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1

Arthroscopic surgery for partial rotator cuff tears  

Microsoft Academic Search

Rotator cuff pathology is one of the most common disorders of the shoulder. However, partial rotator cuff tears, treatment, and natural history are still in a state of flux. We believe that partial rotator cuff tears should be treated surgically when the rotator cuff is torn more than 50% of the thickness or when substantial thinning of the rotator cuff

Richard C Lehman; Clayton R Perry

2003-01-01

2

Reconstructive surgery for massive rotator cuff tear  

Microsoft Academic Search

Surgical Principles\\u000a \\u000a The rotator cuff is repaired with transosseous sutures if possible. If the defect is too large for direct repair, local muscle\\u000a or tendon transfers are used. An anterior acromioplasty with resection of the coraco-acromial ligament is performed in every\\u000a case. In absolutely irreparable tears the authors recommend an open or arthroscopic debridement combined with an anterior\\u000a acromioplasty and

Peter Habermeyer; Ulrich Brunner; Ernst Wiedemann

1993-01-01

3

Biologics in Rotator Cuff Surgery: Management of Rotator Cuff Tears With an Extracellular Matrix Patch  

Microsoft Academic Search

Summary: Chronic large and massive rotator cuff tears remain a treatment challenge for the orthopaedic surgeon. The use of an extracellular matrix (ECM) biologic patch is an emerging field and offers potential for the treatment of patients with failed rotator cuff repairs or those with tears that are chronic and large in nature. There are several commercially available grafts that

Matthew T. Provencher; Augustus Mazzocca; Anthony A. Romeo

2007-01-01

4

Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair  

Microsoft Academic Search

Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff\\u000a surgery. Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully\\u000a treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate\\u000a interpretation of the results. However, we

Robert G. Marx; Panagiotis Koulouvaris; Samuel K. Chu; Bruce A. Levy

2009-01-01

5

The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery  

Microsoft Academic Search

Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment. Hypothesis: Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repair surgery. Study Design: Controlled laboratory study. Methods: Thirty-nine patients (20 men,

Michael M. Reinold; Leonard C. Macrina; Kevin E. Wilk; Jeffrey R. Dugas; E. Lyle Cain; James R. Andrews

6

The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery  

Microsoft Academic Search

Background: Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment.Hypothesis: Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repair surgery.Study Design: Controlled laboratory study.Methods: Thirty-nine patients (20 men, 19 women) who

Michael M. Reinold; Leonard C. Macrina; Kevin E. Wilk; Jeffrey R. Dugas; E. Lyle Cain; James R. Andrews

2008-01-01

7

Six surgery-correlated sonographic signs for rotator cuff tears  

Microsoft Academic Search

The purpose of the study is to correlate the sonographic signs of rotator cuff tears (RCTs) with surgical findings, with emphasis on partial-thickness tear. We prospectively performed ultrasonography (US) on 50 patients with suspected RCTs and comparison with operative findings. Six US signs, which included “nonvisualization”, “focal depression”, “focal thinning”, “focal hypoechoic cleft”, “floating bright spots” and “focal heterogeneous hypoechogenicity”

Chao-Hsuan Yen; Hong-Jen Chiou; Yi-Hong Chou; Chuang-Chuen Hsu; Jinn-Jer Wu; Hsiao-Li Ma; Cheng-Yen Chang

2004-01-01

8

Rotator Cuff Injuries.  

ERIC Educational Resources Information Center

Many baseball players suffer from shoulder injuries related to the rotator cuff muscles. These injuries may be classified as muscular strain, tendonitis or tenosynovitis, and impingement syndrome. Treatment varies from simple rest to surgery, so it is important to be seen by a physician as soon as possible. In order to prevent these injuries, the…

Connors, G. Patrick

9

A less invasive surgery for rotator cuff tear: Mini-open repair  

Microsoft Academic Search

As a less invasive surgery of the shoulder, the mini-open repair was carried out from March 1997 through December 1998 in 22 patients (mini-open repair group) for all types of rotator cuff tears, except massive tears. A transacromial skin incision about 3 cm long was made. The anterior deltoid was split along its muscle fibers, and an anterior acromioplasty was

Yukihiko Hata; Satoru Saitoh; Narumichi Murakami; Hiroshi Seki; Yukio Nakatsuchi; Kunio Takaoka

2001-01-01

10

Rotator Cuff Pathology  

MedlinePLUS

... Hand Anatomy Find a Hand Surgeon Rotator Cuff Pathology Email to a friend * required fields From * To * ... locking and a feeling of instability. Rotator cuff pathology ranges from a normal, asymptomatic aging process to ...

11

Rotator Cuff Tears: Prospective Comparisonof MR Imaging with Arthrography,Sonography,and Surgery  

Microsoft Academic Search

Thirty-eight patients with suspected rotator cuff tears were examined at 1.5 T by using a loop-gap resonator surface coil. The MR findings were compared prospectively in a blinded fashion with the results from double-contrast arthrography in all 38 patients, high-resolution sonography in 23 patients, and surgery in 16 patients. In the total group of 38 patients, MR imaging detected 22

D. Lawrence; David Karasick; Alfred B. Kurtz; Donald G. Mitchell; Matthew D. Rifkin; Cynthia L. Miller; David W. Levy; John M. Fenlin; Arthur R. Bartolozzi

12

Risk Factors for Readmission and Revision Surgery Following Rotator Cuff Repair  

Microsoft Academic Search

Risk factors for revision surgery and hospitalization following rotator cuff repair (RCR) have not been clearly identified.\\u000a We hypothesized patient factors and surgeon and hospital volume independently contribute to the risk of readmission within\\u000a 90 days and revision RCR within one year. Using the SPARCS database, we included patients undergoing primary RCR in New York\\u000a State between 1997 and 2002. These

Seth L. Sherman; Stephen Lyman; Panagiotis Koulouvaris; Andrew Willis; Robert G. Marx

2008-01-01

13

Rotator cuff problems  

MedlinePLUS

... 309-323. Matsen III FA, Fehringer EV, Lippitt SB, Wirth MA, Rockwood CA Jr. Rotator cuff. In: ... CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder . 4th ed. Philadelphia, PA: Saunders ...

14

Rotator Cuff Repair  

MedlinePLUS Videos and Cool Tools

... Dr. Uribe's going to go up into this space. It's called the subacromial space, and that is where the rotator cuff repair ... flap of tissue, gets caught in that subacromial space Dr. Zvijac was talking about and that produces ...

15

Rotator cuff exercises  

MedlinePLUS

... to make the muscles and tendons in your joint stronger and more flexible. Your doctor may refer you to a physical therapist to treat your rotator cuff. A physical therapist is trained to help improve your ability to do the activities you want.

16

Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear  

Microsoft Academic Search

Impingement of the tendinous rotator cuff on the coracoid process (subcoracoid impingement syndrome) has rarely been reported as a cause of pain after surgery for rotator cuff tear. We evaluated clinical features, surgical results, and histopathology findings of resected coracoid processes in patients with subcoracoid impingement syndrome after anterior acromioplasty and management of rotator cuff tear. Pain at the anterior

Naoki Suenaga; Akio Minami; Kiyoshi Kaneda

2000-01-01

17

Rotator Cuff and Impingement  

Microsoft Academic Search

Shoulder pain due to trauma or overuse is a common complaint in the populations of athletes in general, with a variety of\\u000a causes that are frequently diffi cult to differentiate by physical examination alone.\\u000a \\u000a MR imaging and ultrasonography are optimal and complementary tools to discriminate different forms of impingement and to localize\\u000a and classify rotator cuff injuries. A native MR

Henk-Jan Van der Woude; Diana G. Franssen-Franken; W. Jaap Willems

18

Factors affecting rotator cuff healing.  

PubMed

Several studies have noted that increasing age is a significant factor for diminished rotator cuff healing, while biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients. Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing. Arthroscopic rotator cuff repair, double-row repairs, performing a concomitant acromioplasty, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty, or not using PRP. There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair. PMID:24806015

Mall, Nathan A; Tanaka, Miho J; Choi, Luke S; Paletta, George A

2014-05-01

19

Intramuscular Rotator Cuff Cysts: Association with Tendon Tears on MRI and Arthroscopy  

Microsoft Academic Search

OBJECTIVE. This study was designed to explore the relationship between intramuscular cysts and rotator cuff tendon tears. CONCLUSION. Intramuscular cysts are strongly associated with rotator cuff tendon tears. Identification of such a cyst should prompt a search for a rotator cuff tear. Findings on MR arthrography and surgery suggest that a delaminating component of the rotator cuff tear may lead

Ara Kassarjian; Martin Torriani; Hugue Ouellette; William E. Palmer

20

The behavior of rotator cuff tendon cells in three-dimensional culture  

E-print Network

The rotator cuff is composed of the supraspinatus, infraspinatus, subcapularis, and teres minor tendons. Rotator cuff injuries are common athletic and occupational injuries that surgery cannot fully repair. Therefore tendon ...

Gill, Harmeet (Harmeet Kaur)

2007-01-01

21

Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis  

Microsoft Academic Search

OBJECTIVES--To analyse the glycosaminoglycans of the adult human rotator cuff tendon matrix, to characterise changes in the glycosaminoglycan composition with age and in chronic rotator cuff tendinitis. METHODS--Rotator cuff (supraspinatus) tendons (n = 84) and common biceps tendons (n = 26) were obtained from cadavers with no history of tendon pathology (age range 11-95 years). Biopsies of rotator cuff tendons

G P Riley; R L Harrall; C R Constant; M D Chard; T E Cawston; B L Hazleman

1994-01-01

22

Rotator Cuff and Shoulder Conditioning Program  

MedlinePLUS

... orthoinfo.org Rotator Cuff and Shoulder Conditioning Program Introduction 1 Additional Notes Purpose of Program _________________________________________________________________ After an injury ...

23

Prevalence of rotator cuff tears in operative proximal humerus fractures.  

PubMed

Proximal humerus fractures and rotator cuff tears have been shown to have increasing rates with advancing age, theoretically leading to significant overlap in the 2 pathologies. The goal of this study was to examine the prevalence, associated factors, and effect on treatment of rotator cuff tears in surgically treated proximal humerus fractures. A retrospective review was performed of all patients who had surgery for a proximal humerus fracture from January 2007 to June 2012 in the shoulder department of a large academic institution. Patient demographics, the presence and management of rotator cuff tears, and surgical factors were recorded. Regression analysis was performed to determine which factors were associated with rotator cuff tears. This study reviewed 349 fractures in 345 patients. Of these, 30 (8.6%) had concomitant rotator cuff tears. Those with a rotator cuff tear were older (average age, 68.7 vs 63.1 years), were more likely to have had a dislocation (40% vs 12.5%), and were more likely to have undergone subsequent arthroscopic repair or reverse total shoulder arthroplasty than those without a rotator cuff tear. Most (22 of 30) were treated with suture repair at the time of surgery, but 5 patients underwent reverse total shoulder arthroplasty based primarily on the intraoperative finding of a significant rotator cuff tear. A concomitant rotator cuff tear in association with a proximal humerus fracture is relatively common. Rotator cuff tears are associated with older patients and those with a fracture-dislocation. In rare cases, these cases may require the availability of a reverse shoulder prosthesis. PMID:25361372

Choo, Andrew; Sobol, Garret; Maltenfort, Mitchell; Getz, Charles; Abboud, Joseph

2014-11-01

24

Preoperative ultrasonographic mapping of calcium deposits facilitates localization during arthroscopic surgery for calcifying tendinitis of the rotator cuff  

Microsoft Academic Search

Calcifying tendinitis is a relatively common disorder of the rotator cuff. For symptomatic patients, excision of the calcium deposits offers reliable pain relief. The arthroscopic technique is demanding. Arthroscopic localization of the deposit is frequently demanding. The technique described in this article facilitates the localization of calcium deposits based on preoperative ultrasonography. Knowing the exact topography of the deposit relative

S Rupp; R Seil; D Kohn

1998-01-01

25

A two-year clinical outcomes study of 400 patients, comparing open surgery and arthroscopy for rotator cuff repair  

PubMed Central

Objectives The aim of this study was to determine whether there is any significant difference in temporal measurements of pain, function and rates of re-tear for arthroscopic rotator cuff repair (RCR) patients compared with those patients undergoing open RCR. Methods This study compared questionnaire- and clinical examination-based outcomes over two years or longer for two series of patients who met the inclusion criteria: 200 open RCR and 200 arthroscopic RCR patients. All surgery was performed by a single surgeon. Results Most pain measurements were similar for both groups. However, the arthroscopic RCR group reported less night pain severity at six months, less extreme pain and greater satisfaction with their overall shoulder condition than the open RCR group. The arthroscopic RCR patients also had earlier recovery of strength and range of motion, achieving near maximal recovery by six months post-operatively whereas the open RCR patients took longer to reach the same recovery level. The median operative times were 40 minutes (20 to 90) for arthroscopic RCR and 60 minutes (35 to 120) for open RCR. Arthroscopic RCR had a 29% re-tear rate compared with 52% for the open RCR group (p < 0.001). Conclusions Arthroscopic RCR involved less extreme pain than open RCR, earlier functional recovery, a shorter operative time and better repair integrity. PMID:23610693

Walton, J. R.; Murrell, G. A. C.

2012-01-01

26

All-arthroscopic rotator cuff repair.  

PubMed

All-arthroscopic rotator cuff repair has evolved into a viable surgical option, with outcome results equal to that of mini-open and open rotator cuff repair, with less perioperative morbidity and is driven by patient demand. The technique has required refinement of arthroscopic surgical techniques, and further advances from industry to provide alternative tools and techniques to make the procedure technically easier. This manuscript discusses all aspects of arthroscopic rotator cuff repair, and covers the evolution of the technique and provides a step-by-step technique to be used to accomplish a successful rotator cuff repair. PMID:18004220

Fouse, Matthew; Nottage, Wesley M

2007-12-01

27

Ruptures of the rotator cuff.  

PubMed Central

Through the use of improved diagnostic techniques, including arthrography and arthroscopy, ruptures of the rotator cuff that previously might not have been recognized are now being identified more frequently. In most cases the symptoms are relatively mild and respond satisfactorily to rest and therapy. Occasionally, however, there is severe, persistent disability despite treatment. These ruptures require surgical repair. In such cases the data obtained from special investigations help the surgeon select the appropriate surgical approach and repair technique. An imaginative program of physiotherapy before and after the operation contributes greatly to a satisfactory result. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 PMID:7437980

Ha'eri, G B

1980-01-01

28

Rotator cuff injury: still a clinical controversy?  

Microsoft Academic Search

The rotator cuff mechanism is the primary stabiliser of the gleno-humeral joint and is vulnerable to considerable morbidity because of its anatomy and function. Both intrinsic and extrinsic factors are responsible for rotator cuff pathology, which is a disease spectrum ranging from inflammation to full thickness tears. The most notable extrinsic factors are impingement and demographic variables, whereas age-related degeneration

P. Hardy; S. Sanghavi

2009-01-01

29

Rotator cuff repair should be done open: seein’ is believin’!—in opposition  

Microsoft Academic Search

As arthroscopic techniques continue to evolve and become widespread, the repair of rotator cuff tears without an open incision will likely become both commonplace and the new “gold” standard. Similar to the evolution that occurred two decades ago with arthroscopic knee surgery, arthroscopic rotator cuff surgery will allow surgeons and patients to reduce the morbidity of this procedure while still

Sumant G Krishnan; Wayne Z Burkhead

2004-01-01

30

Synthetic augmentation for massive rotator cuff tears.  

PubMed

The management of massive, irreparable rotator cuff tears is challenging. They are associated with persistent defects, weakness, and poor outcomes, and can cause an uncoupling of forces across the glenohumeral joint, with unstable shoulder kinematics. There has been much interest in the development of scaffolds to bridge massive rotator cuff tears. As allograft materials may produce inflammatory responses in the host, there is notable interest in developing synthetic grafts for surgical use. Benefits and limitations of the available synthetic scaffolds for augmentation of rotator cuff tears are reported in the present review. PMID:22089286

Longo, Umile Giuseppe; Lamberti, Alfredo; Khan, Wasim S; Maffulli, Nicola; Denaro, Vincenzo

2011-12-01

31

Understanding and preventing complications in repairing rotator cuff tears.  

PubMed

Repair of rotator cuff tears is a common procedure. Prior to approaching this surgery, it should be realized that each surgical step can lead to complications, including those related to positioning and anaesthesia. Stiffness, infection and failure of repair are the more frequent complications reported. PMID:21986055

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2012-01-01

32

Association of Sonographically Detected Subacromial\\/Subdeltoid Bursal Effusion and Intraarticular Fluid with Rotator Cuff Tear  

Microsoft Academic Search

OBJECTIVE. Although an association between sonographically detected joint fluid and rotator cuff disease has been reported, the significance of sonographically detected subacromial\\/subdeitold bursal effusion has not been studied. We examined a group of patients who had shoulder sonography and surgery to determine the associa- tion between bursal and joint effusion and surgically proved tears of the rotator cuff. MATERIALS AND

Mary S. Hollister; Laurence A. Mack; Randall M. Patten; Thomas C. Winter; Fredrick A. Matsen; Ryan A. Veith

33

Surgical management of irreparable rotator cuff tears.  

PubMed

PURPOSE: In this prospective case control study, the effectiveness of surgical management of irreparable rotator cuff tears in terms of patient's status and quality of life was evaluated in two groups of patients: one group receiving arthroscopic debridement associated with acromioplasty and bursectomy and the other receiving an arthroscopic partial repair of the rotator cuff tear. METHODS: Sixty-eight patients (47 males and 21 females) undergoing arthroscopic shoulder surgery for massive irreparable rotator cuff tear were enrolled in our study. Patients were divided into two groups: Group AP (debridement associated with acromioplasty and bursectomy) and Group PR (partial repair). Pre- and post-operative range of motion (ROM), modified-UCLA shoulder score and strength measurement were performed. The RC-QOL was used at the time of the last follow-up to assess patients' perception of their quality of life. RESULTS: The final follow-up was 7.8 (±2.3, range 5-9) years. ROM measures were significantly increased from pre- to post-operative evaluations, with significant intergroup differences (P < 0.001). The overall modified-UCLA shoulder score showed a mean pre-operative value of 7.6 ± 2.6 (95 % CI 6.7-8.5) for Group AP and 8.6 ± 4.1 (95 % CI 7.0-9.9) (n.s.) for Group PR. The post-operative values at the latest follow-up showed a statistically significant improvement in both groups [21.4 ± 3.7 (95 % CI 20.1-22.7) for Group AP and 28.8 ± 4.2 (95 % CI 27.3-30.2) for Group PR] (P < 0.0001), with a significant intergroup difference (P < 0.0001). The RC-QOL demonstrated a statistically significant difference between the groups [Group AP: 61.8 ± 6.1(95 % CI 59.6-63.9); Group PR: 71.2 ± 9.8 (95 % CI 67.7-74.6)] (P < 0.0002). CONCLUSION: Both techniques are effective in reducing patients' symptoms, with higher functional outcomes for partial repair. However, the choice of which technique to undertake should take into account the patients' features concerning the acromio-humeral interval and levels of daily activities. LEVEL OF EVIDENCE: Therapeutic case-control study, Level III. PMID:23212188

Franceschi, Francesco; Papalia, Rocco; Vasta, Sebastiano; Leonardi, Francesco; Maffulli, Nicola; Denaro, Vincenzo

2012-12-01

34

Arthroscopic rotator cuff repair in elite rugby players  

PubMed Central

Background Rugby is an increasingly popular collision sport. A wide spectrum of injuries can be sustained during training and match play. Rotator cuff injury is uncommon in contact sports and there is little published literature on the treatment of rotator cuff tears in rugby players. Aims We therefore reviewed the results and functional outcomes of arthroscopic rotator cuff repair in elite rugby players. Materials and Methods Eleven professional rugby players underwent arthroscopic rotator cuff repair at our hospital over a 2-year period. We collected data on these patients from the operative records. The patients were recalled for outcome scoring and ultrasound scans. Results There were seven rugby league players and four rugby union players, including six internationals. Their mean age was 25.7 years. All had had a traumatic episode during match play and could not return to the game after the injury. The mean time to surgery was 5 weeks. The mean width of the cuff tear was 1.8 cm. All were full- thickness cuff tears. Associated injuries included two Bankart lesions, one bony Bankart lesion, one posterior labral tear, and two 360° labral tears. The biceps was involved in three cases. Two were debrided and a tenodesis was performed in one. Repair was with suture anchors. Following surgery, all patients underwent a supervised accelerated rehabilitation programme. The final follow-up was at 18 months (range: 6–31 months) post surgery. The Constant scores improved from 44 preoperatively to 99 at the last follow-up. The mean score at 3 months was 95. The Oxford shoulder score improved from 34 to 12, with the mean third month score being 18. The mean time taken to return to full match play at the preinjury level was 4.8 months. There were no complications in any of the patients and postoperative scans in nine patients confirmed that the repairs had healed. Conclusion We conclude that full-thickness rotator cuff tears in the contact athlete can be addressed successfully by arthroscopic repair, with a rapid return to preinjury status. PMID:20616950

Tambe, Amol; Badge, Ravi; Funk, Lennard

2009-01-01

35

Regenerative Medicine in Rotator Cuff Injuries  

PubMed Central

Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP) is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs). Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research.

Randelli, Pietro; Ragone, Vincenza; Menon, Alessandra; Cabitza, Paolo; Banfi, Giuseppe

2014-01-01

36

Enhancement of rotator cuff tendon–bone healing with injectable periosteum progenitor cells-BMP-2 hydrogel in vivo  

Microsoft Academic Search

Purpose  The fixation and incorporation of ruptured rotator cuff tendon to bone is a major concern in rotator cuff repair surgery.\\u000a Rotator cuff repair usually fails at the tendon–bone interface, especially in case of large or massive tears. To enhance tendon–bone\\u000a healing, an injectable hydrogel made with periosteal progenitor cells(PPCs) and poly (ethylene glycol) diacrylate (PEGDA)\\u000a tethered with bone morphogenic protein-2(BMP-2)

Chih-Hwa Chen; Chih-Hsiang Chang; Kun-Chung Wang; Chun-I Su; Hsien-Tao Liu; Chung-Ming Yu; Chak-Bor Wong; I-Chun Wang; Shu Wen Whu; Hsia-Wei Liu

37

The detection of full thickness rotator cuff tears using ultrasound.  

PubMed

We have examined the accuracy of 143 consecutive ultrasound scans of patients who subsequently underwent shoulder arthroscopy for rotator-cuff disease. All the scans and subsequent surgery were performed by an orthopaedic surgeon using a portable ultrasound scanner in a one-stop clinic. There were 78 full thickness tears which we confirmed by surgery or MRI. Three moderate-size tears were assessed as partial-thickness at ultrasound scan (false negative) giving a sensitivity of 96.2%. One partially torn and two intact cuffs were over-diagnosed as small full-thickness tears by ultrasound scan (false positive) giving a specificity of 95.4%. This gave a positive predictive value of 96.2% and a negative predictive value of 95.4%. Estimation of tear size was more accurate for large and massive tears at 96.5% than for moderate (88.8%) and small tears (91.6%). These results are equivalent to those obtained by several studies undertaken by experienced radiologists. We conclude that ultrasound imaging of the shoulder performed by a sufficiently-trained orthopaedic surgeon is a reliable time-saving practice to identify rotator-cuff integrity. PMID:18591598

Al-Shawi, A; Badge, R; Bunker, T

2008-07-01

38

Repair of rotator cuff tears in tennis players  

Microsoft Academic Search

Twenty-three tennis players with a symptomatic full- thickness rotator cuff tear underwent anterior acro mioplasty and rotator cuff repair. There were 8 small tears (<1 cm), 5 moderate tears (1 to 3 cm), 2 large tears (3 to 5 cm), and 8 massive tears (>5 cm). The dominant shoulder was involved in all patients and all were unable to play

Louis U. Bigiliani; Jay Kimmel; Peter D. McCann; Ira Wolfe

1992-01-01

39

The factor validity of the Western Ontario Rotator Cuff Index  

Microsoft Academic Search

BACKGROUND: The Western Ontario Rotator Cuff Index (WORC) is a self-report questionnaire developed specifically to evaluate disability in persons with pathology of the rotator cuff of the shoulder. The authors created items in 5 categories based on a model of quality of life, but never validated this structure. The purpose of this study was to examine the validity of the

Jean Wessel; Helen Razmjou; Yasmin Mewa; Richard Holtby

2005-01-01

40

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine How Does Arthroscopic Rotator Cuff Repair Surgery Work? Rev. 2 Surgical Illustrations (Pages 2-4) · Preparing for Rotator Cuff Surgery (Pages 5-6) · General Post Surgery to embark on the arthroscopic rotator cuff repair journey. The goal of rotator cuff repair surgery is create

Kim, Duck O.

41

When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears  

Microsoft Academic Search

Background: Despite advances in arthroscopic repair of rotator cuff tears, recurrent tears after repair of large and massive tears remain a significant clinical problem. The primary objective of this study was to define the timing of structural failure of surgically repaired large and massive rotator cuff tears by serial imaging with ultrasound. The secondary objective of this study was to

Bruce S. Miller; Brian K. Downie; Robert B. Kohen; Theresa Kijek; Bryson Lesniak; Jon A. Jacobson; Richard E. Hughes; James E. Carpenter

2011-01-01

42

Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report  

PubMed Central

Introduction Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. Case presentation A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an uneventful recovery. Conclusion Impingement syndrome following arthroscopic repair of the rotator cuffs using double row suture anchor has not been widely reported. This is the first such case where anchoring has resulted in impingement syndrome. PMID:19830217

2009-01-01

43

Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement  

PubMed Central

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. © RSNA, 2013 PMID:23401583

Jacobson, Jon A.; Benson, Carol B.; Bancroft, Laura W.; Bedi, Asheesh; McShane, John M.; Miller, Theodore T.; Parker, Laurence; Smith, Jay; Steinbach, Lynne S.; Teefey, Sharlene A.; Thiele, Ralf G.; Tuite, Michael J.; Wise, James N.; Yamaguchi, Ken

2013-01-01

44

Calcific Tendinitis of the Rotator Cuff: A Review  

PubMed Central

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102

Kachewar, Sushil G; Kulkarni, Devidas S

2013-01-01

45

Living with a symptomatic rotator cuff tear 'bad days, bad nights': a qualitative study  

PubMed Central

Background Rotator cuff tears are a common cause of shoulder pain. There is an absence of information about symptomatic rotator cuffs from the patients’ perspective; this limits the information clinicians can share with patients and the information that patients can access via sources such as the internet. This study describes the experiences of people with a symptomatic rotator cuff, their symptoms, the impact upon their daily lives and the coping strategies utilised by study participants. Methods An interpretive phenomenological analysis approach was used. 20 participants of the UKUFF trial (The United Kingdom Rotator Cuff Surgery Trial) agreed to participate in in-depth semi-structured interviews about their experiences about living with a symptomatic rotator cuff tear. Interviews were digitally recorded and fully transcribed. Field notes, memos and a reflexive diary were used. Data was coded in accordance with interpretive phenomenological analysis. Peer review, code-recode audits and constant comparison of data, codes and categories occurred throughout. Results The majority of patients described intense pain and severely disturbed sleep. Limited movement and reduced muscle strength were described by some participants. The predominantly adverse impact that a symptomatic rotator cuff tear had upon activities of daily living, leisure activities and occupation was described. The emotional and financial impact and impact upon caring roles were detailed. Coping strategies included attempting to carry on as normally as possible, accepting their condition, using their other arm, using analgesics, aids and adaptions. Conclusions Clinicians need to appreciate and understand the intensity and shocking nature of pain that may be experienced by participants with known rotator cuff tears and understand the detrimental impact tears can have upon all areas of patient’s lives. Clinicians also need to be aware of the potential emotional impact caused by cuff tears and to ensure that patients needing help for conditions such as depression are speedily identified and provided with support, explanation and appropriate treatment. PMID:25008095

2014-01-01

46

“Bursal reactions” in rotator cuff tearing, the impingement syndrome, and calcifying tendinitis  

Microsoft Academic Search

Subacromial bursal specimens from 63 patients undergoing surgery for rotator cuff tearing (n = 43), the impingement syndrome (n = 14), and calcifying tendinitis (n = 6) were studied to characterize the reactions that develop at the tendinopathy “lesional” sites. Intensity of the bursal reactions and production of type III collagen vary considerably, with the highest incidence of both seen

Hirotada Ishii; Jacques A Brunet; R. Peter Welsh; Hans K Uhthoff

1997-01-01

47

Improved apparatus for predictive diagnosis of rotator cuff disease  

NASA Astrophysics Data System (ADS)

Rotator cuff disease impacts over 50% of the population over 60, with reports of incidence being as high as 90% within this population, causing pain and possible loss of function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder. Heavy use of these muscles can lead to rotator cuff tear, with the most common causes is age-related degeneration or sport injuries, both being a function of overuse. Tears ranges in severity from partial thickness tear to total rupture. Diagnostic techniques are based on physical assessment, detailed patient history, and medical imaging; primarily X-ray, MRI and ultrasonography are the chosen modalities for assessment. The final treatment technique and imaging modality; however, is chosen by the clinician is at their discretion. Ultrasound has been shown to have good accuracy for identification and measurement of full-thickness and partial-thickness rotator cuff tears. In this study, we report on the progress and improvement of our method of transduction and analysis of in situ measurement of rotator cuff biomechanics. We have improved the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining the ultrasound image. This measurement protocol combined with region of interest (ROI) based image processing will help in developing a predictive diagnostic model for treatment of rotator cuff disease and help the clinicians choose the best treatment technique.

Pillai, Anup; Hall, Brittany N.; Thigpen, Charles A.; Kwartowitz, David M.

2014-03-01

48

Complicated acromioclavicular joint cyst with massive rotator cuff tear.  

PubMed

An acromioclavicular (AC) joint cyst is an unusual presentation of full-thickness rotator cuff tears in patients with degenerative changes of the AC joint. It is important to understand the relationship between AC joint cysts and rotator cuff tears because there is a high recurrence rate if the cyst is treated without addressing the rotator cuff tear. Furthermore, recurrence or draining sinus caused by failure to treat the cyst may lead to infection. To our knowledge, there have been no reports of infected AC joint cyst as a serious complication. We present 2 cases involving an infected AC joint cyst with a massive rotator cuff tear caused by simple cyst excision. When patients have an AC joint cyst, physicians should consider the following points: (1) There is the possibility of an underlying rotator cuff tear, (2) Surgical treatment is indicated for a symptomatic cyst, (3) Aspiration and simple cyst excision are not recommended, because of the potential for postoperative complications such as recurrence, a draining sinus, and infection, and (4) Lateral clavicle resection should be performed if there is an irreparable rotator cuff tear. PMID:24551863

Cho, Chul-Hyun

2014-02-01

49

Iatrogenic glenoid fracture after brisement manipulation for the stiffness of shoulder in patients with rotator cuff tear.  

PubMed

In combined stiffness with rotator cuff tear, the brisement manipulation with or without capsular release has been more common procedure prior to the rotator cuff repair. It is known to be relatively safe and easy procedure with rare complications. However, the present authors found the iatrogenic fracture of anteroinferior portion of glenoid after brisement manipulation during the arthroscopic rotator cuff repair. The patient was followed up with the routine postoperative protocol for rotator cuff repair, which was composed of 4 weeks of protection with abduction brace, passive and active assisted range of motion exercise afterward, and progressive strengthening exercise. Two years after surgery, the patient showed improved clinical score and healing of fracture fragment. However, iatrogenic glenoid fracture should be kept in mind when the brisement manipulation is performed during arthroscopic surgery. PMID:23412222

Koh, Kyoung Hwan; Kim, Jong Ho; Yoo, Jae Chul

2013-11-01

50

Cellular response and extracellular matrix breakdown in rotator cuff tendon rupture  

Microsoft Academic Search

Purpose  The aim of this study was to investigate the relationship between the disruption of ECM and cellular events including autophagic\\u000a cell death, apoptosis and cell differentiation into myofibroblasts in the degenerative rotator cuff tendon.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Tendon samples were collected from 30 patients undergoing surgery for rotator cuff tears. Apoptosis, autophagic cell death\\u000a and myofibroblasts of the tendon cells in the ruptured

Bing Wu; Jimin Chen; Tammyl Dela Rosa; Qian Yu; Allan Wang; Jiake Xu; Ming-Hao Zheng

2011-01-01

51

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder.  

PubMed

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

Anley, Cameron M; Chan, Samuel Kl; Snow, Martyn

2014-11-18

52

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder  

PubMed Central

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients.

Anley, Cameron M; Chan, Samuel KL; Snow, Martyn

2014-01-01

53

Rotator cuff tears in patients younger than 50 years of age.  

PubMed

The purpose of this study was to investigate the characteristics of rotator cuff tears and the clinical outcome of rotator cuff repair in patients under 50 years of age. Sixty-eight patients (72 shoulders) aged < 50 years, who underwent repair of rotator cuff tears were evaluated. We analyzed the cause of injury, tear size, time from symptom onset to surgery, and rate that patients returned to previous jobs and sports. Postoperative results were assessed by pain, strength, range of motion, and UCLA scoring system. Most of the injuries were caused by an unambiguous traumatic event. The tear size generally was medium or large, while the time from symptom onset to surgery was shorter than that seen in a mixed population. The postoperative outcomes generally were good to excellent, and the rate that patients returned to previous jobs and sports was high. The findings suggest that a good outcome after early repair in younger patients with traumatic rotator cuff tears can be expected. PMID:23162954

Lin, Yi-Pin; Huang, Tung-Fu; Hung, Shih-Chieh; Ma, Hsiao-Li; Liu, Chien-Lin

2012-10-01

54

Open versus Two Forms of Arthroscopic Rotator Cuff Repair  

PubMed Central

There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months’ followup. We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three cohorts of patients had repair of a symptomatic rotator cuff tear using (1) an open technique (n = 49); (2) arthroscopic knotted (n = 53); or (3) arthroscopic knotless (n = 57) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained preoperatively and at 6 weeks, 3 and 6 months, and 2 years postoperatively. Ultrasound studies were performed with a validated protocol at 6 months and 2 years postsurgery. Clinical outcomes were similar with the exception that the arthroscopic groups had, on average, 20% better American Shoulder and Elbow Surgeons scores than the open group at 6 months and 2 years. Retear correlated with tear size and operation time and occurred more frequently after open repair (39%) than after arthroscopic knotted (25%) and arthroscopic knotless (16%) repair. An intact cuff on ultrasound corresponded to better results for supraspinatus strength, patient outcomes, and rotator cuff functional ability. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19184264

Millar, Neal L.; Wu, Xiao; Tantau, Robyn; Silverstone, Elizabeth

2009-01-01

55

Degenerative rotator cuff tear in an elderly athlete: a case report  

PubMed Central

The incidence of rotator cuff tear increases with age. Degenerative rotator cuff tears are commonly seen in athletes above 40 years. These athletes are commonly involved in overhead activities. Repetitive microtrauma is a more important factor in rotator cuff degeneration than acute trauma. Conservative treatment is the mainstay treatment for these injuries. A case report of an elderly athlete who sailed competitively is presented. The clinical and radiographic presentations, management and rehabilitation of degenerative rotator cuff tears are discussed. ImagesFigure 1

Kazemi, Mohsen

1999-01-01

56

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study  

Microsoft Academic Search

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or\\u000a an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff\\u000a repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair,\\u000a and 32 patients

Leonardo Osti; Rocco Papalia; Massimo Paganelli; Enzo Denaro; Nicola Maffulli

2010-01-01

57

Rotator Cuff Repair in Upper Extremity Ambulators! Andrew Zganjar, 1Steven Grindel MD, 1Dara Mickschl PA-C!  

E-print Network

the two groups- 25.1 vs. 10.9 months for the controls. · Physical therapy time prior to surgery had Mickschl PA-C! 1Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226 outcomes. 1. Medical records of patients who underwent rotator cuff repair from 4/2002 through 8/2012 were

58

MR imaging of delamination tears of the rotator cuff tendons  

Microsoft Academic Search

Objective  The objective was to describe the imaging appearances and location of delamination tears of the rotator cuff tendons on non-contrast\\u000a conventional MR imaging.\\u000a \\u000a \\u000a \\u000a Subjects and methods  This study was reviewed and approved by our Institutional Review Board. The reports of 548 consecutive MR examinations of\\u000a the shoulder were reviewed, looking for mention or description of delamination tears of the rotator cuff.

Daniel M. Walz; Theodore T. Miller; Steven Chen; Josh Hofman

2007-01-01

59

Arthroscopic knots and strength sutures for rotator cuff repair.  

PubMed

Most arthroscopic rotator cuff reconstruction techniques require a method of securing the tendon to the bone to obtain a stable construct. The available options include knotless technology and suture welding, but the most common method uses suture anchors and knots. Tissue quality, surgical technique, repair material, and tension overload influence the stability of tissue repair. Arthroscopic knots are technically demanding because they are tied through cannulas with long-handled knot pushers. The strength of the repair is also influenced by the suture material used. In this study, we review the state-of-the-art of arthroscopic knots and suture materials being used for arthroscopic rotator cuff repair. PMID:21822109

Longo, Umile Giuseppe; Buchmann, Stefan; Berton, Alessandra; Maffulli, Nicola; Denaro, Vincenzo

2011-09-01

60

Rotator cuff strength weakness in recurrent anterior shoulder instability physiopathology  

Microsoft Academic Search

BackgroundAlthough rotator cuff contractions play an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in physiopathological recurrent anterior instability.ObjectiveTo analyze the association between isokinetic internal rotator (IR) and external rotator (ER) muscle strength and glenohumeral joint instability in patients with nonoperated recurrent anterior instability.DesignCase-control study.SettingDepartment of Physical Medicine and Rehabilitation, Laboratory setting.Participants48

P Edouard; L Beguin; F Farizon; P Calmels

2011-01-01

61

Indirect MR arthrography of the shoulder in detection of rotator cuff ruptures.  

