery were done in single anaesthesia in 42 years old female patient suffering from Rheumatoid Arthritis.