PubMed

The aim of this study was to compare the efficacy of indirect MR arthrography images obtained following intravenous contrast injection and conventional MR imaging in the diagnosis of rotator cuff tears. Twenty-four patients with clinically suspected rotator cuff disease were examined. Conventional MR images and post-contrast indirect MR arthrography images were obtained. All images were evaluated in a blinded fashion by two musculoskeletal radiologist. Results were than analyzed depending on surgical output. The correlation coefficient (Spearman rank correlation test) and the kappa values for agreement between surgery and imaging techniques were calculated. The correlation coefficients between indirect MR arthrography and surgery for reader 1 and reader 2 were 0.9137 and 0.9773, respectively. Whereas the agreement between conventional MR imaging and surgery was moderate (n = 0.383-0.571), the agreement between indirect MR arthrography and surgery was excellent (n = 0.873-0.936). We suggest the use of indirect MR arthrography technique when conventional MR images are equivocal in diagnosis of rotator cuff disease. PMID:11218024

Yagci, B; Manisali, M; Yilmaz, E; Ozkan, M; Ekin, A; Ozaksoy, D; Kovanlikaya, I

2001-01-01

62

Anatomical Considerations of the Suprascapular Nerve in Rotator Cuff Repairs  

PubMed Central

Introduction. When using the double interval slide technique for arthroscopic repair of chronic large or massive rotator cuff tears, the posterior interval release is directed toward the scapular spine until the fat pad that protects the suprascapular nerve is reached. Injury to the suprascapular nerve can occur due to the nerve's proximity to the operative field. This study aimed to identify safe margins for avoiding injury to the suprascapular nerve. Materials and Methods. For 20 shoulders in ten cadavers, the distance was measured from the suprascapular notch to the glenoid rim, the articular margin of the rotator cuff footprint, and the lateral border of the acromion. Results. From the suprascapular notch, the suprascapular nerve coursed an average of 3.42?cm to the glenoid rim, 5.34?cm to the articular margin of the rotator cuff footprint, and 6.09?cm to the lateral border of the acromion. Conclusions. The results of this study define a safe zone, using anatomic landmarks, to help surgeons avoid iatrogenic injury to the suprascapular nerve when employing the double interval slide technique in arthroscopic repair of the rotator cuff. PMID:24724030

Tom, James A.; Shah, Mitesh P.; Lee, Dan J.; Cerynik, Douglas L.; Amin, Nirav H.

2014-01-01

63

Conservative management of rotator cuff tears: literature review and proposal for a prognostic. Prediction Score  

PubMed Central

Summary Rotator cuff tears are a common cause of pain and shoulder dysfunction. The prevalence of the rotator cuff tears increases with the age reaching the 80% in patients aged more than 80 year. Symptomatic shoulders usually are initially treated conservatively and then, in case of poor outcomes, with surgery. Different parameters are still used to decide between the conservative or surgical treatment in patients with rotator cuff tears. Aim of the current study is to characterize the various features used in decision making and to validate a “Prediction Score” that let us know which patients could have a good and stable outcome with non operative treatment. We enrolled 60 patients (mean age 52 years) with symptomatic rotator cuff tears who were assigned to conservative treatment and were evaluated at 6,9 and 12 months follow-up. We developed a score based on 18 clinical and radiographic parameters. 27 patients (“non conservative”) (45%) with a mean prediction score of 16.1 ± 1.7 interrupted the conservative treatment, while 33 patients (“conservative”) (55%) with an average prediction score of 11.3 ± 1.8 remained conservatively treated at last follow-up. The conservative patients were 14 years older than non conservative patients. According to the results of this study we identified a value of 13 points as a “cut-off” score to predict good results by conservative management of rotator cuff tear. These outcomes support the assumption that a predictive prognostic score may guarantee a rational approach in the management of subjects with RC tears, especially in elderly who continue to have the higher rate of recurrence and therefore could be well treated with standard conservative therapies. PMID:23738239

Merolla, Giovanni; Paladini, Paolo; Saporito, Marco; Porcellini, Giuseppe

2011-01-01

64

Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure  

PubMed Central

Purpose The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA) lesions. Patients and methods Patients in the senior author’s practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8) and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months) postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test). All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram. Results There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2) and Simple Shoulder Test (4.6±3.2 to 10.1±3.8) scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect. Conclusion Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair. PMID:25114604

Woods, Tom C; Carroll, Michael J; Nelson, Atiba A; More, Kristie D; Berdusco, Randa; Sohmer, Stephen; Boorman, Richard S; Lo, Ian KY

2014-01-01

65

A Shortened Version of the Western Ontario Rotator Cuff Disability Index: Development and Measurement Properties  

PubMed Central

ABSTRACT Purpose: The objective of this study was to develop and examine the measurement properties of a shortened version of the Western Ontario Rotator Cuff Index (WORC), the SHORTWORC, in individuals with rotator-cuff pathology. Methods: The study occurred in two stages, both using secondary analysis of existing data sets. The first stage used cross-sectional data from candidates for rotator-cuff surgery to develop the SHORTWORC. The second stage examined various measurement properties of the SHORTWORC by analyzing scores from the WORC, the American Shoulder and Elbow Surgeons questionnaire, and the Constant–Murley score obtained from patients before and after rotator-cuff surgery. Approaches to validating the SHORTWORC included calculating the standard error of measurement (SEM) at an instant in time, performing a confirmatory factor analysis, correlating findings among the questionnaires, and examining differences between men and women. Sensitivity to change was investigated using standardized response mean and relative efficiency. Results: Data for 712 patients were used to develop the SHORTWORC, the final version of which consisted of 7 questions. Data for 166 patients (86 men, 80 women; mean age 57±11 years) were used for validation. The SEM based on internal consistency (SEMIC) was calculated as 7.43 SHORTWORC points. The SHORTWORC had similar convergent validity (r=0.72?0.82) and sensitivity to change (SRM=1.20 vs. 1.25, p>0.05) to the longer version. The relative efficiency of the SHORTWORC was 3.19 times that of the WORC (95% CI, 1.50–71.51) in discriminating men's from women's level of disability. Conclusions: The SHORTWORC has indicators of validity, relative efficiency, and sensitivity to change comparable to those of the original version but has a smaller response burden. PMID:23450087

Stratford, Paul; Holtby, Richard

2012-01-01

66

Neurohistology of the subacromial bursa in rotator cuff tear  

Microsoft Academic Search

This study was undertaken to identify and quantitate neural elements in the human subacromial bursa. Biopsy specimens of subacromial\\u000a bursae were obtained from patients with rotator cuff tears and from cadavers of patients with no history of shoulder disorder\\u000a (controls). We used a modified gold chloride method to characterize neural elements within the subacromial bursa. The population\\u000a of intrabursal neural

Yasuharu Tomita; Jiro Ozaki; Goro Sakurai; Tosinori Kondo; Kimio Nakagaki; Susumu Tamai

1997-01-01

67

Partial-thickness tears of the rotator cuff  

Microsoft Academic Search

Summary. This review is based on 66 patients with partial-thickness tears of the rotator cuff, verified at operation. Their average\\u000a age was 54 years, and all had symptoms of subacromial impingement. The duration of shoulder pain was for between 2 and 108\\u000a months (mean 11.4 months). Ultrasonography, arthrography and bursography were helpful in establishing the diagnosis. On exploration,\\u000a tears were

H. Fukuda; K. Hamada; T. Nakajima; N. Yamada; A. Tomonaga; M. Goto

1996-01-01

68

Arthroscopic Repair of Rotator Cuff Tears Using Extracellular Matrix Graft  

PubMed Central

Despite advances in surgical technology, as well as generally good outcomes, repairs of full-thickness rotator cuff tears show a retear rate of 25% to 57% and may fail to provide full return of function. The repairs tend to fail at the suture-tendon junction, which is due to several factors, including tension at the repair site, quality of the tendon, and defective tissue repair. One strategy to augment repair of large to massive rotator cuff tears is the development of biological scaffold materials, composed of extracellular matrix (ECM). The goal is to strengthen and evenly distribute the mechanical load across the repair site, thus minimizing the rupture risk of the native tendon while providing the biological elements needed for healing. The promising results of ECM-derived materials and their commercial availability have increased their popularity among shoulder surgeons. In contrast to a traditional open or arthroscopically assisted mini-open approach, this completely arthroscopic technique offers the full advantages warranted by the use of a minimally invasive approach. This technical guide describes arthroscopic rotator cuff repair using an ECM graft technique.

Gilot, Gregory J.; Attia, Ahmed K.; Alvarez, Andres M.

2014-01-01

69

Effect of rotator cuff dysfunction on the initial mechanical stability of cementless glenoid components  

Microsoft Academic Search

The functional outcome of shoulder replacement is related to the condition of the rotator cuff. Rotator cuff disease is a\\u000a common problem in candidates for total shoulder arthroplasty; this study relates the functional status of the rotator cuff\\u000a to the initial stability of a cementless glenoid implant. A 3D finite element model of a complete scapula was used to quantify

Daniel R. Suárez; Edward R. Valstar; Jacqueline C. van der Linden; Fred van Keulen; Piet M. Rozing

2009-01-01

70

Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures  

Microsoft Academic Search

BACKGROUND: Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff disease-specific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff

Helen Razmjou; Andrea Bean; Varda van Osnabrugge; Joy C MacDermid; Richard Holtby

2006-01-01

71

All-arthroscopic patch augmentation of a massive rotator cuff tear: surgical technique.  

PubMed

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation. PMID:24400198

Chalmers, Peter N; Frank, Rachel M; Gupta, Anil K; Yanke, Adam B; Trenhaile, Scott W; Romeo, Anthony A; Bach, Bernard R; Verma, Nikhil N

2013-01-01

72

All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique  

PubMed Central

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation. PMID:24400198

Chalmers, Peter N.; Frank, Rachel M.; Gupta, Anil K.; Yanke, Adam B.; Trenhaile, Scott W.; Romeo, Anthony A.; Bach, Bernard R.; Verma, Nikhil N.

2013-01-01

73

Single versus double-row repair of the rotator cuff  

Microsoft Academic Search

Purpose  Several techniques for arthroscopic repair of rotator cuff defects have been introduced over the past years. Besides established\\u000a techniques such as single-row repairs, new techniques such as double-row reconstructions have gained increasing interest.\\u000a The present article therefore provides an overview of the currently available literature on both repair techniques with respect\\u000a to several anatomical, biomechanical, clinical and structural endpoints.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Systematic

Stephan Pauly; Christian Gerhardt; Jianhai Chen; Markus Scheibel

2010-01-01

74

Interrater reproducibility of clinical tests for rotator cuff lesions  

PubMed Central

Background: Rotator cuff lesions are common in the community but reproducibility of tests for shoulder assessment has not been adequately appraised and there is no uniform approach to their use. Objective: To study interrater reproducibility of standard tests for shoulder evaluation among a rheumatology specialist, rheumatology trainee, and research nurse. Methods: 136 patients were reviewed over 12 months at a major teaching hospital. The three assessors examined each patient in random order and were unaware of each other's evaluation. Each shoulder was examined in a standard manner by recognised tests for specific lesions and a diagnostic algorithm was used. Between-observer agreement was determined by calculating Cohen's ? coefficients (measuring agreement beyond that expected by chance). Results: Fair to substantial agreement was obtained for the observations of tenderness, painful arc, and external rotation. Tests for supraspinatus and subscapularis also showed at least fair agreement between observers. 40/55 (73%) ? coefficient assessments were rated at >0.2, indicating at least fair concordance between observers; 21/55 (38%) were rated at >0.4, indicating at least moderate concordance between observers. Conclusion: The reproducibility of certain tests, employed by observers of varying experience, in the assessment of the rotator cuff and general shoulder disease was determined. This has implications for delegation of shoulder assessment to nurse specialists, the development of a simplified evaluation schedule for general practitioners, and uniformity in epidemiological research studies. PMID:15361389

Ostor, A; Richards, C; Prevost, A; Hazleman, B; Speed, C

2004-01-01

75

[Correlation of the degeneration of the AC joint (acromioclavicular) and rupture of the rotator cuff].  

PubMed

During the past various factors were quoted to be causative of a degeneration of the rotator cuff. In this study 122 shoulder specimen, aged 58-95 years, were dissected. A high correlation between severe degeneration of the ac-joint and rupture of the rotator cuff was found. The correlation was even higher between distally pointing osteophytes and cuff ruptures. The results demand to clearly define the degeneration of the ac-joint and the rotator cuff in patients suffering from shoulder pain. A simultaneous occurrence has to be considered. If conservative treatment fails in patients with cuff tear and ac-joint degeneration, surgical revision is recommended. This should comprise: 1. suture of the cuff-rupture 2. excision of the coraco-acromial ligament 3. anterior acromioplasty according to Neer 4. excision of the outer end of the clavicle PMID:2149245

Jerosch, J; Müller, T; Sons, H U; Castro, W H

1990-01-01

76

Interobserver Agreement in the Classification of Rotator Cuff Tears Using Magnetic Resonance Imaging  

Microsoft Academic Search

Background: Although magnetic resonance imaging (MRI) is a standard method of assessing the extent and features of rotator cuff disease, the authors are not aware of any studies that have assessed the interobserver agreement among orthopaedic surgeons reviewing MRI scans for rotator cuff disease.Hypothesis: Fellowship-trained orthopaedic shoulder surgeons will have good interobserver agreement in predicting the more salient features of

Edwin E. Spencer; Warren R. Dunn; Rick W. Wright; Brian R. Wolf; Kurt P. Spindler; Eric McCarty; C. Benjamin Ma; Grant Jones; Marc Safran; G. Brian Holloway; John E. Kuhn

2008-01-01

77

Metal markers for radiographic visualization of rotator cuff margins: A new technique for radiographic assessment of cuff repair integrity.  

PubMed

Surgically repaired rotator cuff repairs may re-tear in the post-operative follow-up phase, and periodic imaging is useful for early detection. The authors describe a simple surgical technique that provides a visible clue to the tendon edge on an anteroposterior radiograph of the shoulder. The technique involves arthroscopic or mini-open radio-opaque tagging of the tendon edge using a metal marker, and followed by a double-row rotator cuff repair using suture anchors. Serial post-operative radiographs may then be used to monitor the position of the marker. Progressive or marked displacement of the marker suggests a failure of cuff repair integrity and should be evaluated further. PMID:23858295

Bhatia, Deepak N; De Beer, Joe F

2013-01-01

78

Tissue Engineering for Rotator Cuff Repair: An Evidence-Based Systematic Review  

PubMed Central

The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP) augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: “rotator cuff”, “shoulder”, “PRP”, “platelet rich plasma”, “stemcells”, “scaffold”, “growth factors”, and “tissue engineering”. No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair. Three studies compared rotator cuff repair with or without PRP augmentation. All authors performed arthroscopic rotator cuff repair with different techniques of suture anchor fixation and different PRP augmentation. The three studies found no difference in clinical rating scales and functional outcomes between PRP and control groups. Only one study showed clinical statistically significant difference between the two groups at the 3-month follow up. Any statistically significant difference in the rates of tendon rerupture between the control group and the PRP group was found using the magnetic resonance imaging. The current literature on tissue engineering application for rotator cuff repair is scanty. Comparative studies included in this review suggest that PRP augmented repair of a rotator cuff does not yield improved functional and clinical outcome compared with non-augmented repair at a medium and long-term followup. PMID:25098365

Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Berton, Alessandra; Spiezia, Filippo; Denaro, Vincenzo

2012-01-01

79

QUANTIFICATION OF THE DYNAMIC GLENOHUMERAL STABILITY PROVIDED BY THE ROTATOR CUFF MUSCLES IN THE LATE COCKING PHASE OF THROWING  

Microsoft Academic Search

The purpose of this study was to investigate quantitatively the dynamic glenohumeral stability provided by the rotator cuff muscles in the late-cocking phase of throwing. Using ten cadaveric shoulders, a new biomechanical parameter (dynamic stability index) was calculated considering compressive and shear forces to the glenoid provided by each cuff muscle. The rotator cuff muscles provided the joint with significant

Seok-Beom Lee; Shawn W. O'Driscoll; Bernard F. Morrey; Kai-Nan An

80

MRI quantification of fatty infiltration and muscle atrophy in a mouse model of rotator cuff tears.  

PubMed

Rotator cuff pathology is the most common shoulder problem seen by orthopedic surgeons. Rotator cuff muscle fatty infiltration and muscle atrophy are common in larger tears and are considered predicting factors for the prognosis of cuff repair. Clinically, MRI is the gold standard in determining fatty infiltration and muscle atrophy; however, analysis for MRI imaging is primarily qualitative in nature with the results lacking further validation. We have recently developed a mouse model of rotator cuff tears. The goal of this study is to quantify and verify rotator cuff muscle atrophy and fatty infiltration using high-resolution MRI in our mouse model. The rotator cuff muscles were analyzed for fat using a triglyceride quantification assay (TQA), muscle volume was measured through water displacement (WD), and histology. The study revealed that MRI had a high correlation with fat as measured with histology and TQA (R(2) ?=098). MRI also correlated well with atrophy measured with WD and wet weight. This suggests that MRI is a reliable modality in evaluating the progression of fatty infiltration and muscle atrophy following rotator cuff tears in a small animal model. PMID:22991068

Samagh, Sanjum P; Kramer, Erik J; Melkus, Gerd; Laron, Dominique; Bodendorfer, Blake M; Natsuhara, Kyle; Kim, Hubert T; Liu, Xuhui; Feeley, Brian T

2013-03-01

81

Healing rates for challenging rotator cuff tears utilizing an acellular human dermal reinforcement graft  

PubMed Central

Purpose: This study presents a retrospective case series of the clinical and structural outcomes (1.5 T MRI) of arthroscopic rotator cuff repair with acellular human dermal graft reinforcement performed by a single surgeon in patients with large, massive, and previously repaired rotator cuff tears. Materials and Methods: Fourteen patients with mean anterior to posterior tear size 3.87 ± 0.99 cm (median 4 cm, range 2.5–6 cm) were enrolled in the study and were evaluated for structural integrity using a high-field (1.5 T) MRI at an average of 16.8 months after surgery. The Constant-Murley scores, the Flexilevel Scale of Shoulder Function (Flex SF), scapular plane abduction, and strength were analyzed. Results: MRI results showed that the rotator cuff repair was intact in 85.7% (12/14) of the patients studied. Two patients had a Sugaya Type IV recurrent tear (2 of 14; 14.3%), which were both less than 1 cm. The Constant score increased from a preoperative mean of 49.72 (range 13–74) to a postoperative mean of 81.07 (range 45–92) (P value = 0.009). Flexilevel Scale of Shoulder Function (Flex SF) Score normalized to a 100-point scale improved from a preoperative mean of 53.69 to a postoperative mean of 79.71 (P value = 0.003). The Pain Score improved from a preoperative mean of 7.73 to a postoperative mean of 13.57 (P value = 0.008). Scapular plane abduction improved from a preoperative mean of 113.64° to a postoperative mean of 166.43° (P value = 0.010). The strength subset score improved from a preoperative mean of 1.73 kg to a postoperative mean of 7.52 kg (P value = 0.006). Conclusions: This study presents a safe and effective technique that may help improve the healing rates of large, massive, and revision rotator cuff tears with the use of an acellular human dermal allograft. This technique demonstrated favorable structural healing rates and statistically improved functional outcomes in the near term. Level of Evidence: 4. Retrospective case series. PMID:22787332

Agrawal, Vivek

2012-01-01

82

Assessment of the canine model of rotator cuff injury and repair  

PubMed Central

Animal shoulder models are used to systematically investigate the factors influencing rotator cuff injury and repair. Each model has advantages and disadvantages that must be considered in the context of the specific research questions being asked. Herein we evaluate the utility of the canine model for studies of acute, full-thickness rotator cuff tendon injury and repair. We found that time zero failure load is dependent on the suture type and configuration used for repair. Acute, full-width tendon repairs fail anatomically within the first days after surgery in the canine model, regardless of suture type, suture configuration or post-operative protocol. Robust scar tissue forms in the gap between the failed tendon end and the humerus, which can be visually, mechanically and histologically misconstrued as tendon if an objective test of repair connectivity is not performed. We conclude that a full-width injury and repair model in the canine will provide a rigorous test of whether a new repair strategy or post-operative protocol (such as casting or temporary muscle paralysis) can maintain repair integrity in a high load environment. Alternatively, a partial-width tendon injury model allows loads to be shared between the tendon repair and the remaining intact portion of the infraspinatus tendon and prohibits complete tendon retraction. Thus a partial-width injury in the canine may model the mechanical environment of many single tendon tears in the human injury condition and warrants further investigation. PMID:17560802

Derwin, Kathleen A; Baker, Andrew R; Codsi, Michael J; Iannotti, Joseph P

2007-01-01

83

Effectiveness of Physical Therapy in Treating Atraumatic Full Thickness Rotator Cuff Tears. A Multicenter Prospective Cohort Study  

PubMed Central

Purpose To assess the effectiveness of a specific non-operative physical therapy program in treating atraumatic full thickness rotator cuff tears using a multicenter prospective cohort study design. Methods Patients with atraumatic full thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, co-morbidities, willingness to undergo surgery, and patient related outcome assessments (SF-12, ASES, WORC, SANE score, Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits patients could chose one of three courses: 1.) Cured (no formal follow up scheduled), 2.) Improved (continue therapy with scheduled reassessment in 6 weeks), or 3.) No better (offered surgery). Patients were contacted by telephone at 1 and 2 years to determine if they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6 week, and 12 week outcome scores. Results The cohort consists of 452 patients. Patient reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months. Conclusion Non-operative treatment using this physical therapy protocol is effective for treating atraumatic full thickness rotator cuff tears in approximately 75% of patients followed for two years. Level of evidence Level IV, Case Series, Treatment Study PMID:23540577

Kuhn, John E.; Dunn, Warren R.; Sanders, Rosemary; An, Qi; Baumgarten, Keith M.; Bishop, Julie Y.; Brophy, Robert H.; Carey, James L.; Holloway, Brian G.; Jones, Grant L.; Ma, C. Benjamin; Marx, Robert G.; McCarty, Eric C.; Poddar, Sourav K.; Smith, Matthew V.; Spencer, Edwin E.; Vidal, Armando F.; Wolf, Brian R.; Wright, Rick W.

2013-01-01

84

Translation and validation study of the Persian version of the Western Ontario Rotator Cuff Index  

Microsoft Academic Search

The translation, cultural adaptation and validation of the Persian version of the Western Ontario Rotator Cuff Index (WORC)\\u000a were carried out in accordance with published guidelines. One hundred fifty consecutive patients with rotator cuff disorders\\u000a completed the Persian WORC, the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, the Short Form Health Survey\\u000a (SF-36) and visual analog scale

Sayed Javad Mousavi; Mohammad Reza Hadian; Mohsen Abedi; Ali Montazeri

2009-01-01

85

Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears  

Microsoft Academic Search

The purpose of this study was to evaluate the outcome of subcoracoid pectoralis major transfer for the treatment of irreparable\\u000a anterosuperior rotator cuff tears. This type of tear involves complete rupture of the subscapularis in combination with either\\u000a the supraspinatus alone or the supraspinatus and infraspinatus. These ruptures are characterised by a poor quality of the\\u000a rotator cuff that does

Iosif Gavriilidis; Jörn Kircher; Petra Magosch; Sven Lichtenberg; Peter Habermeyer

2010-01-01

86

Do Outcomes Differ after Rotator Cuff Repair for Patients Receiving Workers’ Compensation?  

Microsoft Academic Search

Comparisons of outcomes after rotator cuff repair between Worker’s Compensation Board (WCB) recipients and nonrecipients generally\\u000a do not consider patient, injury, and shoulder characteristics. We compared preoperative differences between WCB recipients\\u000a and nonrecipients and determined the impact on their 6-month postoperative outcome. We evaluated a prospective cohort of 141\\u000a patients with full-thickness rotator cuff tears, 36 of whom (26%) were

R. Balyk; C. Luciak-Corea; D. Otto; D. Baysal; L. Beaupre

2008-01-01

87

Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain).  

PubMed

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic rotator cuff tendonitis (shoulder pain). The acoustic waves may help to accelerate the healing process of chronic rotator cuff tendonitis via an unknown mechanism. (2) ESWT, which is performed as an outpatient procedure, is intended to alleviate the pain due to chronic rotator cuff tendonitis. (3) Limited evidence from a German study indicates that the cost of ESWT for rotator cuff tendonitis is one-fifth to one-seventh the cost of surgical treatment, with longer recovery time and time off work in the surgical treatment group accounting for about two-thirds of the overall cost. (4) The evidence reviewed for this bulletin supports the use of high-energy ESWT for chronic calcific rotator cuff tendonitis, but not for non-calcific rotator cuff tendonitis. High-quality RCTs with larger sample sizes are needed to provide stronger evidence. PMID:17302022

Ho, C

2007-01-01

88

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study  

PubMed Central

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P?>?0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P? 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo

2009-01-01

89

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study.  

PubMed

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P > 0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P < 0.05). No statistically significant difference in the total UCLA scores was found when comparing the two repair techniques (P > 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo; Maffulli, Nicola

2010-03-01

90

Arthroplasty of the shoulder in rheumatoid arthritis with rotator cuff dysfunction.  

PubMed

We carried out a retrospective analysis of 17 total shoulder replacements using the reversed Delta III prosthesis in patients with rheumatoid arthritis of the glenohumeral joint complicated by rotator cuff dysfunction. Outcome was assessed using the Constant-Murley scoring system. In addition, general health status was assessed with the Short Form Health Survey and radiographical analysis of the prostheses undertaken. Mean age at the time of surgery was 64 years. Thirteen shoulders were followed up for more than 5 years (mean 87 months). Median Constant-Murley score was 59.0; median scores for general health were 33.40 and 49.36 for the physical and mental components respectively. Radiographical analysis revealed evidence of lucencies about the humeral component in all cases and about the glenoid component in five cases. Despite the good clinical results, the high incidence of radiographical lucencies is of concern. PMID:12582801

Woodruff, M J; Cohen, A P; Bradley, J G

2003-01-01

91

Assessment and characterization of in situ rotator cuff biomechanics  

NASA Astrophysics Data System (ADS)

Rotator cuff disease is a degenerative disorder that is a common, costly, and often debilitating, ranging in severity from partial thickness tear, which may cause pain, to total rupture, leading to loss in function. Currently, clinical diagnosis and determination of disease extent relies primarily on subjective assessment of pain, range of motion, and possibly X-ray or ultrasound images. The final treatment plan however is at the discretion of the clinician, who often bases their decision on personal experiences, and not quantitative standards. The use of ultrasound for the assessment of tissue biomechanics is established, such as in ultrasound elastography, where soft tissue biomechanics are measured. Few studies have investigated the use of ultrasound elastography in the characterization of musculoskeletal biomechanics. To assess tissue biomechanics we have developed a device, which measures the force applied to the underlying musculotendentious tissue while simultaneously obtaining the related ultrasound images. In this work, the musculotendinous region of the infraspinatus of twenty asymptomatic male organized baseball players was examined to access the variability in tissue properties within a single patient and across a normal population. Elastic moduli at percent strains less than 15 were significantly different than those above 15 percent strain within the normal population. No significant difference in tissue properties was demonstrated within a single patient. This analysis demonstrated elastic moduli are variable across individuals and incidence. Therefore threshold elastic moduli will likely be a function of variation in local-tissue moduli as opposed to a specific global value.

Trent, Erika A.; Bailey, Lane; Mefleh, Fuad N.; Raikar, Vipul P.; Shanley, Ellen; Thigpen, Charles A.; Dean, Delphine; Kwartowitz, David M.

2013-03-01

92

Arthroscopic treatment of ruptures of the rotator cuff.  

PubMed

566 patients with shoulder disease were treated at the Clinic of Orthopaedics at the University Hospital Olomouc. Of these, 181 were operated for ruptures of the rotator cuff (RC). They were categorised according to the Gschwend classification, age and gender(1). Laterality of the operated limb was also evaluated. Patients with ruptures larger than 4 cm were treated by open operation. 84 shoulders with ruptures classified as Gschwend I, II and IIIa -52 males and 32 females-were treated arthroscopically. The age of the operated patients ranged from 40-60 years. In both genders, the right shoulder was more often affected. Two operating techniques were used: 1) Transosseal refixation of the RC muscle tendons, using RC MITEK anchor implants, 2) "End to end" sutures, without implants(2-4). Operating time was reduced to 30-40 min. The operating results were evaluated according to the UCLA criteria- University of California Shoulder Rating Score(2). 45 patients achieved excellent results (53 %), 35 patients had good results (42 %), and 4 patients (5 %) obtained satisfactory results. None of the patients obtained poor results- a score of less than 20 was poor. Patients felt comfortable following the operation and none had any post-operational complications. The author is convinced, along with others, that arthroscopic suturing of RC ruptures classified I-IIIa allows for rupture treatment that in the past had to be treated by open technique(2-5). The deltoid muscle is not affected by arthroscopy. There is normalisation of the patient's movement, pain, force, and rotational stability is comparable to the healthy limb. Treatment time is reduced to a minimum and the patient may soon return to normal daily life. PMID:16601771

Holibka, Radomír; Kalina, Radim; Pach, Miroslav; R?zicková, Katherine

2005-12-01

93

Elevated plasma levels of TIMP-1 in patients with rotator cuff tear  

PubMed Central

Background and purpose Extracellular matrix remodeling is altered in rotator cuff tears, partly due to altered expression of matrix metalloproteinases (MMPs) and their inhibitors. It is unclear whether this altered expression can be traced as changes in plasma protein levels. We measured the plasma levels of MMPs and their tissue inhibitors (TIMPs) in patients with rotator cuff tears and related changes in the pattern of MMP and TIMP levels to the extent of the rotator cuff tear. Methods Blood samples were collected from 17 patients, median age 61 (39–77) years, with sonographically verified rotator cuff tears (partial- or full-thickness). These were compared with 16 age- and sex-matched control individuals with sonographically intact rotator cuffs. Plasma levels of MMPs and TIMPs were measured simultaneously using Luminex technology and ELISA. Results The plasma levels of TIMP-1 were elevated in patients with rotator cuff tears, especially in those with full-thickness tears. The levels of TIMP-1, TIMP-3, and MMP-9 were higher in patients with full-thickness tears than in those with partial-thickness tears, but only the TIMP-1 levels were significantly different from those in the controls. Interpretation The observed elevation of TIMP-1 in plasma might reflect local pathological processes in or around the rotator cuff, or a genetic predisposition in these patients. That the levels of TIMP-1 and of certain MMPs were found to differ significantly between partial and full-thickness tears may reflect the extent of the lesion or different etiology and pathomechanisms. PMID:23043271

2012-01-01

94

Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs  

PubMed Central

Abstract The financial cost of using human tissues in biomedical testing and surgical reconstruction is predicted to increase at a rate that is disproportionately greater than other materials used in biomechanical testing. Our first hypothesis is that cadaveric proximal humeri that had undergone monotonic failure testing of simulated rotator cuff repairs would not differ in ultimate fracture loads or in energy absorbed to fracture when compared to controls (i.e., bones without cuff repairs). Our second hypothesis is that there can be substantial cost savings if these cadaveric proximal humeri, with simulated cuff repairs, can be re-used for fracture testing. Results of fracture tests (conducted in a backwards fall configuration) and cost analysis support both hypotheses. Hence, the bones that had undergone monotonic failure tests of various rotator cuff repair techniques can be re-used in fracture tests because their load-carrying capacity is not significantly reduced. PMID:25371862

Pitts, Todd C.; Knight, Alex N.; Burkhead, Wayne Z.

2014-01-01

95

Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes.  

PubMed

A distinct type of partial-thickness rotator cuff tear has been observed in overhead athletes, characterized by partial failure of the undersurface of the posterior supraspinatus and anterior infraspinatus tendons with intratendinous delamination. We present a technique of percutaneous intratendinous repair using nonabsorbable mattress sutures designed for the management of articular-side delaminated partial-thickness tears. After tear evaluation and preparation, the torn rotator cuff undersurface is held in a reduced position with a grasper through an anterolateral rotator interval portal while viewing intra-articularly. Two spinal needles are then placed percutaneously through the full thickness of the torn and intact rotator cuff. A polydioxanone suture is passed through each needle, retrieved out the anterior portal, and used to shuttle a single nonabsorbable No. 2 suture through the tissue, creating a mattress suture. Multiple mattress sutures can be placed as dictated by tear size and morphology, with suture retrieval and knot securing then proceeding in the subacromial space. We have adopted this approach with the goals of anatomically re-establishing the rotator cuff insertion and sealing the area of intratendinous delamination while preventing significant alteration to the anatomy of the rotator cuff insertion, which could lead to motion deficits, internal impingement, and potential tear recurrence. PMID:18657747

Brockmeier, Stephen F; Dodson, Christopher C; Gamradt, Seth C; Coleman, Struan H; Altchek, David W

2008-08-01

96

Comprehensive Approach to Arthroscopic Rotator Cuff Repair: Options and Techniques  

MedlinePLUS

... one. That was more for grabbing the anterior aspect just to -- for later preparation. 00:38:!6 ... try and bring the cuff from the posterior aspect to the anterior aspect on the tuberosity. 00: ...

97

Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?  

PubMed Central

Background Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. Methods We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. Results The mean occupation ratio was significantly increased postoperatively from 0.44 ± 0.17 to 0.52 ± 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). Conclusions The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair. PMID:23467404

Chung, Seok Won; Kim, Sae Hoon; Tae, Suk-Kee; Yoon, Jong Pil; Choi, Jung-Ah

2013-01-01

98

An epidemiological study of rotator cuff pathology using The Health Improvement Network database.  

PubMed

Little is known about the incidence of rotator cuff pathology or its demographic associations in the general population. We undertook a large epidemiological study of rotator cuff pathology in the United Kingdom using The Health Improvement Network (THIN) database. The incidence of rotator cuff pathology was 87 per 100,000 person-years. It was more common in women than in men (90 cases per 100,000 person-years in women and 83 per 100,000 person-years in men; p < 0.001). The highest incidence of 198 per 100,000 person-years was found in those aged between 55 and 59 years. The regional distribution of incidence demonstrated an even spread across 13 UK health authorities except Wales, where the incidence was significantly higher (122 per 100,000 person-years; p < 0.001). The lowest socioeconomic group had the highest incidence (98 per 100,000 person-years). The incidence has risen fourfold since 1987 and as of 2006 shows no signs of plateauing. This study represents the largest general population study of rotator cuff pathology reported to date. The results obtained provide an enhanced appreciation of the epidemiology of rotator cuff pathology and may help to direct future upper limb orthopaedic services. PMID:24589790

White, J J E; Titchener, A G; Fakis, A; Tambe, A A; Hubbard, R B; Clark, D I

2014-03-01

99

Long-term outcome and structural integrity following open repair of massive rotator cuff tears  

PubMed Central

Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit. Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol. Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs. Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years. Level of evidence: Level IV PMID:22518073

Bartl, Christoph; Kouloumentas, Pannos; Holzapfel, Konstantin; Eichhorn, Stefan; Wortler, Klaus; Imhoff, Andreas; Salzmann, Gian M

2012-01-01

100

Fluoroscopy-Guided Implantation of Subacromial "Biodegradable Spacer" Using Local Anesthesia in Patients With Irreparable Rotator Cuff Tear  

PubMed Central

Treatment of massive rotator cuff tears can be challenging, especially when tears are considered irreparable or, when repaired, at significant risk of retear. A surgical technique is described using a biodegradable subacromial balloon-shaped spacer (InSpace; Ortho-Space, Caesarea, Israel) that, when implanted between the humeral head and acromion, permits smooth, frictionless gliding, supporting shoulder biomechanics. The specific insertion technique described herein is a simple procedure that can be performed in a day-care or outpatient setting with patients under local anesthesia, thus providing a treatment option for patients with multiple comorbidities complicating or contraindicating surgery, such as reverse arthroplasty under general anesthesia.

Gervasi, Enrico; Cautero, Enrico; Dekel, Assaf

2014-01-01

101

Fluoroscopy-guided implantation of subacromial "biodegradable spacer" using local anesthesia in patients with irreparable rotator cuff tear.  

PubMed

Treatment of massive rotator cuff tears can be challenging, especially when tears are considered irreparable or, when repaired, at significant risk of retear. A surgical technique is described using a biodegradable subacromial balloon-shaped spacer (InSpace; Ortho-Space, Caesarea, Israel) that, when implanted between the humeral head and acromion, permits smooth, frictionless gliding, supporting shoulder biomechanics. The specific insertion technique described herein is a simple procedure that can be performed in a day-care or outpatient setting with patients under local anesthesia, thus providing a treatment option for patients with multiple comorbidities complicating or contraindicating surgery, such as reverse arthroplasty under general anesthesia. PMID:25264508

Gervasi, Enrico; Cautero, Enrico; Dekel, Assaf

2014-08-01

102

Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age.  

PubMed

We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group: median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years). The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but different in age. After careful arthroscopic evaluation of the full-thickness rotator cuff tear, rotator cuff repair and biceps tenotomy were performed in all patients. Pre- and post-operatively, each patient was evaluated for range of motion, shoulder score (UCLA), and SF-36 self-administered questionnaire. Comparing pre- versus post-operative status at a minimum 24 months follow-up, forward elevation, internal and external rotation, modified UCLA rating system scores, and SF-36 scores improved significantly in both groups, with no significant difference between the groups. At the last follow-up, strength improved significantly in both groups, with non-significant intergroup difference. The Popeye sign was detected in 13/28 (46%) of the patients in the over 65 group and in 11/28 (39%) in the under 65 group (? = 0.29) with non-significant difference between the two groups. In selected active patients older than 65, arthroscopic rotator cuff repair associated with biceps tenotomy (when necessary) can yield clinical and related quality of life outcomes similar to those of patients younger than 65 years. PMID:20182868

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2010-12-01

103

Fatal pulmonary embolism after arthroscopic rotator cuff repair: a case series  

PubMed Central

Summary Background: pulmonary embolism (PE) is a rare and serious complication of arthroscopic orthopaedic surgery. Currently there is great paucity in the literature regarding PE events following arthroscopic rotator cuff (ARCR) surgery. The purpose of this case series was to (1) report our known incidence rate of symptomatic PE following ARCR for a single surgeon and (2) describe five cases of pulmonary embolism following ARCR, detailing patient medical history and potential perioperative risk factors. Methods: the number of PE events were queried retrospectively from the institutional database with the ICD-9 code 415.1 within a 10 year time frame (2003–2013). Cases of PE identified by ICD-9 query were reviewed for type of procedure, postoperative day of event, and surgeon. Only patients with a confirmed diagnosis by computed tomography (CT) scan or post-mortem exam, were included in this study. Patient medical records belonging to affected patients were ordered and reviewed by a single investigator. Pre, intra, and postoperative information was obtained and summarized. Results: 5 cases of PE were identified, two of which were fatal. All events occurred in the perioperative period following ARCR. The 10 year incidence rate for PE following ARCR was 0.89%. Medical record review revealed significant risk factors for these patients when compared to current VTE prophylactic guidelines. Conclusions: our ten year incidence rate of PE following arthroscopic shoulder surgery and ARCR was 0.25 and 0.89% respectively. These rates were found to be considerably higher than reported rates of PE in the general population and following arthroscopic shoulder surgery. In addition, our methods failed to detect subclinical PE events, resulting in the likelihood of this value to be an underestimate of the true incidence. Medical record review revealed risk factors which would qualify patients for chemoprophylaxis under certain guidelines, however, the validity of available risk stratification methods continue to be a topic of debate. Level of Evidence: Level IV; case series. PMID:25332941

Durant, Thomas J.S.; Cote, Mark P.; Arciero, Robert A.; Mazzocca, Augustus D.

2014-01-01

104

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives  

PubMed Central

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

2014-01-01

105

Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease  

PubMed Central

Background Shoulder pain is common with rotator cuff disease as the most frequently used clinical diagnosis. There is a wide range of treatment options for this condition, but limited evidence to guide patients and clinicians in the choice of treatment strategy. The purpose of this study was to investigate possible prognostic factors of short-term outcome after corticosteroid injection for rotator cuff disease. Methods We performed analyses of data from 104 patients who had participated in a randomized controlled study. Socio-demographic, clinical and radiographic baseline factors were assessed for association with outcome at six-weeks follow-up evaluated by Shoulder Pain and Disability Index (SPADI) and patient perceived outcome. Factors with significant univariate association were entered into multivariate linear and logistic regression analyses. Results In the multivariate analyses; a high SPADI score indicating pain and disability at follow-up was associated with decreasing age, male gender, high baseline pain and disability, being on sick-leave, and using regular pain medication. A successful patient perceived outcome was associated with not being on sick-leave, high active abduction, local corticosteroid injection and previous cortisone injections. Structural findings of rotator cuff tendon pathology on MRI and bursal exudation or thickening on ultrasonography did not contribute to the predictive model. Conclusions Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. Sick-leave was the best predictor of poor short-term outcome. Trial registration: Clinical trials NCT00640575 PMID:20950433

2010-01-01

106

Transplantation of teres major muscle for infraspinatus muscle in irreparable rotator cuff tears  

Microsoft Academic Search

The authors suggest transfer of teres major muscle for a detached and atrophic infraspinatus muscle in irreparable rotator cuff tears. Original studies were done on cadavers. In the period between November 1993 and June 1994, we used this technique on 6 patients. Those patients were evaluated with the Constant-Murley test and improved from an average of 40 points (minimum 27

Luigi Celli; Claudio Rovesta; Maria Carmen Marongiu; Stetano Manzieri

1998-01-01

107

RC-QOL score for rotator cuff pathology: adaptation to Italian.  

PubMed

We translated and adapted the English RC-QOL (rotator cuff quality of life) questionnaire into Italian and performed reliability and validity evaluations of the Italian RC-QOL version in patients with rotator cuff tears. The RC-QOL English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The RC-QOL questionnaire was then administered to 22 subjects (range 45-74 years) with a diagnosis of rotator cuff tears. For test-retest evaluation, the 22 patients were asked to complete the questionnaire at first examination, and 30 min following the end of this examination. The intraclass correlation coefficient for the 22 patients was 0.94 (95% CI = 0.85-0.98), indicating a high reliability. There were no significant differences between the scores immediately after the consultation and 30 min later. The Italian and the English versions of the RC-QOL questionnaire evaluate the same aspects of clinical severity in patients with rotator cuff tears. PMID:19838675

Papalia, Rocco; Osti, Leonardo; Leonardi, Francesco; Denaro, Vincenzo; Maffulli, Nicola

2010-10-01

108

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives.  

PubMed

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

2014-11-18

109

T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear  

PubMed Central

Objectives Rotator cuff tears are among the most common and debilitating upper extremity injuries. Chronic cuff tears result in atrophy and an infiltration of fat into the muscle, a condition commonly referred to as ‘fatty degeneration’. While stem cell therapies hold promise for the treatment of cuff tears, a suitable immunodeficient animal model that could be used to study human or other xenograft-based therapies for the treatment of rotator cuff injuries had not previously been identified. Methods A full-thickness, massive supraspinatus and infraspinatus tear was induced in adult T-cell deficient rats. We hypothesised that, compared with controls, 28 days after inducing a tear we would observe a decrease in muscle force production, an accumulation of type IIB fibres, and an upregulation in the expression of genes involved with muscle atrophy, fibrosis and inflammation. Results Chronic cuff tears in nude rats resulted in a 30% to 40% decrease in muscle mass, a 23% reduction in production of muscle force, and an induction of genes that regulate atrophy, fibrosis, lipid accumulation, inflammation and macrophage recruitment. Marked large lipid droplet accumulation was also present. Conclusions The extent of degenerative changes in nude rats was similar to what was observed in T-cell competent rats. T cells may not play an important role in regulating muscle degeneration following chronic muscle unloading. The general similarities between nude and T-cell competent rats suggest the nude rat is likely an appropriate preclinical model for the study of xenografts that have the potential to enhance the treatment of chronically torn rotator cuff muscles. Cite this article: Bone Joint Res 2014;3:262–72. PMID:25185444

Gumucio, J.; Flood, M.; Harning, J.; Phan, A.; Roche, S.; Lynch, E.; Bedi, A.; Mendias, C.

2014-01-01

110

Biochemical markers in the synovial fluid of glenohumeral joints from patients with rotator cuff tear.  

PubMed

It is known that rotator cuff tears are sometimes accompanied by joint destruction. Our purpose was to elucidate the pathology with this condition. Thirty-two synovial fluid (SF) samples aspirated from the glenohumeral joints of patients with rotator cuff tears, including 7 with partial-thickness and 25 with full-thickness tears of the rotator cuff (10 massive and 15 isolated supraspinatus tendon (SSp) tears), were examined. Collagenase (MMP-1), stromelysin 1 (MMP-3), tissue inhibitor of metalloproteinases-1 (TIMP-1) and carboxy-terminal type II procollagen peptide (pCOL Il-C) were measured in the SF using the respective sandwich enzyme immunoassays. Glycosaminoglycan (GAG) was also quantified with a cationic dye binding method using 1,9-dimethylmethylene blue. Levels of any molecules except pCOL II-C in the SF appeared to be higher in full-thickness tears than those in partial-thickness tears. Moreover, levels of MMP-1, MMP-3 and GAG in the SF were significantly higher in massive tears of the rotator cuff in comparison with those in isolated SSp tears. Such significance was not observed in the levels of TIMP-1 or pCOL II C in the SF. We examined the relation of those levels with operative findings or clinical parameters from full-thickness tears, and observed significant correlations of the tear size with the levels of MMP-1, MMP-3 and GAG in the SF. Although these marker molecules in SF do not always originate from cartilage, our results may indicate the potential for accelerated cartilage-degrading activity in the glenohumeral joint in massive tears of the rotator cuff. PMID:11518264

Yoshihara, Y; Hamada, K; Nakajima, T; Fujikawa, K; Fukuda, H

2001-07-01

111

Estimating optimal shoulder immobilization postures following surgical repair of massive rotator cuff tears.  

PubMed

Although shoulder immobilization is commonly prescribed following surgical repair of rotator cuff tears there is no consensus about the best shoulder immobilization postures. A musculoskeletal model was used with a minimax algorithm to estimate optimal post-operative shoulder immobilization postures for massive rotator cuff tears involving the supraspinatus and infraspinatus. An optimal posture was defined as one in which the stresses in the repaired tendons and the angle of humerus elevation were minimized. The optimal post-operative shoulder immobilization postures were with the humerus elevated and externally rotated. Elevation increased with the severity of the tear from 21° to 45° while external rotation decreased slightly from 23° to 18°. The minimax algorithm effectively balanced the competing criteria, resulting in feasible postures that did not overstress the repaired tendons. This method could be used to guide prescription of shoulder immobilization postures for various injuries. PMID:23116766

Jackson, M; Sylvestre, É; Bleau, J; Allard, P; Begon, M

2013-01-01

112

Synthetic and degradable patches: an emerging solution for rotator cuff repair  

PubMed Central

The use of rotator cuff augmentation has increased dramatically over the last 10 years in response to the high rate of failure observed after non-augmented surgery. However, although augmentations have been shown to reduce shoulder pain, there is no consensus or clear guideline as to what is the safest or most efficacious material. Current augmentations, either available commercially or in development, can be classified into three categories: non-degradable structures, extra cellular matrix (ECM)-based patches and degradable synthetic scaffolds. Non-degradable structures have excellent mechanical properties, but can cause problems of infection and loss of integrity in the long-term. ECM-based patches usually demonstrate excellent biological properties in vitro, but studies have highlighted complications in vivo due to poor mechanical support and to infection or inflammation. Degradable synthetic scaffolds represent the new generation of implants. It is proposed that a combination of good mechanical properties, active promotion of biological healing, low infection risk and bio-absorption are the ideal characteristics of an augmentation material. Among the materials with these features, those processed by electrospinning have shown great promis. However, their clinical effectiveness has yet to be proven and well conducted clinical trials are urgently required. PMID:23837794

Hakimi, Osnat; Mouthuy, Pierre-Alexis; Carr, Andrew

2013-01-01

113

Artrhoscopic rotator cuff repair with augmentation: the V-sled technique.  

PubMed

Numerous techniques have been described for patch positioning in rotator cuff shoulder arthroscopic surgery. These techniques seem to be difficult challenges for the majority of arthroscopic surgeons, and because of that they are called "highly demanding" techniques. Without the use of dedicated instruments and cannulas, the authors propose a V-sled technique that seems to be more reproducible, quicker and less difficult to perform for arthroscopic shoulder surgeons. The patient is placed in the lateral position. All arthroscopic procedures are performed without the use of cannulas. The standard posterior portal is used for the glenohumeral (GH) joint arthroscopy with fluid inflowing through the scope. After an accurate evaluation of the GH space, the scope is then introduced into the subacromial space. With the use of a spinal needle, a lateral portal is performed. The great tuberosity is prepared with a bur to place two 5.5 mm triple-loaded radiolucent anchors. In addition, two free high strength sutures are passed through the muscle, respectively. The repair is performed using two high strength sutures from each anchor. The third wire from each anchor is retrieved out of the accessories portals used for the insertion of the anchors. In addition, two free high strength sutures are passed through the muscle, and the patch sizing is done using a measuring probe introduced through the lateral portal. Next, the patch is then prepared and is introduced into the subacromial space, and then the patch is stabilized, and the free sutures are tied. PMID:22615157

Chillemi, Claudio; El Boustany, Stefano; Giudici, Luca Dei; Ippolito, Giorgio

2012-05-01

114

Relationship between muscle fatty infiltration and the biological characteristics and stimulation potential of tenocytes from rotator cuff tears.  

PubMed

The healing after rotator cuff surgery is still dissatisfying, and increased muscle fatty infiltration even more impairs the healing success. To achieve sufficient healing after rotator cuff reconstructions, the use of growth factors may be one possibility. The aim of the study was to identify a possible relationship between fatty infiltration of the supraspinatus muscle and cellular biological characteristics and stimulation potential of tenocyte-like cells (TLCs). TLCs of 3 donor groups differing in grade of muscle fatty infiltration were analyzed for their cellular characteristics and were stimulated with BMP-2 or BMP-7 in a 3D scaffold culture. The cell count and potency for self-renewal were significantly decreased in TLCs from donors with high muscle fatty infiltration compared to the lower fatty infiltration groups. Cell count and collagen-I expression as well as protein synthesis were stimulated by growth factors. Interestingly, TLCs of the high fatty infiltration group exhibited a weaker stimulation potential compared to the other groups. TLCs from donors with high muscle fatty infiltration generally revealed inferior characteristics compared to cells of lower fatty infiltration groups, which may be one reason for a weaker healing potential and may represent a possible starting point for the development of future treatment options. PMID:24022826

Klatte-Schulz, Franka; Gerhardt, Christian; Scheibel, Markus; Wildemann, Britt; Pauly, Stephan

2014-01-01

115

Effects of selective paralysis of the supraspinatus muscle using botulinum neurotoxin a in rotator cuff healing in rats.  

PubMed

We hypothesized that a temporary rotator cuff paralysis using botulinum-neurotoxin A (BoNtA) would lead to an improved tendon-to-bone healing after repair of supraspinatus lesions. One hundred sixty Sprague-Dawley rats were randomly assigned to either the BoNtA or the control (saline) group. BoNtA/saline-solution was injected into the supraspinatus muscle 1 week prior to surgery. A supraspinatus defect was made; we distinguished between a lesion with normal and increased repair load. Furthermore, one subgroup had the operated shoulder immobilized in a cast. Histologic analysis and biomechanical testing followed. Specimens from the BoNtA-group, which were treated with an increased repair load, showed less cellularity and more organization in the interface tissue compared to the saline control group. In addition, we found that the collagen 1-3 quotient in the BoNtA specimen was significantly (p?=?0.0051) higher than in the control group. Ultimate load at failure between the groups was not significantly different (p?>?0.05). We did not observe any significant differences between the mobilized and immobilized specimen (p?=?0.2079). The study shows that tendon-to-bone healing after rotator cuff repair can be altered positively using BoNtA pre-operatively. Tears with increased repair load seem to benefit the most-at least histologically. PMID:23239559

Ficklscherer, Andreas; Hartl, Tessa-Katharina; Scharf, Markus; Sievers, Birte; Schröder, Christian; Milz, Stefan; Niethammer, Thomas; Pietschmann, Matthias F; Müller, Peter E

2013-05-01

116

Treatment Options for Rotator Cuff Tears: A Guide for Adults  

MedlinePLUS

... but they can limit movement and cause pain. Limited movement Even small shoulder and arm movements, like ... choosing surgery? There is not enough information from studies to ... choice. In some cases, surgery is used when physical therapy does not ...

117

MRI of symptomatic and asymptomatic full-thickness rotator cuff tears  

PubMed Central

Background and purpose Why some full-thickness rotator cuff tears are symptomatic and others are asymptomatic is not understood. By comparing MRI findings in symptomatic and asymptomatic tears, we wanted to identify any tear characteristics that differed between groups. Patients and methods 50 subjects with asymptomatic and 50 subjects with symptomatic full-thickness tears were examined by MRI. Tear characteristics including tear size, tear location, the condition of the long head of the biceps, atrophy, and fatty degeneration of the muscles were compared between groups. Results Single factor logistic regression analysis showed that there were statistically significant associations between symptoms and tear size exceeding 3 cm in the medial-lateral plane, positive tangent sign, and fatty degeneration exceeding grade 1 of the supraspinatus and infraspinatus muscles. Interpretation We found associations between the symptomatic status of a rotator cuff tear and MRI-derived tear characteristics. The causal relationships are unclear. PMID:20450423

Tariq, Rana; Stiris, Morten G; Smith, Hans-J?rgen

2010-01-01

118

A Load-Sharing Rip-Stop Fixation Construct for Arthroscopic Rotator Cuff Repair  

PubMed Central

Despite advancements in arthroscopic rotator cuff repair techniques, achieving tendon-to-bone healing can be difficult in the setting of poor-quality tendon. Moreover, medial tendon tears or tears with lateral tendon loss may preclude standard techniques. Rip-stop suture configurations have been shown to improve load to failure compared with simple or mattress stitch patterns and may be particularly valuable in these settings. The purpose of this report is to describe a technical modification of a rip-stop rotator cuff repair that combines the advantages of a rip-stop suture (by providing resistance to tissue cutout) and a double row of load-sharing suture anchors (minimizing the load per anchor and therefore the load per suture within each anchor). PMID:23766972

Denard, Patrick J.; Burkhart, Stephen S.

2012-01-01

119

Arthroscopic Intratendinous Repair of the Delaminated Partial-Thickness Rotator Cuff Tear in Overhead Athletes  

Microsoft Academic Search

A distinct type of partial-thickness rotator cuff tear has been observed in overhead athletes, characterized by partial failure of the undersurface of the posterior supraspinatus and anterior infraspinatus tendons with intratendinous delamination. We present a technique of percutaneous intratendinous repair using nonabsorbable mattress sutures designed for the management of articular-side delaminated partial-thickness tears. After tear evaluation and preparation, the torn

Stephen F. Brockmeier; Christopher C. Dodson; Seth C. Gamradt; Struan H. Coleman; David W. Altchek

2008-01-01

120

The Biomechanical and Histologic Effects of Platelet-Rich Plasma on Rat Rotator Cuff Repairs  

PubMed Central

Background Rotator cuff tears are common injuries that are often treated with surgical repair. Because of the high concentration of growth factors within platelets, platelet-rich plasma (PRP) has the potential to enhance healing in rotator cuff repairs. Hypothesis Platelet-rich plasma would alter the biomechanical and histologic properties of rotator cuff repair during an acute injury response. Study Design Controlled laboratory study. Methods Platelet-rich plasma was produced from inbred donor rats. A tendon-from-bone supraspinatus tear was created surgically and an immediate transosseous repair performed. The control group underwent repair only. The PRP group underwent a repair with PRP augmentation. Rats in each group were sacrificed at 7, 14, and 21 days. The surgically repaired tendons underwent biomechanical testing, including failure load, stiffness, failure strain, and stress relaxation characteristics. Histological analysis evaluated the cellular characteristics of the repair tissue. Results At 7- and 21-day periods, augmentation with PRP showed statistically significant effects on the biomechanical properties of the repaired rat supraspinatus tear, but failure load was not increased at the 7-, 14-, or 21-day periods (P = .688, .209, and .477, respectively). The control group had significantly higher stiffness at 21 days (P = .006). The control group had higher failure strain at 7 days (P = .02), whereas the PRP group had higher failure strain at 21 days (P = .008). Histologically, the PRP group showed increased fibroblastic response and vascular proliferation at each time point. At 21 days, the collagen fibers in the PRP group were oriented in a more linear fashion toward the tendon footprint. Conclusion In this controlled, rat model study, PRP altered the tissue properties of the supraspinatus tendon without affecting the construct’s failure load. Clinical Relevance The decreased tendon tissue stiffness acutely and failure to enhance tendon-to-bone healing of repairs should be considered before augmenting rotator cuff repairs with PRP. Further studies will be necessary to determine the role of PRP in clinical practice. PMID:22822177

Beck, Jennifer; Evans, Douglas; Tonino, Pietro M.; Yong, Sherri; Callaci, John J.

2013-01-01

121

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique  

Microsoft Academic Search

Background  Treatment of partial-thickness articular surface rotator cuff tears varies from simple débridement with or without an acromioplasty\\u000a to various repair techniques. These repair techniques have included in situ transtendinous methods, as well as completion\\u000a of the tear and repairing the full-thickness defect. The transtendinous techniques can be associated with stiffness and completing\\u000a the tear takes down normal intact tissue. Therefore,

Edwin E. Spencer Jr

2010-01-01

122

Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age  

Microsoft Academic Search

We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group:\\u000a median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years).\\u000a The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but\\u000a different in age. After

Leonardo OstiRocco; Rocco Papalia; Angelo Del Buono; Vincenzo Denaro; Nicola Maffulli

2010-01-01

123

Advantages and techniques of utilizing anterolateral portal in delaminated rotator cuff repair.  

PubMed

Typically, rotator cuff repair is performed two-dimensionally while visualizing the subacromial space. To achieve a more complete repair, sutures can be retrieved from inside the joint utilizing a penetrating suture device through the anterolateral portal, which permits visualization of the articular side and bursal side of the rotator cuff tear. Utilizing other portals can leave the sutures out of sight and reach. The anterolateral portal helps capture both leaves of a delaminated tear and places the sutures in the center of the field for retrieval and tying. The anterolateral portal is located with a spinal needle just off the anterolateral corner of the acromion, and the suture anchor is inserted into the greater tuberosity through this portal. The sutures are passed into the joint through the tear in the rotator cuff with a suture grasper. The scope is redirected intraarticularly, and the suture is visualized. The sutures are positioned, and the penetrator is passed through the tendon. The scope is placed back in the bursa for tying sutures and capturing both leaves of a delaminated tear. It works equally well for simple complete tears and partial articular-sided supraspinatus tendon avulsion lesions. PMID:25153817

Chavan, Prithviraj; Gothelf, Todd K; Nord, Keith M; Garrett, William H; Nord, Keith D

2014-01-01

124

Immunolocalization of cytokines and growth factors in subacromial bursa of rotator cuff tear patients.  

PubMed

Inflammation in the subacromial bursa causes pain in patients suffering from rotator cuff tear, with this long-lasting inflammation leading to fibrosis and thickening of the subacromial bursa. Both inflammatory cytokines and mechanical stress, and impingement in the subacromial space, might induce and worsen this inflammation. However, little is known of the mechanism of this inflammation. In this study, we used immunohistological staining to demonstrate the expression of Interleukin-1 beta (IL-1 beta), Tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta), and basic fibroblast growth factor (bFGF) in subacromial bursa derived from the patients suffering from rotator cuff tear. On the other hand the expression of these inflammatory cytokines and growth factors were little detected only to a small degree in patients with anterior shoulder instability who did not have severe shoulder pain and impingement in the subacromial space. Our findings suggest that those inflammatory cytokines and growth factors may play an important role in inflammation of the subacromial bursa. Controlling the expression of these cytokines and growth factors might be important for treating patients suffering from shoulder pain due to rotator cuff tear. PMID:11565192

Sakai, H; Fujita, K; Sakai, Y; Mizuno, K

2001-02-01

125

Biomechanical testing of a new knotless suture anchor compared with established anchors for rotator cuff repair.  

PubMed

Various suture anchors are available for rotator cuff repair. For arthroscopic application, a knotless anchor was developed to simplify the intra-operative handling. We compared the new knotless anchor (BIOKNOTLESStrade mark RC; DePuy Mitek, Raynham, MA) with established absorbable and titanium suture anchors (UltraSorbtrade mark and Super Revo 5mmtrade mark; ConMed Linvatec, Utica, NY). Each anchor was tested on 6 human cadaveric shoulders. The anchors were inserted into the greater tuberosity. An incremental cyclic loading was performed. Ultimate failure loads, anchor displacement, and mode of failure were recorded. The anchor displacement of the BIOKNOTLESStrade mark RC (15.3 +/- 5.3 mm) after the first cycle with 75 N was significantly higher than with the two other anchors (Super Revo 2.1 +/- 1.6 mm, UltraSorb: 2.7 +/- 1.1 mm). There was no significant difference in the ultimate failure loads of the 3 anchors. Although the Bioknotlesstrade mark RC indicated comparable maximal pullout strength, it bares the risk of losing contact between the tendon-bone-interface due to a significantly higher system displacement. Therefore, gap formation between the bone and the soft tissue fixation jeopardizes the repair. Bioknotlesstrade mark RC should be used in the lateral row only when a double row technique for rotator cuff repair is performed, and is not appropriate for rotator cuff repair if used on its own. PMID:18396417

Pietschmann, Matthias F; Froehlich, Valerie; Ficklscherer, Andreas; Wegener, Bernd; Jansson, Volkmar; Müller, Peter E

2008-01-01

126

Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: a prospective, MRI controlled study  

Microsoft Academic Search

The reported functional results of rotator cuff repair performed arthroscopically have been good. Only little is known about the cuff integrity after arthroscopic repair and how it influences the outcome. The aim of the study is to set a baseline of what rate of healing response respectively re-tears to expect and how cuff integrity alters the outcome. Fifty-three consecutive patients

Sven Lichtenberg; Dennis Liem; Petra Magosch; Peter Habermeyer

2006-01-01

127

Magnetic Resonance Imaging of Rotator Cuff Tears in Shoulder Impingement Syndrome  

PubMed Central

Summary Background Shoulder joint is a common site of musculoskeletal pain caused, among other things, by rotator cuff tears due to narrowing of subacromial space, acute trauma or chronic shoulder overload. Magnetic resonance imaging (MRI) is an excellent modality for imaging of soft tissues of the shoulder joint considering a possibility of multiplanar image acquisition and non-invasive nature of the study. The aim of this study was to evaluate the prevalence of partial and complete rotator cuff tears in magnetic resonance images of patients with shoulder impingement syndrome and to review the literature on the causes and classification of rotator cuff tears. Material/Methods We retrospectively analyzed the results of 137 shoulder MRI examinations performed in 57 women and 72 men in Magnetic Resonance facility of the Department of Radiology and Diagnostic Imaging at the St. Jadwiga the Queen Regional Hospital No. 2 in Rzeszow between June 2010 and February 2013. Examinations were performed using Philips Achieva 1.5T device, including spin echo and gradient echo sequences with T1-, T2- and PD-weighted as well as fat saturation sequences in transverse, frontal and sagittal oblique planes. Patients were referred from hospital wards as well as from outpatient clinics of the subcarpathian province. Results The most frequently reported injuries included partial supraspinatus tendon tear and complete tearing most commonly involved the supraspinatus muscle tendon. The smallest group comprised patients with complete tear of subscapularis muscle tendon. Among 137 patients in the study population, 129 patients suffered from shoulder pain, including 57 patients who reported a history of trauma. There was 44% women and 56% men in a group of patients with shoulder pain. Posttraumatic shoulder pain was predominantly reported by men, while women comprised a larger group of patients with shoulder pain not preceded by injury. Conclusions Rotator cuff injury is a very common pathology in patients with shoulder impingement syndrome. Isolated supraspinatus tendon injury or complete tearing is most frequent, rather than in conjunction with injuries to other rotator cuff tendons. We did not observe isolated complete tears of infraspinatus and subscapular muscle tendons. PMID:25374626

Freygant, Magdalena; Dziurzynska-Bialek, Ewa; Guz, Wieslaw; Samojedny, Antoni; Golofit, Andrzej; Kostkiewicz, Agnieszka; Terpin, Krzysztof

2014-01-01

128

A novel technique of rotator cuff repair using spinal needle and suture loop  

PubMed Central

Background We present a simple technique of arthroscopic rotator cuff repair using a spinal needle and suture loop. Methods With the arthroscope laterally, a spinal needle looped with PDS is inserted percutaneously into the shoulder posteriorly and penetrated through the healthy posterior cuff tear margin. Anteriorly, another spinal needle loaded with PDS is inserted percutaneously to engage the healthy tissue at the anterior tear margin. The suture in the anterior needle is then delivered into the suture loop of the posterior needle using a suture retriever. The posterior needle and loop are then pulled out carrying the anterior suture with it. The two limbs of this suture are then retrieved through a cannula for knotting. The same procedure is then repeated for additional suturing. Suture anchors placed over the greater tuberosity are used to complete the repair. Conclusion This is an easy method of rotator cuff repair using simple instruments and lesser time, hence can be employed at centers with less equipment and at reduced cost to the patient. PMID:21062442

2010-01-01

129

Arthroscopic versus mini-open rotator cuff repair: a prospective, randomized study with 24-month follow-up.  

PubMed

This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up. PMID:23812851

Zhang, Zhenxiang; Gu, Beibei; Zhu, Wei; Zhu, Lixian; Li, Qingsong

2014-08-01

130

Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair.  

PubMed

Suture anchors are increasingly gaining importance in rotator cuff surgery. This means they will be gradually replacing transosseous sutures. The purpose of this study was to compare the stability of transosseous sutures with different suture anchors with regard to their pullout strength depending on bone density. By means of bone densitometry (CT scans), two groups of human humeral head specimens were determined: a healthy and a osteopenic bone group. Following anchor systems were being tested: SPIRALOK 5.0 mm (resorbable, DePuy Mitek), Super Revo 5 mm (titanium, Linvatec), UltraSorb (resorbable, Linvatec) and the double U-sutures with Orthocord USP 2 (partly resorbable, DePuy Mitek) and Ethibond Excel 2 (non-resorbable, Ethicon). The suture anchors/double U-sutures were inserted in the greater tuberosity 12 times. An electromechanical testing machine was used for cyclic loading with power increasing in stages. We recorded the ultimate failure loads, the system displacements and the modes of failure. The suture anchors tended to bring about higher ultimate failure loads than the transosseous double U-sutures. This difference was significant in the comparison of the Ethibond suture and the SPIRALOK 5.0 mm-both in healthy and osteopenic bone. Both the suture materials and the SPIRALOK 5.0 mm showed a significant difference in pullout strength on either healthy or osteopenic bone; the titanium anchor SuperRevo 5 mm and the tilting anchor UltraSorb did not show any significant difference in healthy or osteopenic bone. There was no significant difference concerning system displacement (healthy and osteopenic bone) between the five anchor systems tested. The pullout strength of transosseous sutures is neither on healthy nor on osteopenic bone higher than that of suture anchors. Therefore, even osteopenic bone does not constitute a valid reason for the surgeon to perform open surgery by means of transosseous sutures. The choice of sutures in osteopenic bone is of little consequence anyway since it is mostly the bone itself which is the limiting factor. PMID:18193198

Pietschmann, Matthias F; Fröhlich, Valerie; Ficklscherer, Andreas; Hausdorf, Jörg; Utzschneider, Sandra; Jansson, Volkmar; Müller, Peter E

2008-05-01

131

Posterior Rotator Cuff Strengthening Using Theraband(R) in a Functional Diagonal Pattern in Collegiate Baseball Pitchers  

PubMed Central

The deceleration phase of the pitching mechanism requires forceful eccentric contraction of the posterior rotator cuff. Because traditional isotonic strengthening may not be specific to this eccentric pattern, a more effective and functional means of strengthening the posterior rotator cuff is needed. Twelve collegiate baseball pitchers performed a moderate intensity isotonic dumbbell strengthening routine for 6 weeks. Six of the 12 subjects were randomly assigned to an experimental group and placed on a Theraband® Elastic Band strengthening routine in a functional-diagonal pattern to emphasize the eccentric contraction of the posterior rotator cuff, in addition to the isotonic routine. The control group (n = 6) performed only the isotonic exercises. Both groups were evaluated on a KIN-COM® isokinetic dynamometer in a functional diagonal pattern. Pretest and posttest average eccentric force production of the posterior rotator cuff was compared at two speeds, 60 and 180°/s. Data were analyzed with an analysis of covariance at the .05 level with significance at 60°/s. Values at 180°/s, however, were not significant. Eccentric force production at 60°/s increased more during training in the experimental group (+19.8%) than in the control group (-1.6%). There was no difference in the two groups at 180°/s; both decreased (8 to 15%). Theraband was effective at 60°/s in functional eccentric strengthening of the posterior rotator cuff in the pitching shoulder. ImagesFig 1. PMID:16558251

Page, Phillip A.; Lamberth, John; Abadie, Ben; Boling, Robert; Collins, Robert; Linton, Russell

1993-01-01

132

Rotator cuff healing after continuous subacromial bupivacaine infusion: an in vivo rabbit study  

PubMed Central

Background The objective of this study was to evaluate the effects of continuous subacromial bupivacaine infusion on supraspinatus muscle and rotator cuff tendon healing via gross, biomechanical, and histologic analyses. Methods Thirty-three New Zealand White rabbits underwent unilateral supraspinatus transection and rotator cuff repair (RCR). Rabbits were assigned to 1 of 3 groups: (1)RCR only, (2)RCR with continuous saline infusion for 48 hours, or (3)RCR with continuous 0.25% bupivacaine with epinephrine (1:200,000) infusion for 48 hours. Rabbits were sacrificed at either 2 (for histologic assessment) or 8 weeks post-operatively (for biomechanical and histologic assessment). Results Tensile testing showed significantly higher load to failure in intact tendons compared to repaired tendons (p<0.01); however, no statistical differences were detected among RCR only, RCR Saline, and RCR Bupivacaine groups. Histologically, the enthesis of repaired tendons showed increased cellularity and disorganized collagen fibers compared to intact tendons, with no differences between treatment groups. Muscle histology demonstrated scattered degenerative muscle fibers at 2 weeks in both RCR Saline and RCR Bupivacaine, but no degeneration was noted at 8 weeks. Conclusions The healing supraspinatus tendons exposed to bupivacaine infusion showed similar histologic and biomechanical characteristics compared to untreated and saline infused RCR groups. Muscle histology showed fiber damage at 2 weeks for both the saline and bupivacaine treated groups, with no apparent disruption at 8 weeks, suggesting a recovery process. Therefore, subacromial bupivacaine infusion in this rabbit rotator cuff model does not appear to impair muscle or tendon following acute injury and repair. Level Of Evidence Basic science study PMID:22818894

FRIEL, NICOLE A.; WANG, VINCENT M.; SLABAUGH, MARK A.; WANG, FANCHIA; CHUBINSKAYA, SUSAN; COLE, BRIAN J.

2013-01-01

133

Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy.  

PubMed

Suprascapular neuropathy is generally considered to be a diagnosis of exclusion, although it has been described in association with several activities and conditions. To our knowledge, this is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. We present 4 cases of patients who presented with complete fatty infiltration of the supraspinatus (1 patient), infraspinatus (2 patients), and both (1 patient) resulting from suprascapular neuropathy. Each of these patients underwent arthroscopic suprascapular nerve decompression and subsequently had immediate improvement in pain and subjective shoulder value. PMID:24630957

Leclere, Lance E; Shi, Lewis L; Lin, Albert; Yannopoulos, Paul; Higgins, Laurence D; Warner, Jon J P

2014-05-01

134

Hybrid Repair of Large Crescent Rotator Cuff Tears Using a Modified SpeedBridge and Double-Pulley Technique.  

PubMed

An ideal rotator cuff repair maximizes the tendon-bone interface and has adequate biomechanical strength that can withstand a high level of demand. Arthroscopic transosseous-equivalent rotator cuff repairs have become popular and have been shown to be superior to many other methods of fixation. We present an alternative method of repair for large crescent rotator cuff tears that combines 2 well-known methods of fixation: modified SpeedBridge (Arthrex, Naples, FL) and double-pulley techniques. These 2 repair constructs were combined to provide the greatest amount of compression across the footprint while also providing rigid fixation. Ultimately, this can provide an optimal environment for healing in otherwise significant injuries. PMID:25126513

Chauhan, Aakash; Regal, Steven; Frank, Darren A

2014-06-01

135

[Primary strength of conventional and alternative suture techniques of the rotator cuff. A biomechanical study].  

PubMed

The aim of this biomechanical study was to evaluate rotator cuff repair strength using different suture anchor techniques compared to conventional repair, taking into consideration the native strength of the supraspinatus tendon. Therefore, a defined defect of the supraspinatus was created in 50 freshly frozen cadaver specimen (group size n = 10; median age at death: 56 years). Five methods were employed for cuff repair: standard transosseous suture, modified transosseous suture with patch augmentation and three suture anchors (Acufex Wedge TAG, Acufex Rod TAG und Mitek GII). The maximum tensile load of the five techniques was: standard transosseous suture, 410 N; modified transosseous suture, 552 N; Wedge TAG, 207 N; Rod TAG, 217 N; Mitek GII, 186 N. The difference between the suture anchor and standard techniques were highly significant (P < 0.001). In this series, the Mitek Gll anchor showed the lowest anchor dislocation rate at 3% (n = 1). The Wedge TAG system had a dislocation rate of 27% (n = 8) and the Rod TAG system 43% (n = 13). Suture anchor techniques revealed about 20%, the standard technique 34% and its modification 60% of the hypothetically calculated native tendon strength. Compared to conventional transosseous suture techniques, the use of the suture anchors tested in this series does not significantly increase the primary fixation strength of rotator cuff repair. The metallic implant with two barbs (Mitek GII) seems to be superior to the polyacetal anchors when inserted into the spongiform bone of the greater tubercle. The considerably weaker repair strength needs to be taken into consideration in postoperative patient rehabilitation, especially after the use of suture anchors. PMID:11968555

Rickert, M; Witzel, U; Kölbel, R; Georgousis, H

2002-01-01

136

Greater Tuberosity Osteotomy and Teres Minor Transfer for Irreparable Superior Rotator Cuff Tears  

PubMed Central

The purpose of this study was to evaluate the mid- to long- term objective, subjective and radiographic results of patients who underwent anterior-superior transfer of remaining infraspinatus tendon and teres minor tendon for irreparable superior rotator cuff tears. thirteen patients were identified who underwent infraspinatus tendon transfer to a more superior position on the humeral head between January 1, 1990 and december 31, 2001. nine shoulders in eight patients were available for clinical examination, radiographs and questionnaire follow-up at an average of 83.5 ± 31.4 months. radiographic examination revealed 1 fibrous union and 6 united tuberosity osteotomies. Samilson-Prieto grading of radiographs revealed 4 shoulders with mild, and 4 shoulders with moderate, OA. Seven of the patients were satisfied with their shoulder. there were two poor outcomes. Local antero-superior teres minor and residual infraspinatus transfer provides a viable option for irreparable rotator cuff defects. Mid- to long-term satisfactory outcome was achieved in 7 out of 9 shoulders. PMID:17907433

Wolf, Brian R; Bries, Andrew D; Nepola, James V

2007-01-01

137

Greater tuberosity osteotomy and teres minor transfer for irreparable superior rotator cuff tears.  

PubMed

The purpose of this study was to evaluate the mid- to long- term objective, subjective and radiographic results of patients who underwent anterior-superior transfer of remaining infraspinatus tendon and teres minor tendon for irreparable superior rotator cuff tears. Thirteen patients were identified who underwent infraspinatus tendon transfer to a more superior position on the humeral head between January 1, 1990 and December 31, 2001. Nine shoulders in eight patients were available for clinical examination, radiographs and questionnaire follow-up at an average of 83.5 +/- 31.4 months. Radiographic examination revealed 1 fibrous union and 6 united tuberosity osteotomies. Samilson-Prieto grading of radiographs revealed 4 shoulders with mild, and 4 shoulders with moderate, OA. Seven of the patients were satisfied with their shoulder. There were two poor outcomes. Local antero-superior teres minor and residual infraspinatus transfer provides a viable option for irreparable rotator cuff defects. Mid- to long-term satisfactory outcome was achieved in 7 out of 9 shoulders. PMID:17907433

Wolf, Brian R; Bries, Andrew D; Nepola, James V

2007-01-01

138

Comparative study between hydrokinesio therapy and conventional physiotherapeutic modalities in perspective of rotator cuff impingement: a pilot study  

Microsoft Academic Search

Hydrokinesio therapy means active physical rehabilitation modality with the help of buoyancy, relative density, resistance and turbulence of water in swimming pool or tub. The aim was to evaluate the effect of the said therapy over conventional physiotherapeutic modalities, for example, mobilisation, manipulation in the cases of rotator cuff impingement. Twenty cases (10 males, 10 females with a mean age

Sandipan DasSarma; Anirban Mallick; Manabendra Bhattacharyya

2010-01-01

139

The Factors Affecting the Clinical Outcome and Integrity of Arthroscopically Repaired Rotator Cuff Tears of the Shoulder  

PubMed Central

Background The purpose of this study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repair, and to analyze the factors affecting the integrity of arthroscopically repaired rotator cuff tears of the shoulder. Methods One hundred sixty-nine consecutive shoulders that underwent arthroscopic rotator cuff repair, had a postoperative MRI evaluation and were followed for at least two years were enrolled in this study. The mean age was 57.6 years (range, 38 to 74 years) and the mean follow-up period was 39 months (range, 24 to 83 months). Results The rotator cuff was completely healed in 131 (77.5%) out of 169 shoulders and recurrent tears occurred in 38 shoulders (22.5%). At the last follow-up visit, the mean score for pain during motion was 1.53 (range, 0 to 4) in the completely healed group and 1.59 (range, 0 to 4) in the group with recurrent tears (p = 0.092). The average elevation strength was 7.87 kg (range, 4.96 to 11.62 kg) and 5.25 kg (range, 4.15 to 8.13 kg) and the mean University of California at Los Angeles score was 30.96 (range, 26 to 35) and 30.64 (range, 23 to 34), respectively (p < 0.001, p = 0.798). The complete healing rate was 87.8% in the group less than 50 years of age (49 shoulders), 79.4% in the group over 51 years but less than 60 years of age (68 shoulders), and 65.4% in the group over 61 years of age (52 shoulders, p = 0.049); it was 96.7% in the group with small-sized tears (30 shoulders), 87.3% in the group with medium-sized tears (71 shoulders), and 58.8% in the group with large-sized or massive tears (68 shoulders, p = 0.009). All of the rotator cuffs with a global fatty degeneration index of greater than two preoperatively had recurrent tears. Conclusions Arthroscopic repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the minimum two-year follow up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient's age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle. PMID:19885061

Cho, Nam Su

2009-01-01

140

The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear  

PubMed Central

Background It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear. Methods This prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N?=?69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regression analysis. Results and discussion In this cohort, 38 patients were diagnosed with rotator cuff tears. The individual overall accuracy of the rotator cuff clinical tests was 61%–75%. After backward selection, the model determined that the most important predictors of rotator cuff tears were higher age and a positive Neer test. This internally validated prediction model had good discriminative ability (area under the receiver operating characteristic curve (AUC)?=?0.73). Conclusion Our results showed that individual clinical shoulder tests had moderate diagnostic value for diagnosing rotator cuff tear. Our prediction model showed improved diagnostic value. However, the prediction value is still relatively low, supporting a low threshold for additional diagnostic tests for the diagnosis of rotator cuff tears. Level of evidence Study of diagnostic test: level I. PMID:25099359

2014-01-01

141

Surgery Clerkship MID-ROTATION EVALUATION  

E-print Network

Surgery Clerkship MID-ROTATION EVALUATION The University of Chicago Division of the Biological evaluate the student's level of skill in the following competencies in Surgery. On the next page, please provide written comments to explain your scores. 0 1 2 3 4 5 Diagnosis and Management in Surgery 1

Issa, Naoum

142

Arthroscopic double-locked stitch: a new technique for suturing rotator cuff tears.  

PubMed

There are a number of reasons for failed rotator cuff tear repair. In such cases the suture-tendon interface seems to be the most vulnerable area, especially when tendon degeneration is present. We describe a new technique, the arthroscopic double-locked suture, that increases the tendon fixation and has the added benefit of being placed parallel to the blood vessels, therefore avoiding damage to the tendon vascularization. The suture may be achieved by use of knots or knotless anchors and suture passers, without the need for any additional instrumentation. The new technique is especially helpful in cases in which the tendon is retracted and degeneration is present, impeding the use of the double-row technique or its transosseous equivalents. PMID:24904764

Miyazaki, Alberto N; Zanella, Luiz A Z; La Salvia, João C; Fregoneze, Marcelo; Santos, Pedro D; da Silva, Luciana A; Sella, Guilherme do Vall; Checchia, Sergio L

2014-04-01

143

Scoring systems for the functional assessment of patients with rotator cuff pathology.  

PubMed

Ideally, an outcome instrument measures phenomena that are directly relevant to the patient and provides a comprehensive assessment of the impact of a condition on the patient's daily life. During the past decades, several rating scales have been developed to assess the functional status of patients with shoulder pain. Several scoring systems are currently available for the evaluation of patients with rotator cuff pathology. Each of them evaluates shoulder function using specific variables. The main features of these scoring systems are presented in this review. Although many scoring systems are commonly used to evaluate shoulder function, we are still far from a single outcome evaluation system, which is reliable, valid, and sensitive to clinically relevant changes, takes into account both patient's and physician's perspective, and is short and practical to use. PMID:21822113

Longo, Umile Giuseppe; Vasta, Sebastiano; Maffulli, Nicola; Denaro, Vincenzo

2011-09-01

144

Effective ways of restoring muscular imbalances of the rotator cuff muscle group: a comparative study of various training methods  

PubMed Central

Background: Many studies have compared different training methods for improving muscular performance, but more investigations need to be directed to the restoration of muscular imbalances. Objective: To determine the most effective training for altering strength ratios in the shoulder rotator cuff. Methods: Forty eight physical education students were randomly assigned to four groups (12 per group): (a) experimental group who carried out multijoint dynamic resistance training for shoulder internal and external rotation movement (pull ups or lat pull downs, overhead press, reverse pull ups, push ups) (MJDR group); (b) experimental group who exercised the same muscle group using dumbbells weighing 2 kg (isolated group); (c) experimental group who followed an isokinetic strengthening programme for the rotator cuff muscle group (isokinetic group); (d) control group who had no strength training. Testing was performed in the supine position with the glenohumeral joint in 90° of abduction in the coronal plane, with a range of motion of 0–90° of external rotation and 0–65° of internal rotation at angular velocities of 60, 120, and 180°/s. The test procedure was performed before and after the exercise period of six weeks. Results: One way analysis of variance found no differences between the groups for the initial tests. Analysis of variance with repeated measures showed that the strength ratios in all the experimental groups had altered after the exercise period, with the isokinetic group showing the most significant improvement. Conclusions: Isokinetic strengthening is the most effective method of altering strength ratios of the rotator cuff muscle. PMID:15562178

Malliou, P; Giannakopoulos, K; Beneka, A; Gioftsidou, A; Godolias, G

2004-01-01

145

Classification of the degenerative grade of lesions of supraspinatus rotator cuff tendons by FT-Raman spectroscopy  

NASA Astrophysics Data System (ADS)

FT-Raman spectroscopy was employed to access the biochemical alterations occurring on the degenerative process of the rotator cuff supraspinatus tendons. The spectral characteristic variations in the 351 spectra of samples of 39 patients were identified with the help of Principal Components Analysis. The main variations occurred in the 840-911; 1022- 1218; 1257; 1270; 1300; 1452; 1663; and 1751 cm -1 regions corresponding to the vibrational bands of proline, hydroxiproline, lipids, nucleic acids, carbohydrates, collagen, and elastin. These alterations are compatible with the pathology alterations reported on the literature. Scattering plots of PC 4 vs PC 2 and PC 3 vs PC 2 contrasted with histopathological analysis has enabled the spectral classification of the data into normal and degenerated groups of tendons. By depicting empiric lines the estimated sensibility and specificity were 39,6 % and 97,8 %, respectively for PC 4 vs PC 2 and 36,0 % and 100 %, respectively for PC 3 vs PC 2. These results indicate that Raman spectroscopy can be used to probe the general tendon quality and could be applied as co adjuvant element in the usual arthroscopy surgery apparatus to guide the procedure and possibly infer about the probability of rerupture.

Palma Fogazza, Bianca; da Silva Carvalho, Carolina; Godoy Penteado, Sergio; Meneses, Cláudio S.; Abrahão Martin, Airton; da Silva Martinho, Herculano

2007-02-01

146

Effects of 8 Weeks' Specific Physical Training on the Rotator Cuff Muscle Strength and Technique of Javelin Throwers  

PubMed Central

[Purpose] For maximum efficiency and to prevent injury during javelin throwing, it is critical to maintain muscle balance and coordination of the rotator cuff and the glenohumeral joint. In this study, we investigated the change in the rotator cuff muscle strength, throw distance and technique of javelin throwers after they had performed a specific physical training that combined elements of weight training, function movement screen training, and core training. [Subjects] Ten javelin throwers participated in this study: six university athletes in the experimental group and four national-level athletes in the control group. [Methods] The experimental group performed 8 weeks of the specific physical training. To evaluate the effects of the training, measurements were performed before and after the training for the experimental group. Measurements comprised anthropometry, isokinetic muscle strength measurements, the function movement screen test, and movement analysis. [Results] After the specific physical training, the function movement screen score and external and internal rotator muscle strength showed statistically significant increases. Among kinematic factors, only pull distance showed improvement after training. [Conclusion] Eight weeks of specific physical training for dynamic stabilizer muscles enhanced the rotator cuff muscle strength, core stability, throw distance, and flexibility of javelin throwers. These results suggest that specific physical training can be useful for preventing shoulder injuries and improving the performance for javelin throwers. PMID:25364111

Kim, Hyeyoung; Lee, Youngsun; Shin, Insik; Kim, Kitae; Moon, Jeheon

2014-01-01

147

Effects of 8 weeks' specific physical training on the rotator cuff muscle strength and technique of javelin throwers.  

PubMed

[Purpose] For maximum efficiency and to prevent injury during javelin throwing, it is critical to maintain muscle balance and coordination of the rotator cuff and the glenohumeral joint. In this study, we investigated the change in the rotator cuff muscle strength, throw distance and technique of javelin throwers after they had performed a specific physical training that combined elements of weight training, function movement screen training, and core training. [Subjects] Ten javelin throwers participated in this study: six university athletes in the experimental group and four national-level athletes in the control group. [Methods] The experimental group performed 8 weeks of the specific physical training. To evaluate the effects of the training, measurements were performed before and after the training for the experimental group. Measurements comprised anthropometry, isokinetic muscle strength measurements, the function movement screen test, and movement analysis. [Results] After the specific physical training, the function movement screen score and external and internal rotator muscle strength showed statistically significant increases. Among kinematic factors, only pull distance showed improvement after training. [Conclusion] Eight weeks of specific physical training for dynamic stabilizer muscles enhanced the rotator cuff muscle strength, core stability, throw distance, and flexibility of javelin throwers. These results suggest that specific physical training can be useful for preventing shoulder injuries and improving the performance for javelin throwers. PMID:25364111

Kim, Hyeyoung; Lee, Youngsun; Shin, Insik; Kim, Kitae; Moon, Jeheon

2014-10-01

148

MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects  

Microsoft Academic Search

Objective. To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images\\u000a after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings.\\u000a \\u000a \\u000a Design and patients. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27–53 months (mean 39\\u000a months) after open transosseous reinsertion of

Marco Zanetti; Bernhard Jost; Juerg Hodler; Christian Gerber

2000-01-01

149

Skeletal muscle fibrosis and stiffness increase after rotator cuff tendon injury and neuromuscular compromise in a rat model.  

PubMed

Rotator cuff tears can cause irreversible changes (e.g., fibrosis) to the structure and function of the injured muscle(s). Fibrosis leads to increased muscle stiffness resulting in increased tension at the rotator cuff repair site. This tension influences repairability and healing potential in the clinical setting. However, the micro- and meso-scale structural and molecular sources of these whole-muscle mechanical changes are poorly understood. Here, single muscle fiber and fiber bundle passive mechanical testing was performed on rat supraspinatus and infraspinatus muscles with experimentally induced massive rotator cuff tears (Tenotomy) as well as massive tears with chemical denervation (Tenotomy + BTX) at 8 and 16 weeks post-injury. Titin molecular weight, collagen content, and myosin heavy chain profiles were measured and correlated with mechanical variables. Single fiber stiffness was not different between controls and experimental groups. However, fiber bundle stiffness was significantly increased at 8 weeks in the Tenotomy + BTX group compared to Tenotomy or control groups. Many of the changes were resolved by 16 weeks. Only fiber bundle passive mechanics was weakly correlated with collagen content. These data suggest that tendon injury with concomitant neuromuscular compromise results in extra-cellular matrix production and increases in stiffness of the muscle, potentially complicating subsequent attempts for surgical repair. PMID:24838823

Sato, Eugene J; Killian, Megan L; Choi, Anthony J; Lin, Evie; Esparza, Mary C; Galatz, Leesa M; Thomopoulos, Stavros; Ward, Samuel R

2014-09-01

150

Isolation of mesenchymal stem cells from shoulder rotator cuff: a potential source for muscle and tendon repair.  

PubMed

The self-healing potential of each tissue belongs to endogenous stem cells residing in the tissue; however, there are currently no reports mentioned for the isolation of human rotator cuff-derived mesenchymal stem cells (RC-MSCs) since. To isolate RC-MSCs, minced rotator cuff samples were first digested with enzymes and the single cell suspensions were seeded in plastic culture dishes. Twenty-four hours later, nonadherent cells were removed and the adherent cells were further cultured. The RC-MSCs had fibroblast-like morphology and were positive for the putative surface markers of MSCs, such as CD44, CD73, CD90, CD105, and CD166, and negative for the putative markers of hematopoietic cells, such as CD34, CD45, and CD133. Similar to BM-MSCs, RC-MSCs were demonstrated to have the potential to undergo osteogenic, adipogenic, and chondrogenic differentiation. Upon induction in the defined media, RC-MSCs also expressed lineage-specific genes, such as Runx 2 and osteocalcin in osteogenic induction, PPAR-? and LPL in adipogenic differentiation, and aggrecan and Col2a1 in chondrogenic differentiation. The multipotent feature of RC-MSCs in the myogenic injury model was further strengthened by the increase in myogenic potential both in vitro and in vivo when compared with BM-MSCs. These results demonstrate the successful isolation of MSCs from human rotator cuffs and encourage the application of RC-MSCs in myogenic regeneration. PMID:23006509

Tsai, Chih-Chien; Huang, Tung-Fu; Ma, Hsiao-Li; Chiang, En-Rung; Hung, Shih-Chieh

2013-01-01

151

Comparison of the Tendon Damage Caused by Four Different Anchor Systems Used in Transtendon Rotator Cuff Repair  

PubMed Central

Objectives. The objective of this study was to compare the damage to the rotator cuff tendons caused by four different anchor systems. Methods. 20 cadaveric human shoulder joints were used for transtendon insertion of four anchor systems. The Healix Peek, Fastin RC, Bio-Corkscrew Suture, and Healix Transtend anchors were inserted through the tendons using standard transtendon procedures. The areas of tendon damage were measured. Results. The areas of tendon damage (mean?±?standard deviation, n = 7) were 29.1?±?4.3?mm2 for the Healix Peek anchor, 20.4?±?2.3?mm2 for the Fastin RC anchor, 23.4?±?1.2?mm2 for the Bio-Corkscrew Suture anchor, 13.7?±?3.2?mm2 for the Healix Transtend anchor inserted directly, and 9.1 ± 2.1?mm2 for the Healix Transtend anchor inserted through the Percannula system (P < 0.001 or P < 0.001, compared to other anchors). Conclusions. In a cadaver transtendon rotator cuff repair model, smaller anchors caused less damage to the tendon tissues. The Healix Transtend implant system caused the least damage to the tendon tissues. Our findings suggest that smaller anchors should be considered when performing transtendon procedures to repair partial rotator cuff tears. PMID:22811923

Zhang, Qing-Song; Liu, Sen; Zhang, Qiuyang; Xue, Yun; Ge, Dongxia; O'Brien, Michael J.; Savoie, Felix H.; You, Zongbing

2012-01-01

152

Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement  

PubMed Central

Objective The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. Results The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. Conclusion These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients. PMID:20411160

Phadke, V; Camargo, PR; Ludewig, PM

2009-01-01

153

Fascia lata allograft bridging of a rotator cuff tear in a rabbit animal model  

PubMed Central

Purpose: Despite advances in surgical treatment options, large rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. The purpose of this study was to evaluate the temporary and spatial histological incorporation of fascia lata allografts, used for bridging artificially created defects of the r-c. Materials and Methods: Seventy-two rabbits were divided into two groups and a supraspinatus tendinous defect was created. Half of the rabbit population underwent repair only, while in the other half, the defect was bridged utilizing fascia lata allograft. The animals were euthanized at 2, 4, and 6 weeks postoperative. Half of the specimens were evaluated histologically and the other half underwent mechanical testing. Results: There was an increased remodeling activity, fibroblastic in growth and strong presence of collagen fibers observed at 6 weeks on both groups. A gradually increasing mechanical strength was noticed by week 6 and increased toughness was also found at the same time period. There was no significant difference observed between the two groups regarding their histological and mechanical properties. Conclusions: In the difficult scenario of a large irreparable tear where the simple suture of the remaining r-c is impossible, allograft bridging, could be used with satisfactory results. Clinical Relevance: Treatment Study, Level 1. PMID:25114414

Varvitsiotis, Dimitrios; Papaspiliopoulos, Athanasios; Vlachou, Vasiliki; Feroussis, John; Papalois, Apostolos; Papacharalampous, Xenofon; Soucacos, Panayotis N.; Zoubos, Aristides

2014-01-01

154

Comparison of ultrasonic suture welding and traditional knot tying in a rabbit rotator cuff repair model.  

PubMed

The purpose of this study is to evaluate ultrasonic suture welding of monofilament suture in an animal model of rotator cuff repair with biomechanical and histologic analyses. We randomly assigned 46 shoulders in 23 rabbits to 1 of 3 treatment groups: sham-operated (n = 15), knotted (n = 15), and welded (n = 16). Supraspinatus defects were surgically created and acutely repaired with suture anchors loaded with either No. 2-0 Ethibond for knotted group or No. 2-0 nylon for welded shoulders. Eighteen weeks postoperatively, all animals were killed, and the shoulders underwent either biomechanical testing or histologic analysis. The maximum stress of the sham-operated group (20.6 N/mm2) was significantly greater than that of both the knotted (10.2 N/mm2) and welded (8.3 N/mm2) groups (P < .05), but no differences were observed between the knotted and welded groups. Although some histologic changes were noted, none was considered to be significant to distinguish either group. PMID:16979062

Nho, Shane J; Cole, Brian J; Mazzocca, Augustus D; Williams, James M; Romeo, Anthony A; Bush-Joseph, Charles A; Bach, Bernard R; Hallab, Nadim J

2006-01-01

155

Single-detector polarization-sensitive optical coherence tomography for assessment of rotator cuff tendon integrity.  

PubMed

This preliminary study assessed trimmed supraspinatus tendons from rotator cuff repairs (RCRs) to compare the samples' surgically cut ends and torn ends with histopathology and polarization-sensitive optical coherence tomography (PS-OCT) imaging. PS-OCT can be used to assess collagen content and organization in birefringent tissue and shows promise in RCR. The data were compared to determine correlations between luminosity measured from histopathology and PS-OCT. Bivariate plots and a simple regression were performed to assess the linearity of the 2 groups, with a predictive value of less than .05 showing significant correlation. Approximately 50% of the visually inspected supraspinatus tendons acceptable for RCR exhibited collagen depletion when examined by histopathology, compared with PS-OCT. Because a strong correlation in collagen concentrations existed between histopathology and PS-OCT polarized back-reflection intensity, this study established the potential of PS-OCT for clinical use in the assessment of collagen content and organization to improving outcomes in RCR. PMID:22900245

Rashidifard, Christopher; Martin, Scott; Kumar, Namita; Azimi, Ehsan; Liu, Bin; Brezinski, Mark E

2012-08-01

156

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears  

PubMed Central

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success. PMID:19533125

Circi, Esra; Akgun, Rahmi Can; Tarhan, Nefise Cagla; Cetin, Nuri; Akpinar, Sercan; Tuncay, Ismail Cengiz

2009-01-01

157

ProSeal(TM) laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery  

PubMed Central

Background: The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours. Materials and Methods: One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded. Results: The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups. Conclusion: The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide. PMID:23493234

Sharma, Bimla; Gupta, Rajat; Sehgal, Raminder; Koul, Archna; Sood, Jayashree

2013-01-01

158

Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial  

PubMed Central

Background In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia. Methods/design 177 patients (aged 18–90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months. Discussion Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial. Trial registration Netherlands Trial Register (NTR) 3542: http://www.trialregister.nl. PMID:24067111

2013-01-01

159

Comparison of the cheese-wiring effects among three sutures used in rotator cuff repair  

PubMed Central

Purpose: The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. Materials and Methods: Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire® suture (FiberWire®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper. Results: The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord™ and FiberWire® sutures (P = 0.026), but not significant between Orthocord™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire® sutures (P = 0.103). Conclusion: The cheese-wiring effect is less in the Orthocord™ suture than in the FiberWire® suture in human cadaveric supraspinatus tendons. Clinical Relevance: Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection. PMID:25258499

Lambrechts, Mark; Nazari, Behrooz; Dini, Arash; O'Brien, Michael J.; Heard, Wendell M. R.; Savoie, Felix H.; You, Zongbing

2014-01-01

160

Relationship between clinical and surgical findings and reparability of large and massive rotator cuff tears: a longitudinal study  

PubMed Central

Background The literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. The purpose of this study was twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability. Methods This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (arthroscopic complete or partial repair) and were followed up for two years. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (CMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regressions and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student’s T-tests and non-parametric statistics. Results One hundred and twenty two patients (41 women, 81 men, mean age 64, SD?=?9) were included in the analysis. There were 86 large (39 fully reparable, 47 partially reparable) and 36 (10 fully reparable, 26 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p?>?0.05) but the fully reparable tear group showed a better pre-operative ASES score (p?=?0.01) and better active external rotation in neutral (p?=?0.01). Reparability was associated with tear shape (p?

2014-01-01

161

Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder  

Microsoft Academic Search

Objectives  To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint\\u000a with MR arthrography (MR-A) of the shoulder.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions\\u000a (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon\\u000a insertion were depicted. Anatomical locations were

Christoph Schaeffeler; Dirk Mueller; Chlodwig Kirchhoff; Petra Wolf; Ernst J. Rummeny; Klaus Woertler

2011-01-01

162

Initial fixation and cyclic loading stability of knotless suture anchors for rotator cuff repair.  

PubMed

This study evaluated the resistance to gapping and the mode of failure for 2 knotless suture anchor systems used for rotator cuff repair compared with the performance of a conventional titanium anchor system. Eight matched pairs of fresh-frozen humeri were dissected free of all soft tissues and scanned to measure bone mineral density (BMD). The suture anchor systems tested were the TwinFix 5.0 Titanium (Smith & Nephew, Andover, MA), Bioknotless RC (DePuy Mitek, Norwood, MA), and Magnum (Opus Medical, San Juan Capistrano, CA), and each was inserted into each humerus. Cyclic, tensile loading was applied through the suture loop for 5000 cycles, or until failure, by using a servohydraulic testing machine. Gapping distances, defined as increasing elongation of the bone/anchor/suture system, were continuously measured. Total cycles to failure and mechanism of failure were documented. Mean initial (first cycle) and final (last cycle) gapping distances were 3.81 mm and 5.36 mm for the TwinFix 5.0, 4.02 mm and 5.34 mm for the Bioknotless RC, and 3.56 mm and 4.98 mm for the Magnum anchors. No significant difference was detected among mean gap openings (P > .05). However, the Bioknotless RC had more early failures (5) than the other 2 implants (1 each), approaching significance (P = .07). Trials of the Bioknotless RC that did not fail early were found to have significantly less gap opening than the other 2 systems for both initial (1.89 mm vs 3.82 mm for the TwinFix 5.0 and 3.56 mm for the Magnum) and final (2.00 mm vs 4.68 mm for the TwinFix 5.0 and 4.24 mm for the Magnum) gap opening. BMD was a significant predictor of initial (P = .029) and final (P = .008) gap opening, whereas the site of anchor insertion was a significant predictor of final displacement. The Opus Magnum was comparable with a conventional suture anchor, but the Mitek Bioknotless RC showed a trend toward early failure. Biomechanical analysis of knotless suture anchor systems can demonstrate trends among implants in an experimental setting. Knowledge of these trends could influence implant selection. PMID:18036851

Brown, Barrett S; Cooper, Andrew D; McIff, Terence E; Key, Vincent H; Toby, E Bruce

2008-01-01

163

Arthroscopic assisted rotator cuff repair: Results using a mini-open deltoid splitting approach  

Microsoft Academic Search

Out of 78 patients identified who underwent mini-open cuff repair, 64 were interviewed and returned a detailed questionnaire and 47 returned for a physical examination. Their average age was 64 years (31 to 85 years); and the average follow-up was 29.2 months (image, 12 to 65 months). The average tear size was 8 cm2. Preoperatively, all patients complained of pain

Field T. Blevins; Russell F. Warren; Charles Cavo; David W. Altchek; David Dines; George Palletta; Thomas L. Wickiewicz

1996-01-01

164

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears  

Microsoft Academic Search

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and\\u000a isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up,\\u000a 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest\\u000a follow-up was

Huseyin Demirors; Esra Circi; Rahmi Can Akgun; Nefise Cagla Tarhan; Nuri Cetin; Sercan Akpinar; Ismail Cengiz Tuncay

2010-01-01

165

Matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact portion of those tendons  

PubMed Central

Summary We evaluated whether matrix metalloproteases and their inhibitors are involved in extracellular matrix remodelling and degradation of chronic rotator cuff tears. Tendon samples were harvested from 13 patients who underwent arthroscopic repair of a rotator cuff tear. Supraspinatus specimens were harvested en bloc from the arthroscopically intact middle portion of the tendon, more than 1 cm lateral to the torn edge, from the lateral edge of the tear, and from the superior margin of the macroscopically intact subscapularis tendon, used as control. The collagenases, the stromelysins, and the tissue inhibitors of metalloprotease arrays were analyzed blindly by multiplex sandwich ELISA in each specimen. Histological evidence of tendinopathy was present in all patients with a rotator cuff tear, but not in the macroscopically intact subscapularis tendon. There were significantly increased levels of MMP 1, MMP 2, MMP 3, TIMP-1, and TIMP-2 in all specimens examined, including the macroscopically intact portion of the supraspinatus tendon and the subscapularis (control specimens). The levels of specific matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact tendons. These changes extended medially to the site of tendon tear, and to other tendons. PMID:24367772

Castagna, Alessandro; Cesari, Eugenio; Garofalo, Raffaele; Gigante, Antonio; Conti, Marco; Markopoulos, Nikolaos; Maffulli, Nicola

2013-01-01

166

Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study  

PubMed Central

Summary Background: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: study design: A 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10 cm line, arranged horizontally or vertically. The “0” represents no pain and “10” represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year. Conclusions: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients. PMID:25332939

Castillo-Gonzalez, Federico Del; Ramos-Alvarez, Juan Jose; Rodriguez-Fabian, Guillermo; Gonzalez-Perez, Jose; Calderon-Montero, Javier

2014-01-01

167

The modified massive cuff stitch: functional and structural outcome in massive cuff tears  

PubMed Central

Background The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture. Methods We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analog scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least 1 year post-operatively using Sugaya's classification. Results The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296). Conclusions The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate. PMID:23924298

2013-01-01

168

Knotless anatomic double-layer double-row rotator cuff repair: a novel technique re-establishing footprint and shape of full-thickness tears  

Microsoft Academic Search

The standard technique for restoring footprint after full-thickness tears of the rotator cuff includes double-row or transosseous-equivalent\\u000a techniques. However, the anatomically typical bird’s beak shape and profile of tendon insertion may not be originally restored\\u000a and biomechanics may be altered. In this report, the authors describe a technique that involves creating two intratendinous\\u000a stitches at different levels of the torn

Pierre Hepp; Thomas Engel; Georg Osterhoff; Bastian Marquass; Christoph Josten

2009-01-01

169

Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up  

Microsoft Academic Search

Background  Many surgical procedures have been reported for rotator cuff tears. We adopted the modified transosseous-equivalent procedure,\\u000a also termed “surface-holding repair with transosseous sutures,” and demonstrated that this procedure has a biomechanical advantage\\u000a regarding the concentration of stress on the tendon stump. This study aimed to evaluate the clinical and structural outcomes\\u000a of this technique, which has been demonstrated by postoperative

Hiroshi Yamaguchi; Naoki Suenaga; Naomi Oizumi; Yoshihiro Hosokawa; Fuminori Kanaya

170

Outcome and Structural Integrity After Arthroscopic Rotator Cuff Repair Using 2 Rows of FixationMinimum 2Year Follow-Up  

Microsoft Academic Search

Background: Although arthroscopic repairs of the rotator cuff are becoming increasingly popular, security of fixation remains a concern. Two-row repairs have been described, but clinical outcome reports have primarily involved open techniques.Hypothesis: An arthroscopic repair technique that uses 2 rows of fixation produces satisfactory outcome and structural integrity by ultrasonography.Study Design: Case series; Level of evidence, 4.Methods: Forty-eight patients (52

Kyle Anderson; Michael Boothby; Daniel Aschenbrener; Marnix Van Holsbeeck

2006-01-01

171

Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: A protocol for a randomised, double-blind, placebo-controlled trial  

Microsoft Academic Search

BACKGROUND: Chronic rotator cuff pathology (CRCP) is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there is little conclusive evidence to support or refute its effectiveness and no formal evaluation of its cost-effectiveness. METHODS\\/DESIGN: This randomised, double-blind, placebo-controlled trial will involve 200 participants with CRCP recruited from medical practices,

Kim Bennell; Sally Coburn; Elin Wee; Sally Green; Anthony Harris; Andrew Forbes; Rachelle Buchbinder

2007-01-01

172

Evaluation of the rotator cuff and glenoid labrum using a 0.2-Tesla extremity magnetic resonance (MR) system: MR results compared to surgical findings.  

PubMed

The purpose of this investigation was to evaluate the diagnostic capabilities of magnetic resonance imaging (MRI) performed using a dedicated-extremity MR system in detecting lesions of the rotator cuff and glenoid labrum. This retrospective study compared the MR results obtained in 47 patients that underwent MRI using a 0.2-Tesla extremity MR system (E-scan) to the surgical findings. MR images of the shoulder were obtained as follows: shoulder coil, T1-weighted, coronal-oblique and axial images; short Tau inversion recovery (STIR), coronal-oblique images; and T2-weighted, coronal-oblique, sagittal-oblique, and axial images. The MR examinations were interpreted by three highly experienced, musculoskeletal radiologists. Open surgical (N = 26) or arthroscopic (N = 21) procedures were performed within a mean time of 33 days after MRI. The surgical findings revealed rotator cuff tears in 28 patients and labral lesions in 9 patients. For the rotator cuff tears, the sensitivity, specificity, positive predictive value, and negative predictive value were 89%, 100%, 100%, and 90%, respectively. For the labral lesions, the sensitivity, specificity, positive predictive value, and negative predictive value were 89%, 95%, 80%, and 97%, respectively. The findings indicated that there was good agreement comparing the MR results obtained using the low-field extremity MR system to the surgical findings for determination of lesions of the rotator cuff and glenoid labrum. Notably, the statistical values determined for the use of this MR system were comparable to those reported in the peer-reviewed literature for the use of whole-body, mid- and high-field-strength MR systems. PMID:11747034

Shellock, F G; Bert, J M; Fritts, H M; Gundry, C R; Easton, R; Crues, J V

2001-12-01

173

Ultrasound-Guided Myofascial Trigger Point Injection Into Brachialis Muscle for Rotator Cuff Disease Patients With Upper Arm Pain: A Pilot Study  

PubMed Central

Objective To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain. Methods A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). Results US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (?VAS=-2.8) was significantly larger than caused by oral NSAID (?VAS=-1.5) (p<0.05). Conclusion In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle. PMID:25379497

Suh, Mi Ri; Chang, Won Hyuk; Choi, Hyo Seon

2014-01-01

174

Are Platelet-Rich Products Necessary during the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears: A Meta-Analysis  

PubMed Central

Background Platelet-rich products (PRP) are widely used for rotator cuff tears. However, whether platelet-rich products produce superior clinical or radiological outcomes is controversial. This study aims to use meta-analysis to compare clinical and radiological outcomes between groups with or without platelet-rich products. Methods The Pubmed, Embase, and Cochrane library databases were searched for relevant studies published before April 20, 2013. Studies were selected that clearly reported a comparison between the use or not of platelet-rich products. The Constant, ASES, UCLA, and SST scale systems and the rotator cuff retear rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed-effects model. Results Seven studies were enrolled in this meta-analysis. No significant differences were found for the Constant scale (0.73, 95% CI, ?1.82 to 3.27, P?=?0.58), ASES scale (?2.89, 95% CI, ?6.31 to 0.53, P?=?0.1), UCLA scale (?0.79, 95% CI, ?2.20 to 0.63, P?=?0.28), SST scale (0.34, 95% CI, ?0.01 to 0.69, P?=?0.05), and the overall rotator cuff retear rate (0.71, 95% CI, 0.48 to 1.05, P?=?0.08). Subgroup analysis according to the initial tear size showed a lower retear rate in small- and medium-sized tears (0.33, 95% CI, 0.12 to 0.91, P?=?0.03) after platelet-rich product application but no difference for large- and massive-sized tears (0.86, 95% CI, 0.60 to 1.23, P?=?0.42). Conclusion In conclusion, the meta-analysis suggests that the platelet-rich products have no benefits on the overall clinical outcomes and retear rate for the arthroscopic repair of full-thickness rotator cuff tears. However, a decrease occurred in the rate of retears among patients treated with PRP for small- and medium-sized rotator cuff tears but not for large- and massive-sized tears. Level of Evidence Level II PMID:23874991

Zhang, Qiang; Ge, Heng'an; Zhou, Jiaojiao; Cheng, Biao

2013-01-01

175

Bilateral spontaneous tenodesis of the long head of the biceps at the bicipital groove with massive rotator cuff tear on a 103-year-old female cadaver: the natural evolution of the human shoulder?  

Microsoft Academic Search

During a dissection on a 103-year-old female cadaver, a bilateral spontaneous tenodesis of the long head of the biceps (LHB)\\u000a with massive rotator cuff tear was discovered at the bicipital groove. Neer et al. have introduced the term of cuff-tear arthropathy\\u000a to define severe disorganization of the glenohumeral joint with collapse of the humeral head that occurs following some massive

A.-P. Uzel; R. Bertino; P. Boileau

2011-01-01

176

Vaginal cuff dehiscence: Risk factors and management  

PubMed Central

Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable and there is no consensus on how to manage this complication. In our review, we present a summary of the risk factors, presenting symptoms, precipitating events, and management options for patients who present with vaginal cuff dehiscence after pelvic surgery. In addition, we provide a review of the current literature on this important surgical outcome and suggestions for future research on the incidence and prevention of vaginal cuff dehiscence. PMID:21974989

Cronin, Beth; Sung, Vivian W.; Matteson, Kristen A.

2011-01-01

177

A survey of surgical rotations for oral & maxillofacial surgery trainees.  

PubMed

Seventy oral and maxillofacial surgery departments were sent questionnaires to determine whether they made provision for their medically qualified registrars to undergo 1 year's surgical training in recognition for the Part II FRCS oral and maxillofacial surgery option of the Royal College of Surgeons of Edinburgh. Fifty-six (80%) replies were received revealing that 11 (19.6%) departments had existing arrangements for a surgical rotation while 14 (25%) had plans to implement one. These results are further reported. PMID:2920159

Altman, K

1989-02-01

178

Rotator Cuff Exercises  

MedlinePLUS

... Hint: This is like the backhand swing in tennis.) Lower the arm slowly. Repeat the exercise until ... Hint: This is like the forehand swing in tennis.) Lower the forearm slowly. Repeat the exercise until ...

179

Rotator Cuff Injuries  

MedlinePLUS Videos and Cool Tools

... joins the upper body to the arm. The bones included in the shoulder joint are the following: Humerus Scapula • the scapula, or shoulder blade bone • the humerus, or upper arm bone The shoulder ...

180

Is a Mandatory General Surgery Rotation Necessary in the Surgical Clerkship?  

Microsoft Academic Search

Background: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question.Methods: We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were

Dan Poenaru; Lindsay Davidson; Michael Donnely

1998-01-01

181

Program directors' views on general surgery resident travel for transplant rotations  

Microsoft Academic Search

BackgroundSome program directors in surgery (PDs) must maintain transplant rotations at nonintegrated (away) hospitals. This study investigated the opinions of PDs related to resident travel for transplant surgery experience.

James G. Bittner; Jonathan P. Fryer; Joseph B. Cofer; John D. Mellinger; James J. Wynn; George M. Fuhrman; Karen R. Borman

2011-01-01

182

Imaging of the shoulder after surgery  

Microsoft Academic Search

Postoperative imaging of the shoulder is challenging. This article reviews the radiologic evaluation following surgery for subacromial impingment, rotator cuff lesions and glenohumeral instability, including the common surgical procedures, the expected postoperative findings and potential complications. A specific emphasis is made on magnetic resonance imaging.

Drew McMenamin; George Koulouris; William B. Morrison

2008-01-01

183

Tissue characteristics in tendon-to-bone healing change after rotator cuff repair using botulinumneurotoxin A for temporary paralysis of the supraspinatus muscle in rats.  

PubMed

We hypothesized that botulinumneurotoxin A (BoNtA) positively influences tissue characteristics at the re-insertion site when used as an adjuvant prior to rotator cuff repair. One hundred and sixty Sprague-Dawley rats were randomly assigned to either a BoNtA or saline-injected control group. BoNtA or saline solution was injected into the supraspinatus muscle one week prior to repair of an artificially created supraspinatus tendon defect. Post-operatively, one subgroup was immobilized using a cast on the operated shoulder while the other had immediate mobilization. Histologically, the fibrocartilage transition zone was more prominent and better organized in the BoNtA groups when compared to the saline control group. In the immediately mobilized BoNtA groups significantly more collagen 2 at the insertion was detected than in the control groups (p<0.05). Fiber orientation of all BoNtA groups was better organized and more perpendicular to the epiphysis compared with control groups. Tendon stiffness differed significantly (p<0.05) between casted BoNtA and casted saline groups. Tendon viscoelasticity was significantly higher (p<0.05) in the immobilized saline groups no matter if repaired with increased or normal repair load. The results of this study suggest that reduction of load at the healing tendon-to-bone interface leads to improved repair tissue properties. PMID:24409812

Ficklscherer, A; Scharf, M; Hartl, T K; Schröder, C; Milz, S; Roßbach, B P; Gülecyüz, M F; Pietschmann, M F; Müller, P E

2014-04-01

184

Full thickness tears: retaining the cuff.  

PubMed

Repair of rotator cuff tears is technically challenging. Full thickness rotator cuff tears have no potential for spontaneous healing, no reliable tendons substitutes are available, and their management is only partially understood. Many factors seem to contribute to the final outcome, and considerable variations in the decision-making process exist. For these reasons, decisions are often taken on the basis of surgeon's clinical experience. Accurate and prompt diagnosis is fundamental to guide correct management, and the tear pattern should be carefully evaluated to planning the most appropriate repair. PMID:22089291

Osti, Leonardo; Rizzello, Giacomo; Panascì, Manlio; Denaro, Vincenzo; Maffulli, Nicola

2011-12-01

185

Regional Medical Center (The MED) Plastic Surgery Rotation  

E-print Network

to perform the following plastic surgery procedures including but not limited to: � Skin grafting and flap closure of soft tissue defects of the upper extremity � Specific grafting techniques including the operation of various types of dermatomes, management of graft donor sites, and care of graft recipient sites

Cui, Yan

186

Veteran's Administration Medical Center General Plastic Surgery Rotation  

E-print Network

Biannually With assistance from faculty, refine skills to perform the following plastic surgery procedures Biannually #12;� Skin grafting and flap closure of soft tissue defects of the upper extremity � Specific grafting techniques including the operation of various types of dermatomes, management of graft donor sites

Cui, Yan

187

The two-week pediatric surgery rotation: is it time wasted?  

Microsoft Academic Search

BackgroundWith increasing medical school emphasis on generalist training and decreasing enrollment in surgical residency, the authors assessed the adequacy of a 2-week pediatric surgery rotation on meeting the learning and competency objectives outlined in The Canadian Association of Pediatric Surgeons’ Self-Directed Evaluation Tool.

S Dutta; P. W Wales; A Fecteau

2004-01-01

188

Severed cuff inflation tubing of endotracheal tube: A novel way to prevent cuff deflation  

PubMed Central

A well-secured endotracheal tube (ETT) is essential for safe anesthesia. The ETT has to be fixed with the adhesive plasters or with tie along with adhesive plasters appropriately. It is specially required in patients having beard, in intensive care unit (ICU) patients or in oral surgeries. If re-adjustment of the ETT is necessary, we should be cautious while removal of the plasters and tie, as there may be damage to the cuff inflation system. This can be a rare cause of ETT cuff leak, thus making maintenance of adequate ventilation difficult and requiring re-intubation. In a difficult airway scenario, it can be extremely challenging to re-intubate again. We report an incidence where the ETT cuff tubing was severed while attempting to re-adjust and re-fix the ETT and the patient required re-intubation. Retrospectively, we thought of and describe a safe, reliable and novel technique to prevent cuff deflation of the severed inflation tube. The technique can also be used to monitor cuff pressure in such scenarios.

Rao, Amrut K.; Chaudhuri, Souvik; Joseph, Tim T.; Kamble, Deependra; Gotur, Gopal; Venkatesh, Sandeep

2014-01-01

189

Efficacy of various analgesics on shoulder function and rotator cuff tendon-to-bone healing in a rat (Rattus norvegicus) model.  

PubMed

Although relief of postoperative pain is an imperative aspect of animal welfare, analgesics that do not interfere with the scientific goals of the study must be used. Here we compared the efficacy of different analgesic agents by using an established rat model of supraspinatus tendon healing and a novel gait-analysis system. We hypothesized that different analgesic agents would all provide pain relief in this model but would cause differences in tendon-to-bone healing and gait parameters. Buprenorphine, ibuprofen, tramadol-gabapentin, and acetaminophen were compared with a no-analgesia control group. Gait measures (stride length and vertical force) on the operative forelimb differed between the control group and both the buprenorphine (2 and 4 d postsurgery) and ibuprofen (2 d postsurgery) groups. Step length was different in the control group as compared with the tramadol-gabapentin (2 d after surgery), buprenorphine (2 and 4 d after surgery), and ibuprofen (2 d after surgery) groups. Regarding tendon-to-bone healing, the ibuprofen group showed less stiffness at the insertion site; no other differences in tendon-to-bone healing were detected. In summary, the analgesics evaluated were associated with differences in both animal gait and tendon-to-bone healing. This information will be useful for improving the management of postsurgical pain without adversely affecting tissue healing. Given its ability to improve gait without impeding healing, we recommend use of buprenorphine for postsurgical pain management in rats. In addition, our gait-analysis system can be used to evaluate new analgesics. PMID:24602546

Caro, Adam C; Tucker, Jennica J; Yannascoli, Sarah M; Dunkman, Andrew A; Thomas, Stephen J; Soslowsky, Louis J

2014-03-01

190

Special report: Occlusive cuff controller  

NASA Technical Reports Server (NTRS)

A mechanical occlusive cuff controller suitable for blood flow experiments in space shuttle flights is described. The device requires 115 volt ac power and a pressurized gas source. Two occluding cuff pressures (30 and 50 mmHg) are selectable by a switch on the front panel. A screw driver adjustment allows accurate cuff pressurization levels for under or oversized limbs. Two pressurization cycles (20 second and 2 minutes) can be selected by a front panel switch. Adjustment of the timing cycles is also available through the front panel. A pushbutton hand switch allows remote start of the cuff inflation cycle. A stop/reset switch permits early termination of the cycle and disabling of the controller to prevent inadvertent reactivation. Pressure in the cuff is monitored by a differential aneroid barometer. In addition, an electrocardiogram trigger circuit permits the initiation of the pressurization cycle by an externally supplied ECG cycle.

Baker, J. T.

1975-01-01

191

Shoulder surgery - discharge  

MedlinePLUS

... chap 52. Matsen III FA, Fehringer EV, Lippitt SB, Wirth MA, Rockwood Jr. CA. Rotator cuff. In: ... CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder . 4th ed. Philadelphia, Pa: Saunders ...

192

Effects of magnesium sulphate on coagulation after laparoscopic colorectal cancer surgery, measured by rotational thromboelastometry (ROTEM(®) ).  

PubMed

We investigated the effects of magnesium sulphate on blood coagulation profiles using rotational thromboelastometry in patients undergoing laparoscopic colorectal cancer surgery. Patients were randomly allocated to the magnesium group (n = 22) or control group (n = 22). The magnesium group received intravenous magnesium sulphate (50 mg.kg(-1) followed by a continuous infusion of 15 mg.kg(-1) .h(-1) ), whereas the control group received the same volume of isotonic saline. Mean (SD) postoperative serum magnesium levels were 1.60 (0.13) mmol.l(-1) in the magnesium group compared with 0.98 (0.06) mmol.l(-1) in the control group (p < 0.001). All maximum clot firmness values of ROTEM analysis were significantly lower on the third postoperative day in the magnesium group compared with the control group (p < 0.05). We conclude that ROTEM analysis demonstrated that intra-operative administration of intravenous magnesium sulphate reduces blood hypercoagulability in patients undergoing laparoscopic colorectal cancer surgery. PMID:25132158

Na, H S; Shin, H J; Kang, S B; Hwang, J W; Do, S H

2014-12-01

193

Isokinetic rotator muscles fatigue in glenohumeral joint instability before and after Latarjet surgery: a pilot prospective study.  

PubMed

We aimed to analyze the changes in isokinetic internal (IR) and external (ER) rotator muscles fatigue (a) in patients with non-operated recurrent anterior instability, and (b) before and after shoulder surgical stabilization with the Bristow-Latarjet procedure. Thirty-seven patients with non-operated unilateral recurrent anterior post-traumatic instability (NG) were compared with 12 healthy subjects [control group (CG)]. Twenty patients with operated recurrent anterior instability group (OG) underwent isokinetic evaluation before and 3, 6, and 21 months after Bristow-Latarjet surgery. IR and ER muscles strength was evaluated with Con-Trex® dynamometer, with subjects seated and at a 45° shoulder abduction angle in scapular plane. IR and ER muscle fatigue was determined after 10 concentric repetitions at 180° · s(-1) through the fatigue index, the percent decrease in performance (DP), and the slope of peak torque decrease. There were no differences in rotator muscles fatigue between NG and CG. In OG, 3 months post-surgery, IR DP of operated shoulder was significantly (P < 0.001) higher than presurgery and 6 and 21 months post-surgery. Rotator muscles fatigability was not associated with recurrent anterior instability. After surgical stabilization, there was a significantly higher IR fatigability in the operated shoulder 3 months post-surgery, followed by recovery evidenced 6 months post-surgery and long-term maintenance over 21 months. PMID:23116174

Edouard, P; Bankolé, C; Calmels, P; Beguin, L; Degache, F

2013-03-01

194

Rotator Cuff Tears: Surgical Treatment Options  

MedlinePLUS

... shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to ... referenced herein. This information is provided as an educational service and is not intended to serve as ...

195

Surgery  

MedlinePLUS

... for ENews Home > Lung Disease > COPD > Treating COPD Surgery Some COPD patients with very severe symptoms may ... lung surgery. Are You a Candidate for Lung Surgery? Some people with COPD have improved lung function ...

196

Joint congruency in abduction before surgery as an indication for rotational acetabular osteotomy in early hip osteoarthritis  

Microsoft Academic Search

We conducted a retrospective review of the results of rotational acetabular osteotomy (RAO) procedures in 92 hips of 89 patients\\u000a (81 females and eight males) with early-stage osteoarthritis. In this study, we discuss the indications for this surgery based\\u000a on the preoperative congruency in abduction. The mean postoperative follow-up was 12.2 (7–19) years. The mean age at operation\\u000a was 32.5

Kunihiko Okano; Kenji Yamada; Katsuro Takahashi; Hiroshi Enomoto; Makoto Osaki; Hiroyuki Shindo

2010-01-01

197

Rotational Strength and Flexibility of the Knee Following Pes Anserinus Transplant Surgery.  

ERIC Educational Resources Information Center

Results of this study indicate that there is no significant difference in degrees of rotation or rotational strength of the knee joint between surgical and nonsurgical limbs of rehabilitated subjects. (MM)

Blanke, Daniel J.

1978-01-01

198

Two cases of post-coital vaginal cuff dehiscence with small bowel evisceration after robotic-assisted laparoscopic hysterectomy  

PubMed Central

INTRODUCTION Vaginal cuff dehiscence following robotic surgery is uncommon. Published reports of vaginal cuff dehiscence following robotic surgery are increasing, but the true incidence is unknown. PRESENTATION OF CASE Case 1. A 45 year old female had sexual intercourse and presented with a vaginal cuff dehiscence complicated by small bowel evisceration 4 months after RA-TLH. Case 2. A 44 year old female had sexual intercourse and presented with a vaginal cuff dehiscence with small bowel evisceration 6 weeks after RA-TLH. DISCUSSION We discuss the rate of vaginal cuff dehiscence by mode of hysterectomy, surgical and non-surgical risk factors that may contribute to vaginal cuff dehiscence, and proposed preventative methods at the time of RA-TLH to reduce this complication. CONCLUSION Vaginal cuff dehiscence with associated evisceration of intraabdominal contents is a potentially severe complication of hysterectomy. We recommend counseling patients who undergo RA-TLH to abstain from vaginal intercourse for a minimum of 8–12 weeks. PMID:23708306

Nguyen, My-Linh T.; Kapoor, Monica; Pradhan, Tana S.; Pua, Tarah L.; Tedjarati, Sean S.

2013-01-01

199

Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States  

PubMed Central

Background Musculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. The objective of our study was to assess the overall and age-adjusted utilization rates of rotator cuff repair, shoulder arthroscopy performed for indications other than rotator cuff repair, carpal tunnel release, and wrist arthroscopy performed for indications other than carpal tunnel release in the United States. We also compared demographics, indications, and operating room time for these procedures. Methods We used the 2006 National Survey of Ambulatory Surgery to estimate the number of procedures of interest performed in the United States in 2006. We combined these data with population size estimates from the 2006 U.S. Census Bureau to calculate rates per 10,000 persons. Results An estimated 272,148 (95% confidence intervals (CI)?=?218,994, 325,302) rotator cuff repairs, 257,541 (95% CI?=?185,268, 329,814) shoulder arthroscopies excluding those for cuff repairs, 576,924 (95% CI?=?459,239, 694,609) carpal tunnel releases, and 25,250 (95% CI?=?17,304, 33,196) wrist arthroscopies excluding those for carpal tunnel release were performed. Overall, carpal tunnel release had the highest utilization rate (37.3 per 10,000 persons in persons of age 45–64 years; 38.7 per 10,000 persons in 65–74 year olds, and; 44.2 per 10,000 persons in the age-group 75 years and older). Among those undergoing rotator cuff repairs, those in the age-group 65–74 had the highest utilization (28.3 per 10,000 persons). The most common indications for non-cuff repair related shoulder arthroscopy were impingement syndrome, periarthritis, bursitis, and instability/SLAP tears. Non-carpal tunnel release related wrist arthroscopy was most commonly performed for ligament sprains and diagnostic arthroscopies for pain and articular cartilage disorders. Conclusions Our data shows substantial age and demographic differences in the utilization of these commonly performed upper extremity ambulatory procedures. While over one million upper extremity procedures of interest were performed, evidence-based clinical indications for these procedures remain poorly defined. PMID:24397703

2014-01-01

200

Identification of communication apprehension in medical students starting a surgery rotation  

Microsoft Academic Search

Background: Most methods used to critically evaluate young surgeons for advancement or certification in surgery require oral communication skills, eg, case and research presentations, rounds, morbidity and mortality conferences, interviews, journal clubs and oral examinations. The irony, though, is that much of surgery training focuses on technical skill lists, and the rhetorical aspects are often neglected until the surgeon encounters

Nicholas P Lang; Pamela A Rowland-Morin; Nicholas P. W Coe

1998-01-01

201

Surgery  

MedlinePLUS

... a symptom of a problem or improve some body function. Some surgeries are done to find a problem. For example, ... that once needed large incisions (cuts in the body) can now be done using much smaller cuts. This is called laparoscopic surgery. Surgeons insert a thin tube with a camera ...

202

Stimulation Stability and Selectivity of Chronically Implanted Multicontact Nerve Cuff Electrodes in the Human Upper Extremity  

PubMed Central

Nine spiral nerve cuff electrodes were implanted in two human subjects for up to three years with no adverse functional effects. The objective of this study was to look at the long term nerve and muscle response to stimulation through nerve cuff electrodes. The nerve conduction velocity remained within the clinically accepted range for the entire testing period. The stimulation thresholds stabilized after approximately 20 weeks. The variability in the activation over time was not different from muscle-based electrodes used in implanted functional electrical stimulation systems. Three electrodes had multiple, independent contacts to evaluate selective recruitment of muscles. A single muscle could be selectively activated from each electrode using single-contact stimulation and the selectivity was increased with the use of field steering techniques. The selectivity after three years was consistent with selectivity measured during the implant surgery. Nerve cuff electrodes are effective for chronic muscle activation and multichannel functional electrical stimulation in humans. PMID:19775987

Polasek, Katharine H.; Hoyen, Harry A.; Keith, Michael W.; Kirsch, Robert F.; Tyler, Dustin J.

2010-01-01

203

Effects of Electrosurgery and Vaginal Closure Technique on Postoperative Vaginal Cuff Dehiscence  

PubMed Central

Background and Objectives: The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence. Methods: From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure—laparoscopically in the TLH group and vaginally in the LAVH group. Results: Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02). Conclusion: It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique. PMID:24018078

Kesterson, Joshua; Davies, Matthew; Green, Janis; Penezic, Lindsey; Vargas, Roberto; Harkins, Gerald

2013-01-01

204

Competency-Based Student Self-Assessment on a Surgery Rotation  

Microsoft Academic Search

Background. Although self-assessment is an essential component of self-directed adult learning, few data exist regarding the ability of medical students to perform this important task. Therefore, the purpose of this study was to evaluate the ability of medical students to perform self-assessment during a third-year surgery clerkship.Methods. Sixty-eight (34 male, 34 female) third-year medical students assessed their progress at the

D. Scott Lind; Stelios Rekkas; V. Bui; T. Lam; E. Beierle; E. M. Copeland

2002-01-01

205

External rotator sparing with posterior acetabular fracture surgery: does it change outcome?  

PubMed

This study analyses the results of the treatment with external rotator sparing approach in acetabular fractures to determine whether muscle sparing has a positive impact on functional outcome. 20 patients with a mean age of 45.9 years (range: 26-64) that had been treated for displaced acetabular fractures were included in this series. Short Musculoskeletal Function Assessment (SMFA) questionnaire and hip muscle strength measurement were done at the 24-month of follow-up period. The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta. The average SMFA score for all of the patients was 18.3 (range: 0-55.4). The mean dysfunctional and bother indexes were 17.2 and 20.6, respectively. The overall muscle strength deficit was 11.8%. The greatest loss of strength was in internal rotation. In patients with better postoperative reduction quality of acetabular fracture, peak torque, and maximum work of hip flexion, extension and also internal rotation maximum work deficit were significantly lower (P < 0.05). Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures. PMID:25110590

Ceylan, Halil; Selek, Ozgur; Inanir, Murat; Yonga, Omer; Odabas Ozgur, Bahar; Sarlak, Ahmet Y

2014-01-01

206

Anatomical knowledge retention in third-year medical students prior to obstetrics and gynecology and surgery rotations.  

PubMed

Surgical anatomy is taught early in medical school training. The literature shows that many physicians, especially surgical specialists, think that anatomical knowledge of medical students is inadequate and nesting of anatomical sciences later in the clinical curriculum may be necessary. Quantitative data concerning this perception of an anatomical knowledge deficit are lacking, as are specifics as to what content should be reinforced. This study identifies baseline areas of strength and weakness in the surgical anatomy knowledge of medical students entering surgical rotations. Third-year medical students completed a 20-25-question test at the beginning of the General Surgery and Obstetrics and Gynecology rotations. Knowledge of inguinal anatomy (45.3%), orientation in abdominal cavity (38.8%), colon (27.7%), and esophageal varices (12.8%) was poor. The numbers in parentheses are the percentage of questions answered correctly per topic. In comparing those scores to matched test items from this cohort as first-year students in the anatomy course, the drop in retention overall was very significant (P?=?0.009) from 86.9 to 51.5%. Students also scored lower in questions relating to pelvic organs (46.7%), urogenital development (54.0%), pulmonary development (17.8%), and pregnancy (17.8%). These data showed that indeed, knowledge of surgical anatomy is poor for medical students entering surgical clerkships. These data collected will be utilized to create interactive learning modules, aimed at improving clinically relevant anatomical knowledge retention. These modules, which will be available to students during their inpatient surgical rotations, connect basic anatomy principles to clinical cases, with the ultimate goal of closing the anatomical knowledge gap. Anat Sci Educ 7: 461-468. © 2014 American Association of Anatomists. PMID:24591485

Jurjus, Rosalyn A; Lee, Juliet; Ahle, Samantha; Brown, Kirsten M; Butera, Gisela; Goldman, Ellen F; Krapf, Jill M

2014-11-12

207

The influence of computer-assisted surgery on rotational, coronal and sagittal alignment in revision total knee arthroplasty  

PubMed Central

Background Despite good results of primary total knee arthroplasty (TKA), the number of revision total knee arthroplasties (rTKAs) is rising. Proper implant position is essential, since malposition leads to worse clinical outcome. In rTKA most anatomical landmarks have disappeared because of extensive bone loss, making it more difficult to adequately implant the knee prosthesis. In primary TKA, computer-assisted surgery (CAS) leads to better prosthetic alignment than mechanical navigation guides. Literature about the use of CAS in rTKA is scarce though, and the effect on rotational prosthetic alignment has not been investigated yet. Hence the primary objective of this study is to compare rotational prosthetic alignment when using CAS in rTKA compared to a mechanical navigation guide. Secondary objectives are to compare prosthetic alignment in the coronal and sagittal planes. It is hypothesized that CAS leads to better rotational, coronal and sagittal prosthetic alignment when used during rTKA. Methods/Design A prospective clinical intervention study with use of a historical control group will be conducted. Forty-four patients with a minimum age of 18 to be admitted for CAS-rTKA between September 2012 and September 2015 will be included in the intervention group. Forty-four patients with a minimum age of 18 who underwent rTKA with the use of a mechanical navigation guide between January 2002 and April 2012 will form the historical control group. Both groups will be matched according to gender and type of revision prosthesis. Rotational prosthesis alignment will be evaluated using a CT-scan of the knee joint. Discussion Proper implant position is essential, since malposition leads to worse clinical outcome. Several studies show a significantly positive influence of CAS on prosthetic alignment in primary TKA, but literature about the use of CAS in rTKA is limited. The purpose of this study is thus to investigate the influence of CAS during rTKA on postoperative prosthetic alignment, compared to mechanical navigation guides. Trial registration Netherlands National Trial Register NTR3512 PMID:24646028

2014-01-01

208

Prehospital endotracheal intubation; need for routine cuff pressure measurement?  

PubMed

In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulnerable group of patients. We reviewed cuff pressures after intubation by Helicopter Emergency Medical Services and paramedics noted in a dispatch database. Initial cuff pressures are almost all too high, needing adjustment to be in the safe zone. Dutch paramedics lack manometers and, therefore, only few paramedic intubations are followed by cuff pressure measurements. We recommend cuff pressure measurements after all (prehospital) intubations and, therefore, all ambulances need to be equipped with cuff manometers. PMID:23100319

Peters, Joost H; Hoogerwerf, Nico

2013-10-01

209

Polyimide cuff electrodes for peripheral nerve stimulation.  

PubMed

This paper describes a new tripolar spiral cuff electrode, composed of a thin (10 microm) and flexible polyimide insulating carrier and three circumneural platinum electrodes, suitable for stimulation of peripheral nerves. The cuffs were implanted around the sciatic nerve of two groups of ten rats each, one in which the polyimide ribbon was attached to a plastic connector to characterize the in vivo stimulating properties of the electrode, and one without a connector for testing possible mechanical nerve damage by means of functional and histological methods. The polyimide cuff electrodes induced only a very mild foreign body reaction and did not change the nerve shape over a 2-6 month implantation period. There were no changes in the motor and sensory nerve conduction tests, nociceptive responses and walking track pattern over follow-up, and no morphological evidence of axonal loss or demyelination, except in one case with partial demyelination of some large fibers after 6 months. By delivering single electrical pulses through the cuff electrodes graded recruitment curves of alpha-motor nerve fibers were obtained. Recruitment of all motor units was achieved with a mean charge density lower than 4 microC/cm(2) for a pulse width of 50 micros at the time of implantation as well as 45 days thereafter. These data indicate that the polyimide cuff electrode is a stable stimulating device, with physical properties and dimensions that avoid nerve compression or activity-induced axonal damage. PMID:10880824

Rodríguez, F J; Ceballos, D; Schüttler, M; Valero, A; Valderrama, E; Stieglitz, T; Navarro, X

2000-06-01

210

Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study  

Microsoft Academic Search

SUMMARY The aim of this preliminary, prospective, randomized study was to compare rotation thromboelastography (roTEG) results and D-dimer levels in off-pump versus on-pump coronary surgery in order to identify the activation of fibrinolysis. Twenty patients scheduled for coronary bypass grafting were assessed (off-pump group A, n = 10; on-pump group B, n = 10). Blood samples for roTEG examination were

Martin JARES; Tomas VANEK; Frantisek BEDNAR; Marek MALY; Jana SNIRCOVA; Zbynek STRAKA

211

Measuring tracheal tube cuff pressures--tool and technique.  

PubMed

A three-part study identified factors essential to accurate determination of pressure exerted against the lateral wall of the trachea by three types of endotracheal tube cuffs. Part I compared 31 mercury sphygmomanometer measurements of tracheal cuff pressures to those of pressure-sensitive aneroid Portex manometer during simulated intubation and found 99.28% of mercury manometer readings accurate to within 2 mm Hg of Portex readings. Part II demonstrated that cuff compliance (i.e., the distensibility of the cuff material) influences such pressure determinations. Part III compared two methods of obtaining tracheal cuff pressure readings with the mercury sphygmomanometer during simulated intubation. Accurate measurement was made only with a stopcock system that simultaneously opened to the cuff, the manometer, and the inflator syringe and when a separate cuff distensibility factor was used in the computation. PMID:6909196

Bouvier, J R

1981-01-01

212

Required Rotations 1. Emergency Rotation. Each resident has a 52 week rotation approximate (8 hours per week  

E-print Network

problems. 2. Oral Surgery Rotation at EDC. Each resident has a 3 month rotation (8 hours per week) in Oral Surgery focusing on surgical removal of third molars (rotation can be extended). ResidentsROTATIONS Required Rotations 1. Emergency Rotation. Each resident has a 52 week rotation

Goldman, Steven A.

213

Cuff deflation: rehabilitation in critical care.  

PubMed

This is a case series of rehabilitation failures that resulted in severe reactive depression from patients unnecessarily bereft of verbal communication by being left to breathe or be ventilated via tracheostomy tubes, with or without inflated cuffs, for months to years. PMID:24879555

Bach, John R; Gonçalves, Miguel R; Rodriguez, Pedro Landete; Saporito, Louis; Soares, Luisa

2014-08-01

214

Control device for prosthetic urinary sphincter cuff  

NASA Technical Reports Server (NTRS)

A device for controlling flow of fluid to and from a resilient inflatable cuff implanted about the urethra to control flow of urine therethrough. The device comprises a flexible bulb reservoir and a control unit that includes a manually operated valve that opens automatically when the bulb is squeezed to force fluid into the cuff for closing the urethra. The control unit also includes a movable valve seat member having a relatively large area exposed to pressure of fluid in a chamber that is connected to the cuff and which moves to a position in which the valve member is unseated by an abutment when fluid pressure in the chamber exceeds a predetermined value to thereby relieve excess fluid pressure in the cuff. The arrangement is such that the valve element is held closed against the seat member by the full differential in fluid pressures acting on both sides of the valve element until the seat member is moved away from the valve element to thus insure positive closing of the valve element until the seat member is moved out of engagement with the valve element by excess pressure differential.

Reinicke, Robert H. (Inventor)

1983-01-01

215

Arthroscopic transosseous suture anchor technique for rotator cuff repairs.  

PubMed

The skin is incised 1 to 2 cm distal to the lateral portal. A transosseous tunnel is created through the greater tuberosity by a sharp penetrator, entering 1.5 to 2 cm distal to the top of the greater tuberosity. The penetrator exits medially, between the tip of the greater tuberosity and the articular surface of the humeral head, in the middle of the footprint. The first anchor, a 5-mm Spiralok (DePuy Mitek, Norwood, MA) is placed at the penetrator's exit site on the footprint. Using a specially designed suture leader, the lateral limb of the suture in the anchor, which passes through the previously created transosseous tunnel, is taken from the anchor and pulled out. The other suture end is passed through the supraspinatus tendon. The second suture, placed superficially in the anchor, is passed from the anchor through the supraspinatus tendon, as a mattress suture. If more anchors are required, the procedure should be repeated. The transosseous suture limb and the suture limb that is passed through the supraspinatus tendon are tied through the lateral portal. The knot tying is then performed with a sliding Delimar knot. The mattress suture, passing through the supraspinatus tendon, is tied through the anterior lateral portal. The knot tying procedure is repeated depending on the number of anchors. PMID:16651169

Cicak, Nikola; Klobucar, Hrvoje; Bicanic, Goran; Trsek, Denis

2006-05-01

216

Double-bundle ACL surgery demonstrates superior rotational kinematics to single-bundle technique during dynamic task  

Microsoft Academic Search

BackgroundWhile traditional surgical repair of the anterior cruciate ligament is able to restore anterior–posterior knee stability, laxity in the transverse plane remains. Double-bundle reconstruction has demonstrated greater rotational restraint than the single-bundle technique under passive loading conditions; however, no comparison has been made under physiological weight-bearing conditions. The purpose of this study was to determine differences in rotational knee kinematics

A. Hemmerich; W. van der Merwe; M. Batterham; C. L. Vaughan

2011-01-01

217

Direct navigation on 3D rotational x-ray data acquired with a mobile propeller C-arm: accuracy and application in functional endoscopic sinus surgery  

NASA Astrophysics Data System (ADS)

Recently, three-dimensional (3D) rotational x-ray imaging has been combined with navigation technology, enabling direct 3D navigation for minimally invasive image guided interventions. In this study, phantom experiments are used to determine the accuracy of such a navigation set-up for a mobile C-arm with propeller motion. After calibration of the C-arm system, the accuracy is evaluated by pinpointing divots on a special-purpose phantom with known geometry. This evaluation is performed both with and without C-arm motion in between calibration and registration for navigation. The variation caused by each of the individual transformations in the calibration and registration process is also studied. The feasibility of direct navigation on 3D rotational x-ray images for functional endoscopic sinus surgery has been evaluated in a cadaver navigation experiment. Navigation accuracy was approximately 1.0 mm, which is sufficient for functional endoscopic sinus surgery. C-arm motion in between calibration and registration slightly degraded the registration accuracy by approximately 0.3 mm. Standard deviations of each of the transformations were in the range 0.15-0.31 mm. In the cadaver experiment, the navigation images were considered in good correspondence with the endoscopic images by an experienced ENT surgeon. Availability of 3D localization information provided by the navigation system was considered valuable by the ENT surgeon.

van de Kraats, Everine B.; Carelsen, Bart; Fokkens, Wytske J.; Boon, Sjirk N.; Noordhoek, Niels; Niessen, Wiro J.; van Walsum, Theo

2005-12-01

218

Baby cuff as a reason for laryngeal mask airway cuff malfunction during airway management for anesthesia.  

PubMed

Placement of laryngeal mask airway (LMA) is a blind procedure without requiring laryngoscopy. The reported success rate for LMA insertion at the first attempt is almost 95%; however, many functioning LMAs may not be in an ideal anatomic place. It seems that disposable LMAs have more stable cuff pressure compared to reusable LMAs; therefore, Anesthesiologists should bear in mind this fact when using reusable LMAs to achieve a proper sealing and safe airway management. In this report, we introduced a case with malfunction of LMA cuff during the airway management. PMID:25191199

Panahi, Jafar Rahimi; Mahmoodpoor, Ata; Golzari, Samad E J; Soleimanpour, Hassan

2014-07-01

219

Effect of external cuff pressure on arterial compliance  

Microsoft Academic Search

Pressure is one of the most sensitive factors influencing the arterial wall compliance. Pulse transit time (PTT) is one simple way to assess arterial compliance changes. This study investigated the relationship between external cuff pressure and pulse transit time. The study was performed on 10 subjects with different cuff pressures (0, 10, 20 and 30 mmHg) on the lower arm,

D. Zheng; J. Allen; A. Murray

2005-01-01

220

Development of a rotational cell-seeding system for tubularized extracellular matrix (ECM) scaffolds in vascular surgery.  

PubMed

Tubularized porcine extracellular matrices (ECMs) are under investigation as adjuvant scaffolds for endovascular aneurismal repair (EVAR). Limitations with tubularized ECMs in this setting include difficulties in achieving a confluent endothelium on the scaffold's luminal surface prior to in vivo implantation. In this in vitro study a rotational "cell-seeding rig" (RCR) was constructed to assess the potential for endothelialization of tubular ECM constructs. Human aortic endothelial cells (HAECs) were cultured onto the luminal surfaces of tubular porcine urinary bladder matrix (UBM) scaffolds and rotated in the RCR at experimental rotational speeds. Results showed that endothelial attachment occurred at a rotation speed of six revolutions per hour. HAECs continued to proliferate after the initial attachment period of 24 h and formed a confluent endothelial monolayer after 14 days of growth. Our results demonstrate that RCRs facilitate attachment of HAECs in vitro at a speed of six revolutions per hour. The endothelialization technique presented in the current study may be important for advancing tissue-engineering approaches to address some of the current limitations in endovascular treatments of abdominal aortic aneurysms. PMID:24155222

Callanan, A; Davis, N F; McGloughlin, T M; Walsh, M T

2014-05-01

221

Frontal soft tissue analysis using a 3 dimensional camera following two-jaw rotational orthognathic surgery in skeletal class III patients.  

PubMed

Although two dimensional cephalometry is the standard method for analyzing the results of orthognathic surgery, it has potential limits in frontal soft tissue analysis. We have utilized a 3 dimensional camera to examine changes in soft tissue landmarks in patients with skeletal class III dentofacial deformity who underwent two-jaw rotational setback surgery. We assessed 25 consecutive Asian patients (mean age, 22 years; range, 17-32 years) with skeletal class III dentofacial deformities who underwent two-jaw rotational surgery without maxillary advancement. Using a 3D camera, we analyzed changes in facial proportions, including vertical and horizontal dimensions, facial surface areas, nose profile, lip contour, and soft tissue cheek convexity, as well as landmarks related to facial symmetry. The average mandibular setback was 10.7 mm (range: 5-17 mm). The average SNA changed from 77.4° to 77.8°, the average SNB from 89.2° to 81.1°, and the average occlusal plane from 8.7° to 11.4°. The mid third vertical dimension changed from 58.8 mm to 57.8 mm (p = 0.059), and the lower third vertical dimension changed from 70.4 mm to 68.2 mm (p = 0.0006). The average bigonial width decreased from 113.5 mm to 109.2 mm (p = 0.0028), the alar width increased from 34.7 mm to 36.1 mm (p-value = 0.0002), and lip length was unchanged. Mean mid and lower facial surface areas decreased significantly, from 171.8 cm(2) to 166.2 cm(2) (p = 0.026) and from 71.23 cm(2) to 61.9 cm(2) (p < 0.0001), respectively. Cheek convexity increased significantly, from 171.8° to 155.9° (p = 0.0007). The 3D camera was effective in frontal soft tissue analysis for orthognathic surgery, and enabled quantitative analysis of changes in frontal soft tissue landmarks and facial proportions that were not possible with conventional 2D cephalometric analysis. PMID:23870714

Choi, Jong Woo; Lee, Jang Yeol; Oh, Tae-Suk; Kwon, Soon Man; Yang, Sung Joon; Koh, Kyung Suk

2014-04-01

222

Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure  

PubMed Central

Background Cuff pressure in endotracheal (ET) tubes should be in the range of 20–30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. Methods With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to study purpose. Cuff pressure in tube sizes 7.0 to 8.5 mm was evaluated 60 min after induction of general anesthesia using a manometer connected to the cuff pilot balloon. Nitrous oxide was disallowed. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. Results Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 ± 21.6 cmH2O). Only 27% of pressures were within 20–30 cmH2O; 27% exceeded 40 cmH2O. Although it varied considerably, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size. Conclusion We recommend that ET cuff pressure be set and monitored with a manometer. PMID:15569386

Sengupta, Papiya; Sessler, Daniel I; Maglinger, Paul; Wells, Spencer; Vogt, Alicia; Durrani, Jaleel; Wadhwa, Anupama

2004-01-01

223

Biomedical Paper Computer-Based Periaxial Rotation Measurement for  

E-print Network

surgery; femoral fracture reduction; periaxial rotation measurement INTRODUCTION Closed intramedullary in closed intramedullary nailing surgery is the correct alignment of the peri- axial rotation of the distalBiomedical Paper Computer-Based Periaxial Rotation Measurement for Aligning Fractured Femur

Joskowicz, Leo

224

Mechanics of the occlusive arm cuff and its application as a volume sensor.  

PubMed

Although a common medical instrument, the mechanical function of an occlusive arm cuff has not been fully described in an engineering sense. The occlusive arm cuff is examined here using a mathematical mechanics model and experimental measurements. Cuff stretch was modeled by a nonlinear pressure-volume function. Air compression was represented by Boyle's law. An apparatus was developed to measure pressure due to the air volume pumped into the cuff for fixed arm volume. Data were obtained for two different cuff designs, and reveal a nonlinear cuff pressure-volume relationship that could be represented accurately by the mathematical model. Calibration constants are provided for the two types of occlusive cuff. Thus, the cuff pressure was found to consist of a balance between that produced by stretch of the elastic cuff bladder and that of the compression of the air contained within the bladder. The use of the gas law alone was found to be inadequate to represent the cuff mechanics. When applying the cuff to measure change in arm volume, such as during plethysmography or oscillometry, it cannot be assumed that the cuff sensitivity is constant. More precisely, it was found that the occlusive cuff is a transducer with a volume sensitivity that increases with cuff pressure and volume until it becomes nearly constant at high levels of cuff pressure (150 mmHg). A hypothetical case of a linear elastic artery with constant pulse pressure was used as input to the cuff model to illustrate the change in cuff pressure oscillations that occurs while cuff pressure is released.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8244431

Drzewiecki, G; Bansal, V; Karam, E; Hood, R; Apple, H

1993-07-01

225

Continuous real time endotracheal tube cuff pressure waveform.  

PubMed

Endotracheal tube cuff pressure monitoring is one of the standard degrees of care afforded to anesthetized patients in the operative theater. Traditional pressure transducer when used to monitor cuff pressure provides real time continuous sine wave pressure waveform which has not been described in literature so far. This unique waveform needs to be further processed and evaluated to check its utility in airway pressure monitoring. PMID:24838549

Ganigara, Anuradha; Ramavakoda, Chandrika Y

2014-08-01

226

Airway obstruction involving a laryngeal mask airway during arthroscopic shoulder surgery.  

PubMed

Several earlier reports have described life-threatening airway obstruction during arthroscopic shoulder surgery performed under regional anesthesia, caused by the leakage of irrigation fluid out of the shoulder joint space into the surrounding soft tissues and then the neck and the pharynx. Here, we present a case of airway obstruction that occurred in a patient under general anesthesia. A 77-year-old woman with a rotator cuff rupture who was to undergo right-shoulder arthroscopic surgery was anesthetized with fentanyl and propofol. Her airway was secured with a flexible laryngeal mask airway (LMA). During surgery, the compliance of her breathing bag became gradually poorer, and finally we were not able to ventilate her at an airway pressure of 60 cmH2O. We found that her chest wall, neck, and face were swollen and tense. Laryngoscopy revealed massive swelling of the pharyngeal soft tissues. The vocal cords were not visible. Her trachea was intubated blindly, and adequate ventilation was re-established. She was placed in the Fowler position and furosemide was given intravenously. Her neck and chest swelling were reduced over the next 2 h and she was extubated without any problem. We recommend that physicians should periodically examine the neck of any patient undergoing arthroscopic shoulder surgery, especially when general anesthesia is used, because anesthetized patients cannot complain of breathing difficulty and the airway swelling may progress until it becomes life-threatening. PMID:16261473

Yoshimura, Eriko; Yano, Toshiyuki; Ichinose, Keisuke; Ushijima, Kazuo

2005-01-01

227

A simple method of partial inflation of the LMA cuff before insertion in children to allow cuff pressure without adjustment after insertion  

PubMed Central

Background The cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion. Methods One hundred fifty unpremedicated children aged 0 to 9 yrs were enrolled. The pilot balloon valve was connected to a piston-free syringe to keep the valve open to the atmosphere and allowing the pressure within the cuff of to LMA to equalize to atmospheric pressure. Anesthesia was induced with 6 vol% of sevoflurane in oxygen. After insertion and final positioning of the LMA, the intra-cuff pressure was measured using a cuff pressure manometer. Results The mean intra-cuff pressure was 50 ± 12.9 cmH2O; intra-cuff pressures were 39.1 ± 9.3, 51.6 ± 11.2, and 64.6 ± 12.5 cmH2O for LMAs of sizes 1.5, 2, and 2.5, respectively. Intra-cuff pressure of more than 60 cmH2O was measured in 26 patients, and the median value was 70 cmH2O. There was weak statistical correlation among age, height, and weight with intra-cuff pressure. Conclusions The cuff inflated by the resting volume before insertion may be a simple method for guaranteeing tolerable cuff pressure after insertion. PMID:22778887

Moon, Bo-Eun; Kim, Min-Soo

2012-01-01

228

ROTATION DESCRIPTIONS AND ACTIVITIES -201.00 PHARMACY PRACTICE RESIDENCY  

E-print Network

Experiences: A. Acute Care - One 6-week surgery rotation General Surgery Neurosurgery Orthopedic Surgery) Oncology 9) Orthopedic Surgery/Pain Consult Service 10) Pediatrics 11) Solid Organ Transplant (Liver

Martin, Gail

229

Leakage of fluid around endotracheal tube cuffs: a cadaver study  

PubMed Central

Background The aim of the study was to evaluate the leakage of liquid past the cuffs of tracheal tubes in fresh frozen human heads. Methods Six truncated fresh frozen heads were used and intubated with 8.0 mm endotracheal tubes. The intracuff pressures tested were 30 and 100 cmH2O. Subsequently, 20 ml of each of two oral antiseptic rinses (0.2% chlorhexidine and octenidine [octenidol®, Schülke & Mayr GmbH, Norderstedt, Germany]) was applied for thirty seconds in the mouth. During the trial, leakage of the cuffs was examined. Results The sealing between the tracheal cuff and tracheal wall was leakage-proof for all tested intracuff pressures and all tested antiseptic rinses. However, approximately 5.6 ml and 1.8 ml leaked into the esophagus and remained as a cuff-puddle, respectively. Conclusions The sealing between an endotracheal tube cuff with an intracuff pressure of 30 cmH2O and the tracheal wall is leakage-proof during oral care with antiseptic rinsing. An increase of intracuff pressure to 100 cmH2O does not appear to be required. PMID:24363847

Lucius, Ralph; Ewald, Kristian

2013-01-01

230

Severe, Steroid-responsive, Myositis Mimicking Necrotizing Fasciitis following Orthopedic Surgery: A Pyoderma Variant with Myonecrosis  

PubMed Central

Summary: Postoperative pyoderma gangrenosum is a rare neutrophilic dermatosis that may be confused for necrotizing fasciitis. The inflammatory response is triggered by the trauma of surgery and thus must be managed nonsurgically. Clinical and pathological findings in the 2 diseases can be identical, leading to misdiagnosis and massive surgical defects from the ensuing surgery. This report documents a severe case of postsurgical pyoderma following an elective rotator cuff repair presenting with myositis and myonecrosis. The patient was initially treated as having an infection, which resulted in multiple aggressive surgical debridements. Despite this, the patient continued to deteriorate and was in a critical and hemodynamically unstable condition. Following administration of high-dose intravenous corticosteroids, the patient made a dramatic recovery and went on to have internal fixation of the shoulder and closure of the wound with a combination of a free flap and a rotational flap. Extensive myositis, as seen in this case, has not been previously reported in postoperative pyoderma gangrenosum variants. Clinicians should be aware that the presence of myositis and myonecrosis should not preclude this diagnosis. PMID:25289368

Stanley, Peter; Grinsell, Damien; Daffy, John R.

2014-01-01

231

Effects of Wing-Cuff on NACA 23015 Aerodynamic Performances  

NASA Astrophysics Data System (ADS)

The main subject of this work is the numerical study control of flow separation on a NACA 23015 airfoil by using wing cuff. This last is a leading edge modification done to the wing. The modification consists of a slight extension of the chord on the outboard section of the wings. Different numerical cases are considered for the baseline and modified airfoil NACA 23015 according at different angle of incidence. The turbulence is modeled by two equations k-epsilon model. The results of this numerical investigation showed several benefits of the wing cuff compared with a conventional airfoil and an agreement is observed between the experimental data and the present study. The most intriguing result of this research is the capability for wing cuff to perform short take-offs and landings.

Meftah, S. M. A.; Belhenniche, M.; Madani Fouatih, O.; Imine, B.

2014-03-01

232

What went wrong and what was done about it: pitfalls in the treatment of common shoulder surgery.  

PubMed

When performing revision shoulder surgery, it is important that the surgeon understands why the index procedure failed and has a clear plan to address problems in the revision procedure. The most common cause of failure after anterior instability shoulder surgery is a failure to treat the underlying glenoid bone loss. For most defects, a Latarjet transfer can effectively restore anterior glenoid bone stock and restore shoulder stability. Persistent anterior shoulder pain after rotator cuff surgery may be the result of missed biceps pathology. This can be effectively treated via a biceps tenodesis. The most difficult failures to treat after acromioclavicular joint reconstruction surgery are those involving fractures of either the coracoid or the clavicle. Clavicle hook plates can be used as supplemental fixation during the treatment of these fractures to help offload the fracture site and allow healing while restoring stability to the acromioclavicular articulation. A failed hemiarthroplasty for a proximal humeral fracture frequently results when the tuberosities fail to heal correctly. This complication can be avoided by paying close attention to the implant position and the tuberosity fixation. If hemiarthroplasty is unsuccessful, the patient is best treated with conversion to a reverse shoulder arthroplasty. PMID:24720296

Wiesel, Brent B; Gartsman, Gary M; Press, Cyrus M; Spencer, Edwin E; Morris, Brent J; Zuckerman, Joseph D; Roghani, Reza; Williams, Gerald R

2014-01-01

233

ROTATION DESCRIPTIONS AND ACTIVITIES -201.00 PHARMACY PRACTICE RESIDENCY  

E-print Network

6) Neurological Surgery 7) Oncology 8) Orthopedic Surgery/Pain Consult Service 9) Pediatrics 10 Experiences: A. Acute Care 1) One 6-week surgery rotation · General Surgery · Neurosurgery · Orthopedic Surgery 2) Three-four 6-week elective medicine rotations · General Medicine · Cardiology · Critical Care

Martin, Gail

234

Rotation Swap Policy Rotations are clinical assignments that involve treating patients. They are: Geriatric  

E-print Network

Rotation Swap Policy Protocol Rotations are clinical assignments that involve treating patients. They are: Geriatric Dentistry, Oral and Maxillofacial Surgery, Pediatric Dentistry, Emergency, Periodontology, Orthodontics and Postgraduate Prosthodontics. Students are required to attend the rotations

Dennett, Daniel

235

Comparison of the effects of room air and N 2 O + O 2 used for ProSeal LMA cuff inflation on cuff pressure and oropharyngeal structure  

Microsoft Academic Search

This study aimed to evaluate the effects of different inflating gases used for ProSeal LMA (PLMA) cuff inflation on cuff pressure,\\u000a oropharyngeal structure, and the incidence of sore throat. Eighty patients (American Society of Anesthesiologists; ASA I–II)\\u000a were randomly divided into two groups. PLMA cuff inflation was achieved with appropriate volumes of 50% N2O + 50% O2 in group I

Murat Tek?n; Ismail Kati; Yakup Tomak; Koksal Yuca

2008-01-01

236

Training general surgery residents in pediatric surgery: educational value vs time and cost  

Microsoft Academic Search

BackgroundThis study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery.

Steven L. Lee; Roman M. Sydorak; Harry Applebaum

2009-01-01

237

Comparison of the effects of room air and N2O + O2 used for ProSeal LMA cuff inflation on cuff pressure and oropharyngeal structure.  

PubMed

This study aimed to evaluate the effects of different inflating gases used for ProSeal LMA (PLMA) cuff inflation on cuff pressure, oropharyngeal structure, and the incidence of sore throat. Eighty patients (American Society of Anesthesiologists; ASA I-II) were randomly divided into two groups. PLMA cuff inflation was achieved with appropriate volumes of 50% N2O + 50% O2 in group I and room air in group II, respectively. When the PLMA was removed, oropharyngeal examination was carried out immediately, using a rigid optical telescope. Patients were asked about sore throat symptoms postoperatively. Cuff pressures were significantly lower in group I, except at the initial pressure measurement. Cuff pressure was positively correlated with the length of the operation in group II, and negatively correlated in group I. PLMA cuff inflation with room air led to increased cuff pressure during the operation, possibly due to the diffusion of N2O into the cuff. We consider that a PLMA cuff inflated with an N2O-O2 mixture is convenient, especially in operations in which N2O has been used. PMID:19011792

Tekin, Murat; Kati, Ismail; Tomak, Yakup; Yuca, Koksal

2008-01-01

238

21 CFR 868.5800 - Tracheostomy tube and tube cuff.  

Code of Federal Regulations, 2010 CFR

...intended to establish a seal between the tracheal wall and the tracheostomy tube. The cuff is used to prevent the patient's aspiration of substances, such as blood or vomit, or to provide a means for positive-pressure ventilation of the patient....

2010-04-01

239

21 CFR 868.5800 - Tracheostomy tube and tube cuff.  

Code of Federal Regulations, 2011 CFR

...intended to establish a seal between the tracheal wall and the tracheostomy tube. The cuff is used to prevent the patient's aspiration of substances, such as blood or vomit, or to provide a means for positive-pressure ventilation of the patient....

2011-04-01

240

A Profile of Glenohumeral Internal and External Rotation Motion in the Uninjured High School Baseball Pitcher, Part II: Strength  

PubMed Central

Context: A database describing the range of normal rotator cuff strength values in uninjured high school pitchers has not been established. Chronologic factors that contribute to adaptations in strength also have not been established. Objectives: To establish a normative profile of rotator cuff strength in uninjured high school baseball pitchers and to determine whether bilateral differences in rotator cuff strength are normal findings in this age group. Design: Cohort study. Setting: Baseball playing field. Patients or Other Participants: A total of 165 uninjured male high school baseball pitchers (age = 16 ± 1 years, height = 1.8 ± 0.1 m, mass = 76.8 ± 10.1 kg, pitching experience = 7 ± 2 years). Main Outcome Measure(s): Isometric rotator cuff strength was measured bilaterally with a handheld dynamometer. We calculated side-to-side differences in strength (external rotation [ER], internal rotation [IR], and the ratio of ER:IR at 90° of abduction), differences in strength by age, and the influence of chronologic factors (participant age, years of pitching experience) on limb strength. Results: Side-to-side differences in strength were found for ER, IR, and ER:IR ratio at 90° of abduction. Age at the time of testing was a significant but weak predictor of both ER strength (R2 = 0.032, P = .02) and the ER:IR ratio (R2 = 0.051, P = .004) at 90° of abduction. Conclusions: We established a normative profile of rotator cuff strength for the uninjured high school baseball pitcher that might be used to assist clinicians and researchers in the interpretation of muscle strength performance in this population. These data further suggested that dominant-limb adaptations in rotator cuff strength are a normal finding in this age group and did not demonstrate that these adaptations were a consequence of the age at the time of testing or the number of years of pitching experience. PMID:21669099

Hurd, Wendy J.; Kaplan, Kevin M.; ElAttrache, Neal S.; Jobe, Frank W.; Morrey, Bernard F.; Kaufman, Kenton R.

2011-01-01

241

Dose-Response Evaluation of Braslet-M Occlusion Cuffs  

NASA Technical Reports Server (NTRS)

Introduction: Braslet-M is a set of special elasticized thigh cuffs used by the Russian space agency to reduce the effects of the head-ward fluid shift during early adaptation to microgravity by sequestering fluid in the lower extremities. Currently, no imaging modalities are used in the calibration of the device, and the pressure required to produce a predictable physiological response is unknown. This investigation intends to relate the pressure exerted by the cuffs to the extent of fluid redistribution and commensurate physiological effects. Materials and Methods: Ten healthy subjects with standardized fluid intake participated in the study. Data collection included femoral and internal jugular vein imaging in two orthogonal planes, pulsed Doppler of cervical and femoral vessels and middle cerebral artery, optic nerve imaging, and echocardiography. Braslet-M cuff pressure was monitored at the skin interface using pre-calibrated pressure sensors. Using 6 and 30 head-down tilt in two separate sessions, the effect of Braslet-M was assessed while incrementally tightening the cuffs. Cuffs were then simultaneously released to document the resulting hemodynamic change. Results: Preliminary analysis shows correlation between physical pressure exerted by the Braslet-M device and several parameters such as jugular and femoral vein cross-sections, resistivity of the lower extremity vascular bed, and others. A number of parameters reflect blood redistribution and will be used to determine the therapeutic range of the device and to prevent unsafe application. Conclusion: Braslet-M exerts a physical effect that can be measured and correlated with many changes in central and peripheral hemodynamics. Analysis of the full data set will be required to make definitive recommendations regarding the range of safe therapeutic application. Objective data and subjective responses suggest that a safer and equally effective use of Braslet can be achieved when compared with the current non-imaging calibration techniques.

Ebert, Douglas; Garcia, Kathleen; Sargsyan, Ashot E.; Ham, David; Hamilton, Douglas; Dulchavsky, Scott A.

2010-01-01

242

The influence of socio-demographic features and rotation of plastic, reconstructive and aesthetic surgery on the attitudes of Turkish medical students’ choice of careers  

Microsoft Academic Search

The choice of specialization branch is one of the most important decisions for the medical students during the medical education all over the world. It is known that short rotation period causes insufficient information about the subspecialty branches of medicine during the rotation period of medical education. The objective of the present study was to examine the tendency of students

Hatice Odaci; Ethem Guneren; Yüksel Bek

2005-01-01

243

Movement patterns of the upper extremity and trunk before and after corrective surgery of impaired forearm rotation in patients with cerebral palsy  

Microsoft Academic Search

The effect of surgical correction of impaired forearm rotation on associated body movement patterns was studied prospectively by comparison of preoperative and postoperative three-dimensional video analysis of the upper extremity and trunk in eight male and two female patients with hemiplegic cerebral palsy (CP; mean age 16y 2mo [SD 4y 11mo]; range 11-27y). A customized parameter, 'extrinsic forearm rotation', was

M. Kreulen; M. J. C. Smeulders; H. E. J. Veeger; J. J. Hage

2006-01-01

244

Rotational thromboelastometry and multiple electrode platelet aggregometry in four patients with abnormal routine coagulation studies before removal of epidural catheters after major surgery: a case series and research study  

PubMed Central

Introduction Routine coagulation tests have a low predictability for perioperative bleeding complications, and spinal hematoma after removal of epidural catheters is very infrequent. Thromboelastometry and point-of-care platelet aggregometry may improve hemostatic monitoring but have not been studied in the context of safety around epidural removal. Methods Twenty patients who received an epidural catheter for major thoracoabdominal and abdominal surgery were included prospectively. In addition to routine coagulation tests, rotational thromboelastometry and multiple electrode platelet aggregometry were carried out. Results A coagulation deficit was suggested by routine coagulation tests on the intended day of epidural catheter removal in four out of 20 patients. Prothrombin time-international normalized ratio was elevated to 1.5 in one patient (normal range: 0.9 to 1.2) while rotational thromboelastometry and multiple electrode platelet aggregometry parameters were within normal limits. Activated partial thromboplastin time was elevated to 47 to 50 seconds in the remaining three patients (normal range 28 to 45 seconds). Rotational thromboelastometry showed that one of the patients’ results was due to heparin effect: the clotting time with the HEPTEM® activator was 154 seconds as compared to 261 seconds with INTEM. The three remaining patients with prolonged routine coagulation test results had all received over 1L of hydroxyethyl starch (Venofundin®) and thrombosis prophylaxis with low-molecular-weight heparin (enoxaparin). Rotational thromboelastometry and multiple electrode platelet aggregometrygave normal or hypercoagulative signals in most patients. Conclusions This case series is new in that it examines rotational thromboelastometry and multiple electrode platelet aggregometry postoperatively in the context of epidural analgesia and shows that they may be clinically useful. These methods should be validated before they can be used for standard patient care. PMID:24377397

2013-01-01

245

Evaluation of risk factors of vaginal cuff dehiscence after hysterectomy  

PubMed Central

Objective The purpose of this study was to evaluate risk factors of vaginal cuff dehiscence or evisceration according to the type of operation. Methods Medical records of 604 women who underwent hysterectomies at Korea University Anam Hospital between June 2007 and June 2011 were reviewed. They were allocated to six groups. The six types of hysterectomies included robotic hysterectomy (n = 7), robotic radical hysterectomy and node dissection (RRHND, n = 9), total laparoscopic hysterectomy (TLH, n = 274), laparoscopy assisted vaginal hysterectomy (LAVH, n = 238), laparoscopic radical hysterectomy and node dissection (n = 11), and abdominal radical hysterectomy (ARH, n = 63). The characteristics and outcomes of each groups were compared. Results There was no difference in the characteristics of patients between 6 groups. In total of 604 hysterectomies, 3 evisceration (0.49%) and 21 dehiscences (3.47%) occurred. Evisceration were found in RRHND (1/9, 11.1%), TLH (1/276, 0.36%), and ARH (1/63, 1.56%). Dehiscences occurred in TLH (15/274, 5.42%), LAVH (4/238, 1.68%), and ARH (2/63, 3.17%). In 169 cases of TLH with intra-corporeal continuous suture, 1 evisceration and 4 dehiscences occurred, whereas 11 dehiscences occurred in 105 TLH cases with vaginal continuous locking suture (2.96% vs. 10.47%, P = 0.02). Conclusion The incidence of vaginal cuff dehiscenceand eviscerationwas significantly higher in TLH than LAVH. The intra-corporeal cuff suture was superior to the vaginal suture to prevent the vaginal cuff complications in TLH. PMID:24678487

Kim, Myung Ji; Kim, Seongmin; Bae, Hyo Sook; Lee, Jae Kwan; Lee, Nak Woo

2014-01-01

246

Development of biotube vascular grafts incorporating cuffs for easy implantation.  

PubMed

We are developing functional autologous tubular tissues, called biotubes, as ideal small-caliber vascular grafts that have growth potential without immunological rejection. In this study, to improve surgical handling, a novel biotube reinforced at the anastomosis regions was designed. Silicone rods, 2 mm in diameter and used as a mold, were covered with two pieces of short polyurethane sponge tubing as anastomotic reinforcement cuffs at both ends. After the assembly was placed into dorsal subcutaneous pouches in rabbits for 1 month, seamless biotubes incorporating the cuffs were obtained. The interstices and surfaces of the cuffs were impregnated and covered with connective tissues similar to those of the biotubes, mainly consisting of collagen and fibroblasts. Since the tubular shape of both ends was rigidly maintained, end-to-end anastomosis by conventional microsurgery techniques between biotubes and native carotid arteries was very easy. In preliminary autoimplantation studies, angiographic observation of up to 2 months duration showed no formation of aneurysms or rupturing. PMID:17380291

Watanabe, Taiji; Kanda, Keiichi; Ishibashi-Ueda, Hatsue; Yaku, Hitoshi; Nakayama, Yasuhide

2007-01-01

247

Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate?  

PubMed

The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values. PMID:21641528

Watson, Sheri; Aguas, Marita; Bienapfl, Tracy; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Yosses, Mary Beth; Yu, Larissa; Anastas, Zoe

2011-06-01

248

Nose Surgery  

MedlinePLUS

... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal surgery (rhinoplasty) ... Cover Nasal Surgery? Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, ...

249

Cardiac and vascular adaptation to 0g with and without thigh cuffs (Antares 14 and Altair 21 day Mir spaceflights)  

Microsoft Academic Search

Cardiovascular Actaptation was evaluated on 2 astronauts: one wearing thigh cuffs from flight day 1 to 8 (14d flight), the second without cuffs (21d flight). Ultrasound investigations were performed at rest and during LBNP. Results: Without thigh cuffs the cardiovascular Actaptation consists in (1) the development of a hypovolemia with an increase of the heart rate and the cardiac output,

Ph. Arbeille; G. Fomina; F. Achaibou; J. Pottier; A. Kotovskaya

1995-01-01

250

Cuff-less and Noninvasive Measurements of Arterial Blood Pressure by Pulse Transit Time  

Microsoft Academic Search

The current blood pressure (BP) measurement devices are mostly built on the principle of auscultation, oscillometry or tonometry, all of which use an inflatable cuff to occlude or unload the artery. The need of a cuff in these devices limits the further reduction in size and power consumption, and restricts the frequency and ease of their usage. Therefore, this study

C. C. Y. Poon; Y. T. Zhang

2005-01-01

251

Influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway  

Microsoft Academic Search

We studied the size 4 laryngeal mask airway (LMA) to test the hypothesis that oropharyngeal leak pressure and fibreoptic position improves with increasing cuff volume. After LMA insertion, 50 anaesthetized adult patients had the cuff inflated in 5-ml increments to 40 ml. Oropharyngeal leak pressure was optimal at 15 ml and decreased at higher volumes. The fibreoptic position was optimal

C. KELLER; F. PÜHRINGER; J. R. BRIMACOMBE

252

Stimulation Stability and Selectivity of Chronically Implanted Multicontact Nerve Cuff Electrodes in the Human Upper Extremity  

Microsoft Academic Search

Nine spiral nerve cuff electrodes were implanted in two human subjects for up to three years with no adverse functional effects. The objective of this study was to look at the long term nerve and muscle response to stimulation through nerve cuff electrodes. The nerve conduction velocity remained within the clinically accepted range for the entire testing period. The stimulation

Katharine H. Polasek; Harry A. Hoyen; Michael W. Keith; Robert F. Kirsch; Dustin J. Tyler

2009-01-01

253

Do International Rotations Make Surgical Residents More Resource-Efficient? A preliminary study  

Microsoft Academic Search

OBJECTIVEInterest in international surgery among general surgery residents in the US has been shown in several publications. Several general surgery residency programs have reported their experiences with international surgery rotations (ISRs). Learning to use limited resources more efficiently is often cited as a benefit of such rotations. We hypothesized that general surgery residents become more resource-efficient after they have completed

Jason L. Oliphant; Ronell R. Ruhlandt; Stanley R. Sherman; Marc G. Schlatter; Joel A. Green

254

Histological reaction of sintered nanohydroxyapatite-coated cuff and its fibroblast-like cell hybrid for an indwelling catheter.  

PubMed

Rapid tissue-ingrowth of a sintered hydroxyapatite(HAp)-coated and cell-hybrid subcutaneous cuff equipped with an indwelling catheter was developed. The rod-like HAp nanoparticles were coated by covalent bonding on the surface of the silk fibroin (SF) fibers for about 100 microm of the length. The fibers were transplanted three-dimensionally on a cuff substrate made of silicone elastomer with an adhesive. The fibroblast-like cells, explanted and proliferated from skin tissue containing the epidermis, dermis, and subcutaneous tissue of Japanese white rabbits, were incubated on the three-dimensional cuff for three days. Three types of cuff--polyester, HAp-coated, and cell-hybrid cuffs--were percutaneously implanted into the backs of the same animals for 3 and 7 days. The subcutaneous tissues around the cuffs were stained with hematoxylin-eosin. Immunohistochemical staining to identify macrophages and alpha-smooth muscle actin (alpha-SMA) was also done and examined by light microscopy. The alpha-SMA-positive area was very limited in the polyester cuff group even after 7 days, although many macrophages infiltrated into the fibers. In the cell-hybrid cuff group, on the other hand, an alpha-SMA-positive area was formed extensively after 3 and 7 days, causing severe inflammation. In the HAp-coated cuff group, an alpha-SMA-positive area was formed among the fibers with little inflammation. The extent order of the alpha-SMA-positive area was cell-hybrid cuff > HAp-coated cuff > polyester cuff, while the degree of inflammatory cells order was cell-hybrid cuff > polyester cuff > HAp-coated cuff. PMID:18767065

Furuzono, Tsutomu; Ueki, Mitsuki; Kitamura, Harumi; Oka, Kazumasa; Imai, Enyu

2009-04-01

255

The Brandt tube system attenuates the cuff deflationary phenomenon after anesthesia with nitrous oxide.  

PubMed

The Brandt tube system can limit excessive cuff pressure during nitrous oxide (N(2)O) anesthesia, but there is a lack of data assessing whether the Brandt tube system avoids cuff deflation after cessation of N(2)O administration. In this study, we recorded air-filled cuff pressures of the Mallinckrodt Brandt or Hi-Contour (control) tracheal tubes (Mallinckrodt, Athlone, Ireland) during 67% N(2)O anesthesia and the cuffs were aspirated if the cuff pressure exceeded 22 mm Hg; 180 min later, O(2) was substituted for N(2)O. The cuff pressure of both groups significantly decreased after N(2)O anesthesia but the time required for the cuff pressure to return to the initial pressure was longer in the Brandt group than in the control group (76.5 +/- 35.2 min and 36.5 +/- 18.1 min, respectively; P = 0.03). The incidence of air leaks was more frequent in the control group than in the Brandt group (P = 0.015); changes in intracuff N(2)O were small in the Brandt group (6.6 +/- 1.2% to 3.4 +/- 0.9%) compared with those in the control group (46.2 +/- 3.8% to 18.6 +/- 5.6%). Therefore, the Brandt tube system attenuates the cuff deflationary phenomenon after N(2)O anesthesia, whereas repeated cuff deflation during N(2)O anesthesia causes cuff deflation after cessation of N(2)O, resulting in a possible risk of air leaks. PMID:12538220

Karasawa, Fujio; Takita, Akira; Mori, Tomohisa; Takamatsu, Isao; Kawatani, Yasushi; Oshima, Takashi

2003-02-01

256

Heart Surgery  

MedlinePLUS

... heart with a healthy heart from a donor Traditional heart surgery, often called open-heart surgery, is ... off-pump, or beating heart, surgery. It's like traditional open-heart surgery because the chest bone is ...

257

Lung surgery  

MedlinePLUS

... Lung tissue removal; Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... do surgery on your lungs are thoracotomy and video-assisted thoracoscopic surgery (VATS). Lung surgery using a ...

258

Neuroblastoma: Surgery  

MedlinePLUS

... neuroblastoma treated? Next Topic Chemotherapy for neuroblastoma Neuroblastoma surgery Surgery can be used both to help diagnose ... long, thin instruments and remove pieces of tumor. Surgery as treatment After neuroblastoma is diagnosed, surgery is ...

259

[A new metal tube for laser surgery of the laryngotracheal region].  

PubMed

Various measures have been taken to minimize laser-specific hazards during laryngotracheal microsurgery with CO2-laser equipment. Endorsing Norton's view that only a metal tube ensures complete safety during laser surgery, we tested the "Laser-Flex", a new endotracheal tube (ETT) of high-grade stainless steel. This reconstructed, flexible, gas-tight ETT was designed to avoid perforation and even ignition of the tube with consecutive inhalation of combustion products known to be very strong lung irritants. The dull surface of the spiral ETT prevents damage to the surrounding mucosa by diverging the laser beam. The flexibility and greater stability compared with PVC- or silicone armored tubes makes intubation possible without a guide even under difficult conditions. A small PVC-tube with two high-volume-low-pressure cuffs is attached to the distal end of the metal ETT. The cuffs are filled via different inlets clearly distinguished by color as well as by the inscriptions "proximal" and "distal". Both inlet lines float inside the metal tube, thus being protected from accidental laser beams. The cuffs are filled with saline solution. In case of inflammation and destruction of the proximal cuff, the discharged solution will extinguish the flame and also protect the distal cuff, ensuring normal ventilation. Thus none of the laser operations had to be interrupted during our test period if accidentally perforation of the proximal cuff occurred. The high price of the "Laser-Flex" should not be a reason to abstain from using this tube. In view of the higher margin of patient safety, this tube might be used even from an economic point of view. In our tests we reused each tube five to eight times, thus lowering the costs with each reuse. Checks following sterilization after each use did not show any dysfunction of the cuffs or valves. PMID:2782601

Heine, P

1989-08-01

260

Murine cervical heart transplantation model using a modified cuff technique.  

PubMed

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are available to perform mechanistic in vivo studies. While heart transplantation models using a suture technique were first successfully developed in rats, the translation into an equally widespread used murine equivalent was never achieved due the technical complexity of the microsurgical procedure. In contrast, non-suture cuff techniques, also developed initially in rats, were successfully adapted for use in mice(1-3). This technique for revascularization involves two major steps I) everting the recipient vessel over a polyethylene cuff; II) pulling the donor vessel over the formerly everted recipient vessel and holding it in place with a circumferential tie. This ensures a continuity of the endothelial layer, short operating time and very high patency rates(4). Using this technique for vascular anastomosis we performed more than 1,000 cervical heart transplants with an overall success rate of 95%. For arterial inflow the common carotid artery and the proximal aortic arch were anastomosed resulting in a retrograde perfusion of the transplanted heart. For venous drainage the pulmonary artery of the graft was anastomosed with the external jugular vein of the recipient(5). Herein, we provide additional details of this technique to supplement the video. PMID:25350682

Oberhuber, Rupert; Cardini, Benno; Kofler, Markus; Ritschl, Paul; Oellinger, Robert; Aigner, Felix; Sucher, Robert; Schneeberger, Stefan; Pratschke, Johann; Brandacher, Gerald; Maglione, Manuel

2014-01-01

261

Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways.  

PubMed

The aim of this study was to investigate cuff pressure changes found in disposable size 3 laryngeal mask airways (LMAs) from different manufacturers during nitrous oxide exposure and to compare the results with the re-usable Classic LMA. In an in vitro experiment, laryngeal mask airway cuff pressures starting from a baseline pressure of 40 cm H(2)O were recorded using a pressure transducer for 60 min with the laryngeal mask airway cuff exposed to 66% N(2)O in oxygen. Cuff pressure increases within 5 min of nitrous oxide exposure were > 250% in the Classic LMA and were not significantly different from those found in the Marshall laryngeal mask airway. However, they were significantly greater than those in the Soft Seal, the Unique, the AMBU, and Intersurgical laryngeal mask airways, all of which demonstrated stable cuff pressure levels within the first 5 min. The cuff pressure increase following 60 min of nitrous oxide exposure was 13.0 +/- 1.1 and 14.6 +/- 0.7 cm H(2)O in the Intersurgical and Unique laryngeal mask airways, respectively, which was significantly lower than the cuff pressure increase in the Soft Seal and in the Ambu laryngeal mask airways (28.3 +/- 2.9 and 30.9 +/- 1.2 cm H(2)O, respectively). Unlike the re-usable Classic LMA and the disposable Marshall laryngeal mask airway, which have silicone cuffs, the disposable Ambu, Intersurgical, Portex Soft Seal and Unique laryngeal mask airways have cuffs constructed from PVC, which seems to be less susceptible to hyperinflation caused by nitrous oxide diffusion. PMID:15710013

Maino, P; Dullenkopf, A; Bernet, V; Weiss, M

2005-03-01

262

Runway Rotations  

NSDL National Science Digital Library

Students will use small paper airplanes to model rotations required to turn onto a runway. Students will rotate planes 45, 90, 180, 270, and 360 degrees. Students will identify and describe the results of rotations using benchmark angles.

2012-11-16

263

Blood pressure measurement in freely moving rats by the tail cuff method.  

PubMed

Inconsistency in consecutive blood pressure values is one of the most frequently observed problems in tail cuff method. The aim of this study was to measure blood pressure using the tail cuff method in rats without heating, anesthesia, and movement restriction. In this study, it has been shown that blood pressure measurement could be obtained without problem using the tail cuff method in freely moving rats in their cage environment. Also, the reliability of consecutive blood pressure values obtained from freely moving rats was higher than ether anesthesia and restricted groups. PMID:22571543

Erken, Haydar Ali; Erken, Gülten; Genç, Osman

2013-01-01

264

} Surgery 7 weeks } Medicine 7 weeks  

E-print Network

#12;} Surgery 7 weeks } Medicine 7 weeks } Pediatrics 7 weeks } OB-GYN 7 weeks } Psychiatry 7 weeks;} Medicine, Surgery, Pediatrics 8 weeks } OB-GYN, Family Med, Psychiatry 6 weeks } Elective block 6 weeks;} Educational and LCME concerns } Student wish for longer Medicine and Surgery rotations } National norms

Myers, Lawrence C.

265

In vitro evaluation of a nitinol based vein cuff for external valvuloplasty.  

PubMed

This study shows first in vitro tests of a nitinol based vein cuff developed for external valvuloplasty. In contrary to currently existing vein cuffs the tested model enables minimal invasive implantation and also maintains its round pre-shaped profile at body temperature (37 degrees C). The examination of the cuff surface structure by scanning electron microscopy, profilometry and X-ray photoelectron spectroscopy after sterilization with ethylene oxide and before cyto-compatibility testing revealed a nearly smooth surface (mean square roughness Rq 66 +/- 33 nm) which was primarily composed of nickel, oxygen, titanium, carbon and silicon where nickel was the least fraction (Ni: 0.7%, Ti: 1.7%, Si: 15.8%, O: 29.5%, C: 52.3%) of the surface elements. Si and C are supposed to be contaminations caused by a final cuff polishing with silicon carbide at the end of the manufacturing process. To evaluate cyto-compatibility initial cell adherence and cell activity were assessed. The results showed good initial cell adherence of L929 fibroblast-like cells on the cuff surface already after 24 h. The results also revealed no inhibitory effects on the activity of these cells (MTS test) later on. The test setup developed to analyse functionality in a dynamic mode was shown to be suited at blood pressures up to 300 mmHg. The cuff successfully limited dilation of varicose veins (Vena saphena magna) at physiological blood pressures (< 120 mmHg) and also in cases of hypertonia (300 mmHg) to the diameter determined by the cuff (4.0 mm) over thecomplete testing period. This indicates that the clasp based cuff closure mechanism is suited to close the cuff under variable physiological and pathological blood pressure conditions. The cuff structure only allowed minimal adaptation on the inhomogenously dilating vein profile in the both peripheral cuff modules. Both peripheral modules followed the vessel dilation in correlation to the applied pressure. At pressures within the physiological range cuff also maintained the pre-shaped round profile in the central and peripheral modules during the pressure increase and the consecutive cuff expansion. The study showed that the first nitinol based vein cuff for external valvuloplasty was processed well enough by electropolishing and sterilization to allow culturing of L929 fibroblast-like cells on the cuff surface as a test of general biocompatibility. The cuff also proved to limit dilation of varicose veins at physiological and pathological blood pressures in vitro. Further tests with primary cells from the venous wall will follow to test the specific biocompatibility before tests in vivo can be envisaged. PMID:20675918

Hiebl, B; Jung, F; Schossig, M; Scharnagl, N; Richau, K; Niehues, S

2010-01-01

266

Impact of the new cuff design on reliability of the AS800 artificial urinary sphincter.  

PubMed

The effect of 2 cuff design changes on the mechanical reliability of the current AS800 artificial urinary sphincter was assessed in 126 patients. The surface-treated cuff was introduced in 1983 and the narrow-back design was introduced in 1987. Mean followup for the surface-treated cuff was 40 months, while that for the narrow back was 27.2 months. The incidence of cuff leaks was 1.3%, while the revision rate for clinically significant pressure atrophy, in the absence of a bladder flap urethroplasty, was 2.3%. The overall revision rate for clinically significant pressure atrophy was 9%. No leaks involving the balloon or tubing occurred. The mechanical reliability of the current AS800 artificial urinary sphincter has improved significantly. PMID:1538439

Light, J K; Reynolds, J C

1992-03-01

267

Laryngeal mask airway cuff pressure and position during anaesthesia lasting one to two hours  

Microsoft Academic Search

The cuff of the laryngeal mask airway (LMA) is highly permeable to nitrous oxide (N2O), and cuff pressure increases during N2O\\/O2 anaesthesia. The extent of these changes and their effect on LMA position have previously only been investigated for short\\u000a procedures. The current study was designed to investigate the effects of nitrous oxide-oxygen (N2O\\/O2) anaesthesia lasting one to two hours

J. Brimacombe; A. Berry

1994-01-01

268

Rotating photons  

NASA Astrophysics Data System (ADS)

We propose a quantum theory of rotating light beams and study some of its properties. Such beams are polychromatic and have either a slowly rotating polarization or a slowly rotating transverse mode pattern. We show there are, for both cases, three different natural types of modes that qualify as rotating, one of which is a new type not previously considered. We discuss differences between these three types of rotating modes on the one hand and non-rotating modes as viewed from a rotating frame of reference on the other, thus resolving some paradoxes mentioned recently.

van Enk, S. J.; Nienhuis, G.

2007-01-01

269

Plastic Surgery  

MedlinePLUS

... significant defects or problems. But what about having cosmetic surgery just to change your appearance? Is it a ... are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board- ...

270

Foot Surgery  

MedlinePLUS

... on crutches after the surgery or in a cast. Hammer Toe Surgery: Hammer toe surgery may involve ... other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone ...

271

Endotracheal tube cuff ignited by electrocautery during tracheostomy.  

PubMed

A 64-year old female requiring prolonged ventilatory support was scheduled for an elective tracheostomy. Anesthesia consisted of surgical infiltration of 1% lidocaine and supplemental isoflurane. The patient was mechanically ventilated with an FIO2 of 1.0. An incision was made over the third and fourth tracheal rings. Opening the trachea with electrocautery resulted in a large leak around the endotracheal tube. The cuff was visualized through the tracheal incision and noted to be deflated. A small bleeder was coagulated on the tracheal ring. At this point, a flash fire occurred rising about one-inch high through the tracheal incision. The surgeon immediately covered the site with his hand. The anesthetist promptly disconnected the anesthesia circuit and removed the endotracheal tube. The surgeon inserted the tracheostomy tube and ventilation resumed. The fire lasted approximately 1-2 seconds. Dexamethasone 10 mg was administered intravenously. End-tidal CO2 and oxygen saturation levels were unchanged. The endotracheal tube was inspected. Approximately one-third to one-half of the cuff was charred. Proper management of an endotracheal tube fire includes stopping ventilation, disconnecting the oxygen source, removing the endotracheal tube, diagnosing injury, administering short-term steroids, administering antibiotics if indicated, providing ventilation and medical support as necessary and monitoring the patient for at least 24 hours. Extreme caution is necessary when using electrocautery in close proximity to an endotracheal tube. If electrocautery is used in close proximity to an endotracheal tube, an FIO2 of 0.3 or less with helium should be used. PMID:2399778

Le Clair, J; Gartner, S; Halma, G

1990-08-01

272

Cardiac, arterial and venous adaptation to weightlessness during 6-month MIR spaceflights with and without thigh cuffs (bracelets)  

Microsoft Academic Search

The objectives of this investigation were to study the effects of thigh cuffs (bracelets) on cardiovascular adaptation and\\u000a deconditioning in 0?g. The cardiovascular parameters of six cosmonauts were measured by echocardiography, Doppler, and plethysmography, during\\u000a three 6-month MIR spaceflights. Measurements were made at rest during preflight (?30?days), inflight (1, 3–4, and 5–5.5?months)\\u000a without cuffs (morning) and after 5?h with cuffs,

S. Herault; G. Fomina; I. Alferova; A. Kotovskaya; V. Poliakov; P. Arbeille

2000-01-01

273

Novel Nanofiber-Based Scaffold for Rotator Cuff Repair and Augmentation  

E-print Network

associated with current grafts underscore the clinical demand for functional solutions for tendon repair the shoulder, with more than 75,000 repair procedures performed annually in the United States alone.1 Clinical tendons post- injury.2­4 Due to the high failure rates associated with current repair procedures, coupled

Lu, Helen H.

274

Cardiac and vascular adaptation to 0g with and without thigh cuffs (Antares 14 and Altair 21 day Mir spaceflights)  

NASA Astrophysics Data System (ADS)

Cardiovascular Actaptation was evaluated on 2 astronauts: one wearing thigh cuffs from flight day 1 to 8 (14d flight), the second without cuffs (21d flight). Ultrasound investigations were performed at rest and during LBNP. Results: Without thigh cuffs the cardiovascular Actaptation consists in (1) the development of a hypovolemia with an increase of the heart rate and the cardiac output, (2) the decrease of the vascular tone in the deep (mesenteric and splanchnic) and peripheral (Lower limbs) vascular areas. The use of thigh cuffs maintains the volemia and the cardiac output at the preflight level (without heart rate increase) and prevents the loss of vascular tone in the deep and peripheral areas. Moreover the adaptative process changes since the cuffs are removed and even the volemia seems to be unaffected at this stage the vascular tone decreases to a comparable extend as during the flight without cuffs. Nevertheless during the flight without cuffs or 3 days after removing the cuffs hemodynamic signs of decreased orthostatic tolerance are present during the inflight and the 3 days post flight LBNP. Presently the possible contribution of the thigh cuffs to the reduction of the vascular deconditioning has not been tested yet.

Arbeille, Ph.; Fomina, G.; Achaibou, F.; Pottier, J.; Kotovskaya, A.

275

UCSF GPR Rotation Specific Goals and Objectives General Dentistry Rotation -5 months  

E-print Network

UCSF GPR Rotation Specific Goals and Objectives General Dentistry Rotation - 5 months · Assess notes in an orderly and timely fashion Hospital Dentistry Rotation - 3 months · Ambulatory Service-1201 Implant Center and Oral Surgery Clinic o Obtain a thorough history and physical exam, collecting

Klein, Ophir

276

Shoulder rotational properties of throwing athletes.  

PubMed

Throwing arm injuries are common and often related to the shoulder external and internal rotation. Quantitative assessment may provide new insights to physical assessment and options for treatment. After having signed IRB approved consents and filled out injury questionnaires, 96 baseball pitchers were examined on both shoulders using a custom-made wireless device. The resistance onset angle (ROA), end-point angle (EPA), shoulder rotational flexibility (SRF) in both external and internal rotation, and rotational ranges of motion (ROM) of both shoulders were determined. About 34% of subjects had surgeries on their throwing arm. Another 15% of subjects had throwing arm injuries that did not require surgical treatments. The throwing arm had significantly lower internal ROA, EPA and SRF, but significantly higher external ROA, EPA and SRF than the non-throwing arm. There were significant differences in shoulder rotational properties among groups with different surgery locations. Subjects with shoulder surgeries had greater internal rotation flexibility of their throwing arm than those with surgeries on the elbow. Throwers with injury and surgery history had significantly different shoulder rotational properties. Abnormal shoulder rotational properties may be related to throwing arm injuries. A better understanding of their relationship may lead us to effective preventive measures of throwing arm injuries. PMID:22422310

Zheng, N; Eaton, K

2012-06-01

277

Rotational geophone  

SciTech Connect

A combination velocity and rotational geophone apparatus is described for obtaining data for seismic records representing the direction of propagation of shear waves in a seismic wave, the apparatus comprising: a velocity geophone; and a rotational geophone, the rotational geophone being disposed in relation to the velocity geophone to respond to the rate of rotational waves in a plane including the sensitive axis of the velocity geophone.

Cowles, C.S.

1986-07-29

278

Calculated vs measured pharyngeal mucosal pressures with the laryngeal mask airway during cuff inflation: assessment of four locations  

Microsoft Academic Search

We have compared calculated with measured pharyngeal mucosal pressures at four different locations on the surface of the laryngeal mask airway (LMA) during cuff inflation in 10 anaesthetized, paralysed adult patients. Microchip sensors were attached to a size 5 LMA at the following locations: the anterior and lateral side, tip and backplate. Pressures were recorded during inflation of the cuff

C. Keller; J. Brimacombe; A. Benzer

279

Cataract Surgery  

MedlinePLUS Videos and Cool Tools

... truck driver from Chandler, Arizona, is having cataract surgery today on his left eye. A month ago ... anesthesia to numb the eye area. With microscopic surgery the surgeon can make a very small incision, ...

280

Impact of blood pressure cuff inflation rates on flow-mediated dilatation and contralateral arm response.  

PubMed

Flow-mediated dilatation (FMD) is widely used as an index of nitric oxide-mediated vasodilator function, yet its methodology has not been well established. Previous research indicates that a rapid inflation of a blood pressure cuff evokes systemic vasoconstriction, as it was observed even on non-occluded contralateral arm. This would potentially contribute to the variability of FMD readings and complicate the emerging evidence that non-occluded contralateral arm fingertip temperature responses during the FMD procedure may be an indicator of the presence of coronary artery disease. To test the hypotheses that rapid inflation of a blood pressure cuff could reduce FMD values and influence contralateral vasodilatory states, 33 apparently healthy adults (18 males and 15 females, 29±6 years) were studied in two randomized FMD trials. The blood flow-occluding cuff was inflated rapidly (<1?s) in one trial or slowly over 10?s in the other trial. Arterial diameter, fingertip temperature and infrared thermography were obtained throughout each session. FMD values were not different between the rapid and slow cuff inflation trials (5.9±0.6 vs 5.9±0.4%). There were no differences in reactive hyperaemia (6.4±1.6 vs 6.2±1.7?AU), shear stress (80±20 vs 77±17?dyn?cm(-2)) and fingertip temperature rebound (TR; 1.8±1.2 vs 1.9±1.0?°C) between the rapid and slow inflation. Changes in finger temperature on the contralateral (non-occluded) arm were positively associated with those on the occluded arm (r=0.26 to 0.61, P<0.05). We concluded that rates of inflating a blood pressure cuff do not affect FMD and TR response, and that neurovascular-induced vasodilatation of the contralateral arm was not observed regardless of cuff inflation rates. PMID:21248779

Lin, H-F; Dhindsa, M S; Tarumi, T; Miles, S C; Umpierre, D; Tanaka, H

2012-01-01

281

Implantation of a Carotid Cuff for Triggering Shear-stress Induced Atherosclerosis in Mice  

PubMed Central

It is widely accepted that alterations in vascular shear stress trigger the expression of inflammatory genes in endothelial cells and thereby induce atherosclerosis (reviewed in 1 and 2). The role of shear stress has been extensively studied in vitro investigating the influence of flow dynamics on cultured endothelial cells 1,3,4 and in vivo in larger animals and humans 1,5,6,7,8. However, highly reproducible small animal models allowing systematic investigation of the influence of shear stress on plaque development are rare. Recently, Nam et al. 9 introduced a mouse model in which the ligation of branches of the carotid artery creates a region of low and oscillatory flow. Although this model causes endothelial dysfunction and rapid formation of atherosclerotic lesions in hyperlipidemic mice, it cannot be excluded that the observed inflammatory response is, at least in part, a consequence of endothelial and/or vessel damage due to ligation. In order to avoid such limitations, a shear stress modifying cuff has been developed based upon calculated fluid dynamics, whose cone shaped inner lumen was selected to create defined regions of low, high and oscillatory shear stress within the common carotid artery 10. By applying this model in Apolipoprotein E (ApoE) knockout mice fed a high cholesterol western type diet, vascular lesions develop upstream and downstream from the cuff. Their phenotype is correlated with the regional flow dynamics 11 as confirmed by in vivo Magnetic Resonance Imaging (MRI) 12: Low and laminar shear stress upstream of the cuff causes the formation of extensive plaques of a more vulnerable phenotype, whereas oscillatory shear stress downstream of the cuff induces stable atherosclerotic lesions 11. In those regions of high shear stress and high laminar flow within the cuff, typically no atherosclerotic plaques are observed. In conclusion, the shear stress-modifying cuff procedure is a reliable surgical approach to produce phenotypically different atherosclerotic lesions in ApoE-deficient mice. PMID:22294044

Kuhlmann, Michael T.; Cuhlmann, Simon; Hoppe, Irmgard; Krams, Rob; Evans, Paul C.; Strijkers, Gustav J.; Nicolay, Klaas; Hermann, Sven; Schafers, Michael

2012-01-01

282

Rotating Wavepackets  

ERIC Educational Resources Information Center

Any free-particle wavepacket solution of Schrodinger's equation can be converted by differentiations to wavepackets rotating about the original direction of motion. The angular momentum component along the motion associated with this rotation is an integral multiple of [h-bar]. It is an "intrinsic" angular momentum: independent of origin and…

Lekner, John

2008-01-01

283

Surgery on Herman Rings of the Complex Standard Family  

E-print Network

rotation number #18; form a curve T #18; in the parameter plane. Using quasi-conformal surgerySurgery on Herman Rings of the Complex Standard Family N#19;uria Fagella #3; Dep. de Matem#18;atica;;#12; . Given an irrational rotation number #18;, the param- eters (#11;; #12;) such that f #11;;#12; has

Fagella, Núria

284

Suitable location and optimum bladder width for the occluding cuff used for indirect arterial blood pressure measurements at the wrist.  

PubMed

Using a finite element method (FEM) and a volume oscillometric method with a photo-electric plethysmograph, we tried to determine which location(s) and which bladder width(s) of the occluding cuff would allow the most accurate indirect blood pressure measurements at the human wrist. Nuclear magnetic resonance imaging of the wrist allowed us to determine the geometry of two-dimensional (2D) finite element models. FEM analysis showed that the pressure transmission ratio (calculated tissue pressure: externally applied pressure) from the cuff to the radial artery (RA) was 100% when the cuff was placed over the site (L1) at which the RA crosses the most protuberant spot on the volar aspect of the distal end of the radius. In fact, the mean blood pressure (BPM) measured at this site in human subjects coincided with that measured at the upper arm (BPMA). In addition, a three-dimensional (3D) FEM was constructed by extending the 2D FEM at site L1 in the longitudinal direction to investigate the relation between pressure transmission to the RA and cuff bladder width. FEM analysis using the 3D finite element model showed that for all cuff widths greater than 0.25 times the diameter of the wrist, the external pressure was transmitted almost completely to the RA beneath the cuff center. Moreover, when the cuff width was as large as 0.45 times the diameter of the wrist, the BPM measured at site L1 in human subjects was similar to the BPMA. The theoretical and experimental results in the present study both suggest that for accurate indirect blood pressure measurements at the wrist, the L1 site is a suitable location for the occluding cuff and a cuff whose bladder width is more than one-third but less than one-half the wrist diameter can be used. PMID:10354907

Lu, W; Tsukada, A; Kawarada, A; Sasaki, K

1999-01-01

285

An improved technique for tail-cuff blood pressure measurements with dark-tailed mice  

Microsoft Academic Search

Study of the genetics of hypertension has been facilitated greatly by the use of mice with modified genes that affect blood pressure. A current successful method for measuring blood pressure in mice relies on detection of light passing through the tail to determine the pressure in a tail-cuff necessary to stop pulsed flow. Success in obtaining reliable blood pressure measurements

J R Hagaman; S John; L Xu; O Smithies; N Maeda

2005-01-01

286

The Single Needle Lockstitch Machine. [Making and Setting Cuffs.] Module 6.  

ERIC Educational Resources Information Center

This module on making and setting cuffs, one in a series on the single needle lockstitch sewing machine for student self-study, contains three sections. Each section includes the following parts: an introduction, directions, an objective, learning activities, student information, student self-check, check-out activities, and an instructor's final…

South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

287

Saline as an alternative to air for filling the laryngeal mask airway cuff  

Microsoft Academic Search

Summary We have assessed a new method to evacuate saline completely from the laryngeal mask airway (LMA) cuff and tested the hypothesis that intracuff pressures, fibreoptic position and oropharyngeal leak pressures are similar for saline compared with air during nitrous oxide-oxygen anaesthesia. Eight size 4 LMA were inflated with saline 30 ml. After syringe evacuation, median residual weight was 0.56

A. COOREY; J. BRIMACOMBE; C. KELLER

288

Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?  

PubMed Central

Background Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers’ professional background. Methods Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an emergency department to a higher facility. Results This study included 101 patients scheduled for aeromedical transport. Median cuff pressure measured at handover was 45 (25.0/80.0) cmH2O; range, 8-120 cmH2O. There was no difference between patient characteristics and tracheal tube-size or whether anaesthesia personnel or non-anaesthesia personnel inflated the cuff (30 (24.8/70.0) cmH2O vs. 50 (28.0/90.0) cmH2O); p?=?0.113. With regard to mission type (63 patients underwent an emergency transfer, 38 patients an ICU transport), median cuff pressure was different: 58 (30.0/100.0) cmH2O in emergency transfers vs. 30 (20.0/45.8) cmH2O in inter-ICU transports; p?cuff pressure assessment by the intubating team, a manometer had been applied in 2 of 59 emergency transfers and in 20 of 34 inter-ICU transports (method was unknown for 4 cases each). If a manometer was used, median cuff pressure was 27 (20.0/30.0) cmH2O, if not 70 (47.3/102.8) cmH2O; p?Cuff pressures in the pre-hospital setting and in intensive care units are often too high. Interestingly, there is no significant difference between non-anaesthesia and anaesthesia personnel. Acceptable cuff pressures are best achieved when a cuff pressure manometer has been used. This method seems to be the only feasible one and is recommended for general use. PMID:24304522

2013-01-01

289

Effect of the Push-up Plus (PUP) Exercise at Different Shoulder Rotation Angles on Shoulder Muscle Activities  

PubMed Central

[Purpose] Although the Push-Up Plus is a useful exercise method for shoulder stabilization, few studies have examined its effects at different angles of shoulder rotation. Therefore, the present study investigated the most effective exercise method for shoulder stabilization by analyzing muscle activities of the rotator cuff muscles at different angles of shoulder rotation. [Subjects] Fifteen healthy university students in their 20s were the subjects of this study. [Methods] Changes in muscle EMG related to shoulder stabilization were analyzed by performing the Push-Up Plus in shoulder positions of neutral, internal and external rotation. [Results] The highest muscle activity was found in external rotation, and in internal rotation the pectoralis major and levator scapula showed significantly lower activities than the other positions. [Conclusion] Selectively changing the rotation angle of the shoulder for different purposes of the shoulder exercise would be an effective exercise method.

Cho, Sung-Hak; Baek, Il-Hun; Cheon, Ju Young; Cho, Min Jung; Choi, Mi Young; Jung, Da Hye

2014-01-01

290

Effect of respiration on Korotkoff sounds and oscillometric cuff pressure pulses during blood pressure measurement.  

PubMed

Blood pressure (BP) measurement accuracy depends on consistent changes in Korotkoff sounds (KorS) for manual measurement and oscillometric pulses for automated measurement, yet little is known about the direct effect of respiration on these physiological signals. The aim of this research was to quantitatively assess the modulation effect of respiration on Korotkoff sounds and oscillometric pulses. Systolic and diastolic blood pressures were measured manually from 30 healthy subjects (age 41 ± 12 years). Three static cuff pressure conditions were studied for two respiratory rates. Cuff pressure [with oscillometric pulses (OscP)], ECG, chest motion respiration [respiration signal (Resp), from magnetometer] and Korotkoff sounds (KorS, from digital stethoscope) were recorded twice for 20 s. The physiological data were evenly resampled. Respiratory frequency was calculated from Resp (fR), OscP (fO) and KorS (fK) from peak spectral frequency. There was no statistically significant difference between fR and fO or fK. Respiratory modulation was observed in all subjects. OscP amplitude modulation changed significantly between the two respiratory rates (p < 0.05) and between the three cuff pressures (p < 0.0001), and decreased significantly with decreasing cuff pressure (p < 0.05). The phase shift between Resp and modulation of OscP was statistically significant with respiratory rates (p < 0.05), but not with cuff pressures. It is accepted that BP in individuals is variable and that this relates to respiration; we now show that this respiration modulates oscillometric pulse and Korotkoff sound amplitudes from which BP is measured. PMID:24668326

Zheng, Dingchang; Di Marco, Luigi Yuri; Murray, Alan

2014-05-01

291

Submental intubation in maxillofacial surgery: a prospective study.  

PubMed

We designed a prospective study with the objective to evaluate the efficacy, indications and our experience of submental intubation in different types of maxillofacial surgeries. From May 2008 to August 2010, 23 patients with different conditions were intubated by submental route of tracheal intubation and patients were evaluated on different parameters during and after surgery to find its efficacy, indications and utilization in maxillofacial surgeries. All the patients were managed well with this technique of intubation with no significant difference in intubation and extubation time. We did not face any uneventful complication. There was only one reported complication that is rupture of the bulb of cuffed flexometallic tube but was managed well by changing tube. We found skull base access surgery as a new indication for submental intubation. The submental route for endotracheal intubation may be utilized as an alternative to blind nasal intubation or tracheostomy in the surgical management of patients involving complex maxillofacial surgeries. We hypothesized that the submental intubation should not be used where long term ventilation support is needed. We did a technique modification to deliver the endotracheal tube out from the submental region to avoid pilot cuff damage. Our study proposes that skull base access surgery is a safe and potential indication for submental intubation. In our experience submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial surgeries. PMID:24431850

Thomas, Shaji; Vaithilingam, Yuvaraj; Sundararaman, Prabhu; Thukral, Rishi; Pasupathy, Sanjay

2013-09-01

292

Stanford University School of Medicine Department of Otolaryngology/Head & Neck Surgery  

E-print Network

Goals & Objectives : Skills & Knowledge 10 General Surgery Rotation 10 Stanford Head and Neck Team PGY2 Appendix F: Palo Alto Veteran's Affairs Rotation Checklist Documentation Policies Scheduling Surgery CasesStanford University School of Medicine Department of Otolaryngology/Head & Neck Surgery Resident

Kay, Mark A.

293

Hepatobiliary surgery  

Microsoft Academic Search

The transformation of liver and biliary tract surgery into a full speciality began with the application of functional anatomy to segmental surgery in the 1950's, reinforced by ultrasound and new imaging techniques. The spectrum of gall-stone disease encountered by the hepatobiliary surgeon has changed with the laparoscopic approach to cholecystectomy. There is increased need for conservation techniques to repair the

Henri Bismuth; Pietro E. Majno

2000-01-01

294

Unnecessary surgery.  

PubMed Central

The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Most evidence of the existence of unnecessary surgery, such as information from studies of geographic variations and the results of second surgical opinion programs, is circumstantial. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 30 percent. Most unnecessary surgery results from physician uncertainty about the effectiveness of an operation. Elimination of this uncertainty requires more efficient production and dissemination of scientific information about clinical effectiveness. In the absence of adequate data from scientific studies, the use of a consensus of expert opinion, disseminated by means of comprehensive practice guidelines, offers the best opportunity to identify and eliminate unnecessary surgery. PMID:2668237

Leape, L L

1989-01-01

295

The extracellular potential of a myelinated nerve fiber in an unbounded medium and in nerve cuff models.  

PubMed Central

A model is presented for the calculation of single myelinated fiber action potentials in an unbounded homogeneous medium and in nerve cuff electrodes. The model consists of a fiber model, used to calculate the action currents at the nodes of Ranvier, and a cylindrically symmetrical volume conductor model in which the fiber's nodes are represented as point current sources. The extracellular action potentials were shown to remain unchanged if the fiber diameter and the volume conductor geometry are scaled by the same factor (principle of corresponding states), both in an unbounded homogeneous medium and in an inhomogeneous volume conductor. The influence of several cuff electrode parameters, among others, cuff length and cuff diameter, were studied, and the results were compared, where possible, with theoretical and experimental results as reported in the literature. Images FIGURE 2 PMID:9168022

Struijk, J J

1997-01-01

296

Influence of prosthetic humeral head size and medial offset on the mechanics of the shoulder with cuff tear arthropathy: a numerical study.  

PubMed

This numerical study assesses the influence of an oversized humeral hemiprosthesis with a larger medial offset on the mechanics of the shoulder with cuff tear arthropathy (CTA). Shoulder elevation in the scapular plane is performed, and a Seebauer Type IIa CTA is simulated: a massive rotator cuff tear, a proximal and static migration of the humeral head, and two contacts with friction (glenohumeral and acromiohumeral). The CTA model without a prosthesis (friction coefficient 0.3) is evaluated first as a reference model. Then, three humeral head prosthetic geometries (friction coefficient 0.15) are evaluated: anatomical head, oversized head, and oversized head with a large medial offset. The function of the middle deltoid (i.e. moment arm, applied force, and strength), the contact forces, and the range of motion are studied. The anatomical head, which reduces friction by half, decreases the middle deltoid force (25%) and the contact forces (glenoid 7%; acromion 25%), and increases the range of motion from 41 to 54°. The oversized head increases the moment arm (15%) and the middle deltoid strength (13%), which further decreases the deltoid force (7%) and the contact forces (glenoid 7%; acromion 17%), and increases the range of motion from 54° to 69°. The oversized head with a large medial offset enhances these effects: the moment arm increases by another 3.1%, the deltoid force decreases by another 5% and the acromiohumeral contact force by another 12%, and the range of motion increases from 69° to 84°. These results suggest that increasing the medial offset and oversizing the hemiprosthetic head improve the function of the deltoid, reduce acromial solicitation, and restore elevation to almost 90°. PMID:23219280

Lemieux, P O; Tétreault, P; Hagemeister, N; Nuño, N

2013-02-22

297

Fabrication of an ?-lipoic acid-eluting poly-(D,L-lactide-co-caprolactone) cuff for the inhibition of neointimal formation  

PubMed Central

The purpose of this study was to develop a novel polymer cuff for the local delivery of ?-lipoic acid (ALA) to inhibit neointimal formation in vivo. The polymer cuff was fabricated by incorporating the ALA into poly-(D,L-lactide-co-caprolactone) 40:60 (PLC), with or without methoxy polyethylene glycol (MethoxyPEG). The release kinetics of ALA and in vitro degradation by hydrolysis were analyzed by HPLC and field emission scanning electron microscopy (FE-SEM), respectively. In vivo evaluation of the effect of the ALA-containing polymer cuff was carried out using a rat femoral artery cuff injury model. At 24 h, 48% or 87% of the ALA was released from PCL cuffs with or without MethoxyPEG. FE-SEM results indicated that ALA was blended homogenously in the PLC with MethoxyPEG, whereas ALA was distributed on the surface of the PLC cuff without MethoxyPEG. The PLC cuff with MethoxyPEG showed prolonged and controlled release of ALA in PBS, in contrast to the PLC cuff without MethoxyPEG. Both ALA-containing polymer cuffs had a significant effect on the inhibition of neointimal formation in rat femoral artery. Novel ALA-containing polymer cuffs made of PLC were found to be biocompatible and effective in inhibiting neointimal formation in vivo. Polymer cuffs containing MethoxyPEG allowed the release of ALA for one additional week, and the rate of drug release from the PLC could be controlled by changing the composition of the polymer. These findings demonstrate that polymer cuffs may be an easy tool for the evaluation of anti-restenotic agents in animal models. PMID:19287197

Lee, Hyo Jeong; Choi, Seung Hee; Nah, Mun Hee

2009-01-01

298

Rotation Curves  

NSDL National Science Digital Library

This website, from the University of California, Berkeley, provides a description of the study of stellar motion around the center of a galaxy, and includes a graph of rotational speed versus distance from the center. The site relates this study to the prediction of dark matter. The page also gives explanations of other lines of evidence for dark matter. ____________________________________

White, Martin

2008-08-04

299

Rotation Matrices  

NSDL National Science Digital Library

Using Maple, Mathmatica, or MatLab, learner should be able to introduce the concept of using matrix multiplication to rotate vectors in two-dimensional space; to provide motivation for the definition of matrix multiplication; to lay the groundwork for using matrices to work with graphics.

Smith, David

2002-01-11

300

Rotating Phasors  

NSDL National Science Digital Library

This interactive phasor page allows you to control the values of a rotating phasor and see a visualization of each change that is done. You can control: one, pos/neg, two, beats, delta, sawtooth, square, triangle, time, zoom, plus you can put into five different values: Frequency (rel, HZ, mHZ), Amplitude (raw, rel), and Phases (Deg, Rad, unitrad).

Sharp, Cory

2011-05-04

301

Rodding Surgery  

MedlinePLUS

... may be rodded to reduce a scoliosis. With modern anesthesia, children can undergo surgery for longer periods ... recovery. Your doctor or physical therapist can suggest techniques for reducing their pain and frequency. For more ...

302

Sinus Surgery  

MedlinePLUS

... patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting. Image guided surgery: The sinuses are physically close to the brain, ...

303

Tennis elbow surgery  

MedlinePLUS

Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is usually an outpatient surgery. This means you will not stay in the hospital overnight. You will be ...

304

Endovenous Surgery  

Microsoft Academic Search

\\u000a Surgery of the veins was dominant in the early days of the modern era of vascular surgery up to about 1980. Now it has languished\\u000a in performance and in progress. One of the many reasons for this is that arterial reconstruction is so spectacular and appealing\\u000a to both patient and surgeon that performance of its procedures has crowded out teaching

John J. Bergan; Nisha Bunke

305

Plastic Surgery  

Microsoft Academic Search

\\u000a Comprehensive cancer centers in the United States interweave subspecialty care from multiple disciplines. These centers’ very\\u000a existence is testimony to the broad interdisciplinary approach to cancer care today. Plastic surgery, with its ability to\\u000a restore form and function, represents a small but critical component of the comprehensive care of patients with cancer. Plastic\\u000a surgical reconstruction extends the capabilities of surgery

Neil A. Fine; Charles E. Butler

306

A device for emulating cuff recordings of action potentials propagating along peripheral nerves.  

PubMed

This paper describes a device that emulates propagation of action potentials along a peripheral nerve, suitable for reproducible testing of bio-potential recording systems using nerve cuff electrodes. The system is a microcontroller-based stand-alone instrument which uses established nerve and electrode models to represent neural activity of real nerves recorded with a nerve cuff interface, taking into consideration electrode impedance, voltages picked up by the electrodes, and action potential propagation characteristics. The system emulates different scenarios including compound action potentials with selectable propagation velocities and naturally occurring nerve traffic from different velocity fiber populations. Measured results from a prototype implementation are reported and compared with in vitro recordings from Xenopus Laevis frog sciatic nerve, demonstrating that the electrophysiological setting is represented to a satisfactory degree, useful for the development, optimization and characterization of future recording systems. PMID:24760928

Rieger, Robert; Schuettler, Martin; Chuang, Sheng-Chih

2014-09-01

307

The effect of laryngeal mask cuff pressure on postoperative sore throat incidence  

Microsoft Academic Search

Study objective: To study the effect of laryngeal mask airway (LMA) cuff pressure on the incidence of postoperative sore throat.Design: Prospective, randomized, observational study.Setting: Operating room of a university hospital.Patients: 200 consecutive adult patients requiring anesthesia for gynecologic procedures.Interventions: Anesthesia was induced with thiopental 3–5 mg\\/kg, fentanyl 2 ?g\\/kg, vecuronium bromide 0.05 mg\\/kg, and enflurane, 0.8% to 2% and maintained

Gerald Burgard; Thomas Möllhoff; Thomas Prien

1996-01-01

308

On the identification of sensory information from mixed nerves by using single-channel cuff electrodes  

PubMed Central

Background Several groups have shown that the performance of motor neuroprostheses can be significantly improved by detecting specific sensory events related to the ongoing motor task (e.g., the slippage of an object during grasping). Algorithms have been developed to achieve this goal by processing electroneurographic (ENG) afferent signals recorded by using single-channel cuff electrodes. However, no efforts have been made so far to understand the number and type of detectable sensory events that can be differentiated from whole nerve recordings using this approach. Methods To this aim, ENG afferent signals, evoked by different sensory stimuli were recorded using single-channel cuff electrodes placed around the sciatic nerve of anesthetized rats. The ENG signals were digitally processed and several features were extracted and used as inputs for the classification. The work was performed on integral datasets, without eliminating any noisy parts, in order to be as close as possible to real application. Results The results obtained showed that single-channel cuff electrodes are able to provide information on two to three different afferent (proprioceptive, mechanical and nociceptive) stimuli, with reasonably good discrimination ability. The classification performances are affected by the SNR of the signal, which in turn is related to the diameter of the fibers encoding a particular type of neurophysiological stimulus. Conclusions Our findings indicate that signals of acceptable SNR and corresponding to different physiological modalities (e.g. mediated by different types of nerve fibers) may be distinguished. PMID:20423488

2010-01-01

309

Optimal care and design of the tracheal cuff in the critically ill patient  

PubMed Central

Despite the increasing use of non-invasive ventilation and high-flow nasal-oxygen therapy, intubation is still performed in a large proportion of critically ill patients. The aim of this narrative review is to discuss recent data on long-term intubation-related complications, such as microaspiration, and tracheal ischemic lesions. These complications are common in critically ill patients, and are associated with substantial morbidity and mortality. Recent data suggest beneficial effects of tapered cuffed tracheal tubes in reducing aspiration. However, clinical data are needed in critically ill patients to confirm this hypothesis. Polyurethane-cuffed tracheal tubes and continuous control of cuff pressure could be beneficial in preventing microaspiration and ventilator-associated pneumonia (VAP). However, large multicenter studies are needed before recommending their routine use. Cuff pressure should be maintained between 20 and 30 cmH2O to prevent intubation-related complications. Tracheal ischemia could be prevented by manual or continuous control of cuff pressure. PMID:24572178

2014-01-01

310

Rotational Equilibrium  

NSDL National Science Digital Library

In this activity, learners explore the concept of rotational equilibrium. Learners work in teams to estimate and determine the force within a mobile design. Learners solve algebraic equations, apply graphing techniques, compare results and discuss findings. Designing the mobile requires learners to solve a set of two linear algebraic equations. Learners solve the equations using three different methods: by substitution, by graphing the equations and finding the intersection, and by using determinants.

Ieee

2014-05-22

311

Rotation Matrices  

NSDL National Science Digital Library

Created by Lewis Blake and David Smith for the Connected Curriculum Project, the purposes of this module are to introduce the concept of using matrix multiplication to rotate vectors in two-dimensional space; to provide motivation for the definition of matrix multiplication; to lay the groundwork for using matrices to work with graphics. This is part of a larger collection of learning modules hosted by Duke University.

Blake, Lewis; Smith, David

2010-05-24

312

Cardiac and Vascular Responses to Thigh Cuffs and Respiratory Maneuvers on Crewmembers of the International Space Station  

NASA Technical Reports Server (NTRS)

The transition to microgravity eliminates the hydrostatic gradients in the vascular system. The resulting fluid redistribution commonly manifests as facial edema, engorgement of the external neck veins, and a decrease in leg diameter. This experiment examined the responses to modified Valsalva and Mueller maneuvers measured by cardiac and vascular ultrasound (ECHO) in a baseline steady state and during preload reduction introduced with thigh occlusion cuffs used as a counter-measure device (Braslet cuffs) measured by cardiac and vascular ultrasound examinations. Methods: Nine International Space Station crewmember subjects (Expeditions 16 - 20) were examined in 15 experiment sessions 101 +/- 46.days after launch (mean +/- SD; 33 - 185). Twenty Seven cardiac and vascular parameters were obtained with/without respiratory maneuvers before and after tightening of the Braslet cuffs. Results: Non-physicians performed diagnostic-quality cardiac and vascular ultrasound examinations using remote guidance. Three of 27 combinations of maneuvers and Braslet or Braslet alone were identified as being significant changed when compared to baseline. Eleven of 81 differences between combinations of Mueller, Valsalva or baseline were significant and related to cardiac preload reduction or increase in lower extremity venous volume. Conclusions: Acute application of Braslet occlusion cuffs causes lower extremity fluid sequestration and exerts commensurate measurable effects on cardiac performance in microgravity. Ultrasound techniques to measure the hemodynamic effects of thigh cuffs in combination with respiratory maneuvers may serve as an invaluable tool in determining the volume status of the cardiac patient at the 'microgravity bedside'.

Hamilton, Douglas; Sargsyan, Ashot E.; Garcia, Kathleen; Ebert, Douglas; Whitson, Peggy A.; Feiveson, Alan; Alferova, Irina V.; Dulchavsky, Scott A.; Matveev, Vladimir P.; Bogomolov, Valery V.; Duncan, J. Michael

2011-01-01

313

Rotating Motion  

NSDL National Science Digital Library

In these problems, two people ride on a merry-go-round (radius fixed at 10 m..it's big!). One rider tosses a ball toward the other. The period of motion can be varied as can the initial velocity of the ball, relative to rider. One of the problems is to select the initial velocity of the ball so that it passes through center of the merry-go-round. Another is for the rider who throws the ball to catch it him/herself after exactly half a rotation.

Christian, Wolfgang; Belloni, Mario

2008-02-19

314

Nerve cuff recordings of muscle afferent activity from tibial and peroneal nerves in rabbit during passive ankle motion.  

PubMed

Activity from muscle afferents regarding ankle kinesthesia was recorded using cuff electrodes in a rabbit preparation in which tactile input from the foot was eliminated. The purpose was to determine if such activity can provide information useful in controlling functional electrical stimulation (FES) systems that restore mobility in spinal injured man. The rabbit's ankle was passively flexed and extended while the activity of the tibial and peroneal nerves was recorded. Responses to trapezoidal stimulus profiles were investigated for excursions from 10 degrees to 60 degrees using velocities from 5 degrees/s to 30 degrees/s and different initial ankle positions. The recorded signals mainly reflect activity from primary and secondary muscle afferents. Dorsiflexion stretched the ankle extensors and produced velocity dependent activity in the tibial nerve, and this diminished to a tonic level during the stimulus plateau. The peroneal nerve was silent during dorsiflexion, but was activated by stretch of the peroneal muscles during ankle extension. The responses of the two nerves behaved in a reciprocal manner, but exhibited considerable hysteresis, since motion that relaxed the stretch to the driving muscle produced an immediate cessation of the prior stretch induced activity. A noted difference between the tibial and peroneal nerve responses is that the range of joint position change that activated the flexor afferents was greater then for the extensor afferents. Ankle rotation at higher velocities increased the dynamic stretch evoked responses during the stimulus ramp but showed no effect on the tonic activity during the stimulus plateau. Prestretching the muscles by altering the initial position increased the response to the ramp movement, however, for the peroneal nerve, when the prestretch brought the flexor muscles near to their maximal lengths, the response to additional stretch provided by the ramp movement was diminished. The results indicate that the whole nerve recorded muscle afferent activity may be useful for control of FES assisted standing, because it can indicate the direction of rotation of the passively moved ankle joint, along with coarse information regarding the rate of movement and static joint position. PMID:10896197

Riso, R R; Mosallaie, F K; Jensen, W; Sinkjaer, T

2000-06-01

315

[Glaucoma and retinal surgery].  

PubMed

In the therapeutic approach to complex glaucomas different initial situations were considered: pre-existing glaucoma, induction of glaucoma after vitreoretinal surgery and antiglaucomatous procedures. In pre-existing glaucoma and after filtering surgery maintenance of the filtering bleb requires a vitreoretinal approach for conjunctiva preservation with techniques such as pneumatic retinopexy or small gauge vitrectomy. After vitreoretinal surgery an increase in intraocular pressure (IOP) is common. Secondary glaucoma may occur after scleral buckling and after vitrectomy with or without gas or silicone oil tamponade as well as after application of steroids. Angle closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Vitreous tamponades with expansive or saturated gases may cause angle-closure glaucoma with or without pupillary blockage and may critically shorten ocular perfusion. Postoperative checks, immediate action and a ban on boarding aircraft over the period of intraocular gas tamponade prevent permanent damage to the eye. The majority of secondary glaucomas can effectively be controlled by topical medication and adequate postoperative posture of the patient. Besides the temporary use of systemic antiglaucomatous medication or laser therapy, very rarely in cases of massive swelling or overfill, a direct intervention, such as partial gas or silicone oil removal is required. A prophylactic inferior peripheral iridectomy prevents pupillary blockage in aphakic eyes with intraocular tamponade. In cases of heavy silicone oil use, the peripheral iridectomy is placed in the superior position. Nd:YAG laser application will regulate IOP in cases of occlusion. Secondary glaucoma due to silicone oil emulsification overload is treated by trabecular meshwork aspiration and lavage. In refractory glaucoma repetitive cyclophotocoagulation and drainage implants represent an approved method for long-term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial in nature and may benefit from an exact analysis for an adequate and successful treatment regimen. PMID:20454902

Müller, M; Geerling, G; Zierhut, M; Klink, T

2010-05-01

316

Blood pressure cuffs as a potential fomite for transmission of pathogenic micro- organisms: A prospective study in a university teaching hospital  

Microsoft Academic Search

Objective: To investigate the contamination of blood pressure cuffs on medical, surgical, paediatric and intensive care areas in a university teaching hospital.Design: A comprehensive, prospective study quantitatively and qualitatively evaluating the bacterial contamination on blood pressure cuffs of 100 sphygmomanometers in use in ten hospital units from June through to July 2007.Setting: A university teaching hospital with medical, surgical, paediatric

J. Baruah; S. Kumar; A. Gratrix; W. Dibb; M. Madeo

2008-01-01

317

Cosmetic surgery.  

PubMed Central

The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks. PMID:2589786

Harris, D. L.

1989-01-01

318

Rehabilitative Surgery  

Microsoft Academic Search

Graves’ orbitopathy (GO) is a debilitating disease which adversely interferes with the quality of life of affected patients [1]. It is characterised by different degrees of disfigurement and alterations in vision, both of which contribute to loss of self-confidence, psychosocial stability and ability to function. In GO, surgery, which may be necessary to protect visual function in the active phase

L. Baldeschi

2010-01-01

319

Arthroscopic Surgery.  

ERIC Educational Resources Information Center

Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

Connors, G. Patrick

320

Cardiac Surgery  

PubMed Central

Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

Weisse, Allen B.

2011-01-01

321

Plastic Surgery for Teenagers  

MedlinePLUS

... A. and Weston, J. Attitudes of adolescents about cosmetic surgery. Annals of Plastic Surgery 2003; 50:628-630. ... An investigation of changes in body image following cosmetic surgery. Plastic and Reconstructive Surgery 2002 . 109:363-371. ...

322

Corrective Jaw Surgery  

MedlinePLUS

... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...

323

Facial Cosmetic Surgery  

MedlinePLUS

... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...

324

Dental Implant Surgery  

MedlinePLUS

... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...

325

Scoliosis surgery - child  

MedlinePLUS

Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... Before surgery, your child will receive general anesthesia. This will make ... and unable to feel pain during the operation. During ...

326

Abdominal wall surgery  

MedlinePLUS

Abdominal wall surgery is surgery that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. It ... tummy tuck" to more complicated, extensive surgery. Abdominal wall surgery is not the same as liposuction, which ...

327

Pharyngeal airway space changes after counterclockwise rotation of the maxillomandibular complex  

Microsoft Academic Search

The purpose of this study was to evaluate the effects of double-jaw surgery with counterclockwise rotation of the maxillomandibular complex on the pharyngeal airway space and velopharyngeal anatomy in patients with high occlusal plane facial morphology. Fifty patients (22 men, 28 women) with high occlusal plane facial morphology underwent double-jaw surgery with counterclockwise rotation of the maxillomandibular complex. The patients

Pushkar Mehra; Michael Downie; Marcos C. Pita; Larry M. Wolford

2001-01-01

328

Bloodless surgery in geriatric surgery.  

PubMed

In bloodless surgery a series of measures has to be implemented to reduce the perioperative need for transfusion of whole blood or its components. Jehovah's Witness are the most representative group of patients opting for bloodless surgery as their faith follows strict believes that prohibits receiving blood. Geriatric patients requiring bloodless surgery are even more delicate and represent a challenge for surgeons. The physiological response of the over 65 year population to decreased hemoglobin level is slower and less effective than in young and adult patients. Herby we describe the perioperative protocol implemented in our surgical Department offered to geriatric Jehovah's Witness patients. Preoperative optimization of the patients is the key step in the preparation period. Intraoperative anesthetic and surgical measures are also required along with a strict postoperative follow-up. From our experience, bloodless surgery is feasible in the geriatric population as long as it is performed in specialized centers where a multidisciplinary team is prepared to specifically manage this scenario. Rigorous patients selection and preparation are mandatory. PMID:25183638

Guarino, Salvatore; Di Matteo, Filippo; Sorrenti, Salvatore; Greco, Roberto; Nardi, Matteo; Favoriti, Pasqualino; De Antoni, Enrico; Filippini, Angelo; Catania, Antonio

2014-10-01

329

Rotating Bioreactor  

NASA Technical Reports Server (NTRS)

The NASA Bioreactor provides a low turbulence culture environment which promotes the formation of large, three-dimensional cell clusters. Due to their high level of cellular organization and specialization, samples constructed in the bioreactor more closely resemble the original tumor or tissue found in the body. NASA-sponsored bioreactor research has been instrumental in helping scientists to better understand normal and cancerous tissue development. In cooperation with the medical community, the bioreactor design is being used to prepare better models of human colon, prostate, breast and ovarian tumors. Cartilage, bone marrow, heart muscle, skeletal muscle, pancreatic islet cells, liver and kidney are just a few of the normal tissues currently being cultured in rotating bioreactors by investigators.

1988-01-01

330

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine How Does Arthroscopic Shoulder Instability Surgery Work? Rev. 2/13 1 Table of Contents · Introduction to Shoulder Instability Surgery (Page 1) · Shoulder Instability Surgery Illustrations (Page 2) · Preparing for Shoulder Surgery (Pages 3-4) · General Post Surgery (Pages

Kim, Duck O.

331

Assessment of air pockets in high-dose-rate vaginal cuff brachytherapy using cylindrical applicators  

PubMed Central

Purpose To retrospectively assess the incidence and magnitude of air pockets around vaginal cylinders and its impact on dose distribution in vaginal cuff image-guided high-dose-rate (HDR) brachytherapy. Material and methods Fifty endometrial carcinoma patients treated by postoperative HDR vaginal cuff brachytherapy were included in the study. The average age of patients was 58.3 ± 11.8 years (range: 31-87 years). Brachytherapy was performed using cylindrical applicators, and the dose prescribed to 0.5 cm from the applicator's surface, over a length of 5 cm from the applicator's tip. Computed tomography (CT) simulation was used for each brachytherapy fraction. The incidence, vaginal mucosa displacement, volume, and dosimetric effect of air pockets around the vaginal cylinder were evaluated. Results A total of 78 air pockets were found in 29/50 patients (58%) and 45/135 (33%) brachytherapy plans. They were located at the apex: 16/78 (20%) and lateral to the applicator: 62/78 (80%). The volume of air pockets ranged between 0.01 and 2.1 cm3 (mean: 0.15 cm3 ± 0.36 cm3), and the maximum displacement of vaginal mucosa from cylinder surface was between 0.1 and 1.09 cm (mean: 0.34 cm ± 0.2 cm). The dose reduction to the vaginal mucosa generated by the air pockets ranged from 0.5 to 66% (mean: 26.4% ± 13.9%). Conclusions The presence of air pockets around vaginal cylinder applicators is frequently noticed in post-operative vaginal cuff brachytherapy. The dose to the vaginal mucosa is reduced, as a result of displacement generated by air pockets. The effect on the clinical outcome of this dose reduction is yet to be determined. PMID:25337128

Hassouna, Ashraf; Constantinescu, Camelia

2014-01-01

332

Electrochemical performance of platinum electrodes within the multi-electrode spiral nerve cuff.  

PubMed

In this study, the electrochemical performance of platinum electrodes within a multi-electrode spiral cuff to be used for selective nerve stimulation was investigated. The original cuff, simplified into a half-cuff, contained a single row of nine electrodes (0.5 × 2 mm) at a distance of 2 mm from its inner surface. Cyclic voltammetry was used to investigate the electrochemical reactions at the electrode-electrolyte interface, to define a potential window within which the electrode could be safely used in selective nerve stimulation, to calculate the charge injection capacity and cathodal charge storage capacity. Voltage transients retrieved during excitation with quasitrapezoidal biphasic current pulses, tested by selective nerve stimulation of the isolated porcine left cervical vagus nerve segment, were used to determine the maximum polarization across the electrode-electrolyte interface and to calculate cathodic charge injection capacity of the electrode. The results show that the most negative and most positive potentials across the electrode-electrolyte interface reached -0.54 and 0.59 V; these did not exceed the safe potential limits for water electrolysis. Furthermore, the time integral of the cathodic current by cyclic voltammetry measured over the potential range of water electrolysis, actually representing the cathodal charge storage capacity, was approximately -4 mC cm(-2). The charge injection capacity, representing the maximum charge density injected in a current stimulation pulse, using only reversible processes, however, was around 75 µC cm(-2). In conclusion, both, the tested stimulation pulse and electrode are suitable for efficient and safe selective nerve stimulation. PMID:24938675

Rozman, Janez; Pe?lin, Polona; Mehle, Andraž; Sala, Martin

2014-09-01

333

Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------  

E-print Network

38 Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------ http://ctstokyo.umin.ne.jp/ We are leading in Japan by annual surgery case volume of 700. New knowledge. ·Clinical research · Brain and spinal cord protection in thoracic aortic surgery · Minimally invasive

Miyashita, Yasushi

334

Human Cadaver Material in Preclinical Oral Surgery.  

ERIC Educational Resources Information Center

A University of Michigan dental school curriculum for oral surgery that uses human cadaver heads is described. Selection, preparation, and laboratory use of the materials are outlined. Faculty and students have received the sequence well and found it prepared them for clinical rotation. (MSE)

Barber, H. Dexter; And Others

1993-01-01

335

[Robotic surgery].  

PubMed

Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures. PMID:24144815

Sándor, József; Haidegger, Tamás; Kormos, Katalin; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

2013-10-01

336

Swirling flow pattern in a non-planar model of an interposition vein cuff anastomosis.  

PubMed

One of the main causes of long-term failure of ePTFE grafts is the development of anastomotic intimal hyperplasia which leads to graft thrombosis. Experimental studies with bypass grafts have shown an inverse relationship between mean wall shear stress and intimal hyperplasia. The geometry of the anastomosis has a strong influence on the flow pattern and wall shear stress distribution. The aim of this in vitro study was to investigate the influence of non-planarity in a model of a distal anastomosis with interposition vein cuff, an anastomosis configuration that is increasingly being used because of improved clinical results. Laser Doppler anemometer measurements were carried out in silicone rubber models of interposition vein cuff anastomoses with planar and non-planar inflow. The pulsatile flow waveforms were typical of those found in femoro-infrapopliteal bypass. Axial and radial velocities were measured in the proximal and distal outflow segments. As expected a symmetrical helical flow pattern (Dean flow) was evident in the planar model. The model with non-planar inflow, however, gave rise to swirling flow in both the distal and proximal artery outflow segments for during the systolic phase. In patients, the anastomosis is usually non-planar. Since the configuration depends in part upon the tunnelling of the graft, this may be altered to some extent. Non-planar anastomotic configurations induce a swirling flow pattern, which may normalise wall shear stress, thereby potentially reducing intimal hyperplasia. PMID:15921948

How, T V; Fisher, R K; Brennan, J A; Harris, P L

2006-01-01

337

Model-based analysis and design of nerve cuff electrodes for restoring bladder function by selective stimulation of the pudendal nerve  

PubMed Central

Objective Electrical stimulation of the pudendal nerve (PN) is being developed as a means to restore bladder function in persons with spinal cord injury. A single nerve cuff electrode placed on the proximal PN trunk may enable selective stimulation of distinct fascicles to maintain continence or evoke micturition. The objective of this study was to design a nerve cuff that enabled selective stimulation of the PN. Approach We evaluated the performance of both flat interface nerve electrode (FINE) cuff and round cuff designs, with a range of FINE cuff heights and number of contacts, as well as multiple contact orientations. This analysis was performed using a computational model, in which the nerve and fascicle cross-sectional positions from five human PN trunks were systematically reshaped within the nerve cuff. These cross-sections were used to create finite element models, with electric potentials calculated and applied to a cable model of a myelinated axon to evaluate stimulation selectivity for different PN targets. Subsequently, the model was coupled to a genetic algorithm (GA) to identify solutions that used multiple contact activation to maximize selectivity and minimize total stimulation voltage. Main results Simulations did not identify any significant differences in selectivity between FINE and round cuffs, although the latter required smaller stimulation voltages for target activation due to preserved localization of targeted fascicle groups. Further, it was found that a 10 contact nerve cuff generated sufficient selectivity for all PN targets, with the degree of selectivity dependent on the relative position of the target within the nerve. The GA identified solutions that increased fitness by 0.7–45.5% over single contact activation by decreasing stimulation of non-targeted fascicles. Significance This study suggests that using an optimal nerve cuff design and multiple contact activation could enable selective stimulation of the human PN trunk for restoration of bladder function. PMID:23594706

Kent, Alexander R; Grill, Warren M

2013-01-01

338

Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport  

Microsoft Academic Search

Background: Helicopters and light (unpressurised) aircraft are used increasingly for the transport of ventilated patients. Most of these patients are ventilated through endotracheal tubes (ETTs), others through laryngeal mask airways (LMAs). The cuffs of both ETTs and LMAs inflate with increases in altitude as barometric pressure decreases (30 mbar\\/1000 feet).Tracheal mucosa perfusion becomes compromised at a pressure of approximately 30

Catherine Mann; Neil Parkinson; Anthony Bleetman

2007-01-01

339

DEHN SURGERY SIDDHARTHA GADGIL  

E-print Network

DEHN SURGERY SIDDHARTHA GADGIL Contents 1. Introduction 1 2. Co-ordinates for surgery 1 3. Some algebraic topology 2 4. The theorem of Lickorish and Wallace 3 5. Surgeries and Cobordisms 4 6. The Kirby Calculus 5 7. Constructing knots using surgery 5 8. Surgeries about knots 5 References 6 1. Introduction

Gadgil, Siddhartha

340

Minimally invasive thyroid surgery  

Microsoft Academic Search

Endoscopic surgery is often considered to be ‘minimally invasive surgery’ in the light of recent technical developments. Endoscopic neck surgery, including thyroid and parathyroid surgery, has developed rapidly over the past 2 years. The various techniques of thyroid surgery, including sites of incision and procedures for creating adequate working space, are described here. The cosmetic benefits of endoscopic versus conventional

Kazuo Shimizu

2001-01-01

341

DEHN SURGERIES ON 2-BRIDGE LINKS WHICH YIELD REDUCIBLE 3-MANIFOLDS  

E-print Network

of the surgery slopes 1, 2 is not crucial since every 2-bridge links has a symmetry of -rotation which exchangesDEHN SURGERIES ON 2-BRIDGE LINKS WHICH YIELD REDUCIBLE 3-MANIFOLDS HIROSHI GODA, CHUICHIRO HAYASHI AND HYUN-JONG SONG 1. Introduction No surgery on a non-torus 2-bridge knot yields a reducible 3-manifold

Hachimori, Masahiro

342

Development of adaptive pneumatic tourniquet systems based on minimal inflation pressure for upper limb surgeries  

PubMed Central

Background Pneumatic tourniquets are medical devices that occlude blood flow to distal part of extremities and are commonly used in upper limb surgeries to provide a dry, clean and bloodless field. To decrease pressure-related injuries and potential risk of complications subjected to the high inflation pressure of pneumatic tourniquet, minimal inflation pressures are recommended. Methods A new occlusion pressure mathematical model for the upper limb was established based on the correlation analysis between several possible influencing parameters and the minimal pneumatic tourniquet pressure at which the peripheral pulse disappeared was recorded using a digital plethysmograph. A prototype of an adaptive pneumatic tourniquet which automatically varies the pressure in the tourniquet cuff according to the above prediction model was developed for the upper limb which used the lowest possible inflation pressure to achieve occlusion. The prototype comprises a blood pressure monitoring module, an inflatable tourniquet cuff, and a pressure relief mechanism to maintain an optimal cuff inflation pressure. Simulation experiments were conducted to verify the function and stability of the designed adaptive pneumatic tourniquet and clinical experiments using volunteers were undertaken to evaluate the performance of the prototype design in achieving adequate haemostasis in the upper limb. Results Results demonstrated that the mean arterial occlusion pressure was 152.3?±?16.7 mmHg, obviously below the 250 to 300 mmHg previously recommended (J Bone Joint Surg Br 68:625-628, 1986 and Arthroscopy 11:307–311, 1995). Conclusions In conclusion, this adaptive method and apparatus which can provide minimal inflation pressure may be a clinically practical alternative for upper limb surgery performed with pneumatic tourniquets. PMID:24053348

2013-01-01

343

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation Protocol Conditioning: Stationary bike Treadmill #12;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear

Oliver, Douglas L.

344

Ear Plastic Surgery  

MedlinePLUS

... receive light-weight earrings. Does Insurance Pay for Cosmetic Ear Surgery? Insurance usually does not cover surgery solely for ... you can expect. Updated 6/11/12 Ears Cosmetic Surgery, Facelift, Rhinoplasty, Blepharoplasty

345

Cosmetic breast surgery  

MedlinePLUS

Cosmetic breast surgery is done at an outpatient surgery clinic or in a hospital. Most women receive general anesthesia ... with a plastic surgeon if you are considering cosmetic breast surgery. Discuss how you expect to look and feel ...

346

Pediatric heart surgery  

MedlinePLUS

Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... after the baby is born. For others, your child may be able to safely wait for months ...

347

Who Needs Heart Surgery?  

MedlinePLUS

... page from the NHLBI on Twitter. Who Needs Heart Surgery? Heart surgery is used to treat many heart problems. For ... haven't worked or can't be used, heart surgery might be an option. Specialists Involved Your primary ...

348

Pediatric refractive surgery.  

PubMed

This article reviews current thoughts regarding pediatric refractive surgery. This encompasses current trends in adult refractive surgery, differences between adult and pediatric refractive surgery, and future possibilities for refractive technology for the pediatric population. PMID:24852149

Stahl, Erin D

2014-06-01

349

Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes.  

PubMed

Imbalance of the eccentrically-activated external rotator cuff muscles versus the concentrically-activated internal rotator cuff muscles is a primary risk factor for glenohumeral joint injuries in overhead activity athletes. Nonisokinetic dynamometer based strength training studies, however, have focused exclusively on resulting concentric instead of applicable eccentric strength gains of the external rotator cuff muscles. Furthermore, previous strength training studies did not result in a reduction in glenoumeral joint muscle imbalance, thereby suggesting that currently used shoulder strength training programs do not effectively reduce the risk of shoulder injury to the overhead activity athlete. Two collegiate women tennis teams, consisting of 12 women, participated in this study throughout their preseason training. One team (n = 6) participated in a 5-week, 4 times a week, external shoulder rotator muscle strength training program next to their preseason tennis training. The other team (n = 6) participated in a comparable preseason tennis training program, but did not conduct any upper body strength training. Effects of this strength training program were evaluated by comparing pre- and posttraining data of 5 maximal eccentric external immediately followed by concentric internal contractions on a Kin-Com isokinetic dynamometer (Chattecx Corp., Hixson, Tennessee). Overall, the shoulder strength training program significantly increased eccentric external total work without significant effects on concentric internal total work, concentric internal mean peak force, or eccentric external mean peak force. In conclusion, by increasing the eccentric external total exercise capacity without a subsequent increase in the concentric internal total exercise capacity, this strength training program potentially decreases shoulder rotator muscle imbalances and the risk for shoulder injuries to overhead activity athletes. PMID:18296967

Niederbracht, Yvonne; Shim, Andrew L; Sloniger, Mark A; Paternostro-Bayles, Madeline; Short, Thomas H

2008-01-01

350

Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery  

PubMed Central

A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C3F8 gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid–gas exchange with 14% C3F8 gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding. PMID:24008807

Rishi, Pukhraj; Reddy, Sumanth; Rishi, Ekta

2014-01-01

351

Internal Rotation and Scapular Position Differences: A Comparison of Collegiate and High School Baseball Players  

PubMed Central

Abstract Context: Conditions such as labral and rotator cuff injuries have been linked with decreases in glenohumeral internal-rotation and increases in external-rotation motion. Also, decreased glenohumeral internal rotation is strongly associated with scapular dyskinesis. Objective: To compare healthy collegiate and high school baseball players' glenohumeral joint range of motion and scapular position. Design: Cross-sectional study. Setting: Institutional research laboratory. Patients or Other Participants: Thirty-one male National Collegiate Athletic Association Division I collegiate (age ?=? 20.23 ± 1.17 years, height ?=? 186.24 ± 5.73 cm, mass ?=? 92.01 ± 7.68 kg) and 21 male high school baseball players (age ?=? 16.57 ± 0.76 years, height ?=? 180.58 ± 6.01 cm, mass ?=? 79.09 ± 11.51 kg). Main Outcome Measure(s): Glenohumeral internal and external rotation and scapular upward rotation were measured with a digital inclinometer. Scapular protraction was measured with a vernier caliper. All variables except scapular upward rotation were calculated as the difference between the dominant and nondominant sides. Results: Collegiate baseball players had more glenohumeral internal-rotation deficit (4.80°, P ?=? .028) and total motion deficit (5.73°, P ?=? .009) and less glenohumeral external-rotation gain (3.00°, P ?=? .028) than high school players. Collegiate baseball players had less scapular upward rotation than high school players at the 90° (4.12°, P ?=? .015, versus 3.00°, P ?=? .025) and 120° (4.00°, P ?=? .007, versus 3.40°, P ?=? .005) positions. The scapular protraction difference was greater in collegiate baseball players than in high school players in the hands-on-hips and 90° positions (0.77 cm, P ?=? .021, and 1.4 cm, P ?=? .001). Conclusions: When comparing high school with collegiate baseball players, these data suggest that glenohumeral internal-rotation deficit and scapular position change as the level of competition increases. PMID:20064047

Thomas, Stephen J.; Swanik, Kathleen A.; Swanik, Charles B.; Kelly, John D.

2010-01-01

352

Implantable pulsed Doppler cuff for long-term monitoring of free flaps: a preliminary study.  

PubMed

High-frequency (20 mHz) ultra-sonic Doppler in a pulsed mode rather than continuous mode allows blood flow detection in small arteries using a 1-mm crystal embedded in a silastic cuff. The "probe factor" used to determine flow was first established in an in vitro system and found to be reliable. The probe was then tested in five dogs on the saphenous artery and found to be highly responsive to hemodynamic changes in the pedicle. Finally, in 15 long-term studies of island flaps and free flaps, the probes were implanted to obtain daily readings and then removed at 7 days. Except for some dog-related problems and technical errors, the system produced reliable flow data in the percutaneous cable. It is anticipated that such immediate and direct information on the pedicle blood flow would be useful in monitoring flaps. PMID:6493028

Parker, P M; Fischer, J C; Shaw, W W

1984-01-01

353

Safety and reliability of the sealing cuff pressure of the Microcuff pediatric tracheal tube for prevention of post-extubation morbidity in children: A comparative study  

PubMed Central

Objectives: The objective of this study is to evaluate the efficacy and safety of sealing pressure as an inflation technique of the Microcuff pediatric tracheal cuffed tube. Materials and Methods: A total of 60 children were enrolled in this study. After induction of anesthesia and intubation with Microcuff pediatric tracheal tube, patients were randomly assigned, to one of the three groups. Control group (n = 20) the cuff was inflated to a cuff pressure of 20 cm H2O; sealing group (n = 20) the cuff was inflated to prevent the air leak at peak airway pressure of 20 cm H2O and the finger group (n = 20) the cuff was inflated to a suitable pressure using the finger estimation. Tracheal leak, incidence and severity of post-extubation cough, stridor, sore throat and hoarseness were recorded. Results: The cuff pressure as well as the volume of air to fill the cuff was significantly low in the sealing group when compared with the control group (P < 0.001); however, their values were significantly high in the finger group compared with both the control and the sealing group (P < 0.001). The incidence and severity of sore throat were significantly high in the finger group compared with both the control and the sealing group (P = 0.0009 and P = 0.0026). Three patients in the control group developed air leak around the endotracheal tube cuff. The incidence and severity of other complications were similar in the three groups. Conclusion: In pediatric N2O, free general anesthesia using Microcuff pediatric tracheal tub, sealing cuff pressure is safer than finger palpation technique regarding post-extubation morbidities and more reliable than recommended safe pressure in prevention of the air leak.

Al-Metwalli, Roshdi Roshdi; Sadek, Sayed

2014-01-01

354

Fibre-selective recording from the peripheral nerves of frogs using a multi-electrode cuff  

NASA Astrophysics Data System (ADS)

Objective. We investigate the ability of the method of velocity selective recording (VSR) to determine the fibre types that contribute to a compound action potential (CAP) propagating along a peripheral nerve. Real-time identification of the active fibre types by determining the direction of action potential propagation (afferent or efferent) and velocity might allow future neural prostheses to make better use of biological sensor signals and provide a new and simple tool for use in fundamental neuroscience. Approach. Fibre activity was recorded from explanted Xenopus Laevis frog sciatic nerve using a single multi-electrode cuff that records whole nerve activity with 11 equidistant ring-shaped electrodes. The recorded signals were amplified, delayed against each other with variable delay times, added and band-pass filtered. Finally, the resulting amplitudes were measured. Main Result. Our experiments showed that electrically evoked frog CAP was dominated by two fibre populations, propagating at around 20 and 40 m/s, respectively. The velocity selectivity, i.e. the ability of the system to discriminate between individual populations was increased by applying band-pass filtering. The method extracted an entire velocity spectrum from a 10 ms CAP recording sample in real time. Significance. Unlike the techniques introduced in the 1970s and subsequently, VSR requires only a single nerve cuff and does not require averaging to provide velocity spectral information. This makes it potentially suitable for the generation of highly-selective real-time control-signals for future neural prostheses. In our study, electrically evoked CAPs were analysed and it remains to be proven whether the method can reliably classify physiological nerve traffic. The work presented here was carried out at the laboratories of the Implanted Devices Group, Department of Medical Physics and Bioengineering, University College London, UK.

Schuettler, Martin; Donaldson, Nick; Seetohul, Vipin; Taylor, John

2013-06-01

355

Assessment of central haemomodynamics from a brachial cuff in a community setting  

PubMed Central

Background Large artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been validated in laboratory settings. However, the feasibility of this method in a community based setting has not been assessed. Methods One-off peripheral and central haemodynamic (systolic and diastolic blood pressure (BP) and pulse pressure) and wave reflection parameters (augmentation pressure (AP) and index, AIx) were obtained from 1,903 volunteers in an Austrian community setting using a transfer-function like method (ARCSolver algorithm) and from waveforms recorded with a regular oscillometric cuff. We assessed these parameters for known differences and associations according to gender and age deciles from <30?years to >80?years in the whole population and a subset with a systolic BP?cuff-based waveform recordings, provides robust and feasible estimates of central systolic pressure and augmentation in community-based settings. PMID:22734820

2012-01-01

356

Bariatric Surgery  

PubMed Central

Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Background Obesity is defined as a body mass index (BMI) of at last 30 kg/m2.1 Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m2 has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m2. An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999–2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25–29.9 kg/m2) or obese (BMI ? 30 kg/m2). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the “normal” range may begin at slightly above 18.5 kg/m2 and extend into the “overweight” range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight. The actual number of Ontario adults who are overweight or obese may be higher. Diet, exercise, and behavioural therapy are used to help people lose weight. The goals of behavioural therapy are to identify, monitor, and alter behaviour that does not help weight loss. Techniques include self-monitoring of eating habits and physical activity, stress management, stimulus control, problem solving, cognitive restructuring, contingency management, and identifying and using social support. Relapse, when people resume old, unhealthy behaviour and then regain the weight, can be problematic. Drugs (including gastrointestinal lipase inhibitors, serotonin norepinephrine reuptake inhibitors, and appetite suppressants) may be used if behavioural interventions fail. However, estimates of efficacy may be confounded by high rates of noncompliance, in part owing to the side effects of the drugs. In addition, the drugs have not been approved for indefinite use, despite the chronic nature of obesity. The Technology Morbidly obese people may be eligible for bariatric surgery. Bariatric surgery for morbid obesity is considered an intervention of last resort for patients who have attempted first-line forms of medical management, such as diet, increased physical activity, behavioural modification, and drugs. There are various bariatric surgical procedures and several different variations for each of these procedures. The surgical interventions can be divided into 2 general types: malabsorptive (bypassing parts of the gastrointestinal tract to limit the absorption of food), and restrictive (decreasing the size of the stomach so that the patient is satiated with less food). All of these may be performed as either open surgery or laparoscopically. An example of a malabsorptive technique is Roux-en-Y gastric bypass (RYGB). Examples of restrictive techniques are vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB). The Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Physician Services includ

2005-01-01

357

Rotational Vertebral Artery Compression : Bow Hunter's Syndrome  

PubMed Central

Bow hunter's syndrome (BHS) is rare cause of vertebrobasilar insufficiency that arises from mechanical compression of the vertebral artery by head rotation. There is no standardized diagnostic regimen or treatment of BHS. Recently, we experienced 2 cases resisted continues medication and treated by surgical approach. In both cases, there were no complications after surgery and there were improvements in clinical symptoms. Thus, we describe our cases with surgical decompression with a review of the relevant medical literature. PMID:24278656

Go, Gyeongo; Hwang, Soo-Hyun; Park, In Sung

2013-01-01

358

Rotational Vertebral Artery Compression : Bow Hunter's Syndrome.  

PubMed

Bow hunter's syndrome (BHS) is rare cause of vertebrobasilar insufficiency that arises from mechanical compression of the vertebral artery by head rotation. There is no standardized diagnostic regimen or treatment of BHS. Recently, we experienced 2 cases resisted continues medication and treated by surgical approach. In both cases, there were no complications after surgery and there were improvements in clinical symptoms. Thus, we describe our cases with surgical decompression with a review of the relevant medical literature. PMID:24278656

Go, Gyeongo; Hwang, Soo-Hyun; Park, In Sung; Park, Hyun

2013-09-01

359

Preliminary ultrasound evaluation of the rotator cable in asymptomatic volunteers?  

PubMed Central

Purpose To characterize the rotator cable high-resolution ultrasound appearance in asymptomatic shoulders of volunteers of different age. Materials and methods IRB approval and volunteers’ written consent was obtained. Excluding subjects with known shoulder affections, we screened 24 asymptomatic volunteers. Supraspinatus and infraspinatus tendons high-resolution ultrasound evaluation was performed according to standard scan protocols, further excluding shoulders with partial/full-thickness cuff tears. Thus, we studied 24 shoulders in 12 young volunteers (age range 21–39 years, mean age 33 ± 8 years) and 21 shoulders in 11 elderly volunteers (age range 62–83 years, mean age 75 ± 45 years). For each shoulder, we noted rotator cable visibility and its thickness and width. Fisher’s and U Mann–Whitney statistics were used. Results Rotator cable was less frequently detected in young than in elderly volunteers (5/24 vs. 11/21 shoulders; P = 0.034). When detected, rotator cable was significantly thicker in young (range 1.2–1.5 mm, mean thickness 1.3 ± 0.1 mm) than in elderly (range 0.9–1.4 mm, mean thickness 1.2 ± 0.1 mm) volunteers (P = 0.025), while its width was not significantly different in young (range 4.5–7.1 mm, mean 5.6 ± 1.1 mm) compared to elderly (range 2.5–7.1 mm, mean 4.2 ± 1.4 mm) volunteers (P = 0.074) although a tendency can be highlighted. Conclusions Ultrasound demonstrated the different consistency of rotator cable in young and elderly asymptomatic patients, with high interobserver reproducibility. PMID:23396940

Orlandi, D.; Sconfienza, L.M.; Fabbro, E.; Ferrero, G.; Martini, C.; Lacelli, F.; Serafini, G.; Silvestri, E.

2012-01-01

360

Rotational Preference in Gymnastics  

PubMed Central

In gymnastics, most skills incorporate rotations about one or more body axes. At present, the question remains open if factors such as lateral preference and/or vestibulo-spinal asymmetry are related to gymnast’s rotational preference. Therefore, we sought to explore relationships in gymnast’s rotation direction between different gymnastic skills. Furthermore, we sought to explore relationships between rotational preference, lateral preference, and vestibulo-spinal asymmetry. In the experiment n = 30 non-experts, n = 30 near-experts and n = 30 experts completed a rotational preference questionnaire, a lateral preference inventory, and the Unterberger-Fukuda Stepping Test. The results revealed, that near-experts and experts more often rotate rightward in the straight jump with a full turn when rotating leftward in the round-off and vice versa. The same relationship was found for experts when relating the rotation preference in the handstand with a full turn to the rotation preference in the straight jump with a full turn. Lateral preference was positively related to rotational preference in non-expert gymnasts, and vestibulo-spinal asymmetry was positively related to rotational preference in experts. We suggest, that gymnasts should explore their individual rotational preference by systematically practicing different skills with a different rotation direction, bearing in mind that a clearly developed structure in rotational preference between different skills may be appropriate to develop more complex skills in gymnastics. PMID:23486362

Heinen, Thomas; Jeraj, Damian; Vinken, Pia M.; Velentzas, Konstantinos

2012-01-01

361

Program directors' perspective of transplant training during general surgery residency.  

PubMed

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) began to mandate "a formal transplant experience" rather than a formal rotation to allow programs more flexibility. What constitutes a "transplant experience" or how to optimize such education remains unclear. The objectives of this study were to identify changes in residents' transplant exposure and determine the opinions of program directors (PDs) in response to the new requirements. A 15-item questionnaire was sent to all general surgery PDs. Demographics, resident experiences, and PDs' opinions regarding transplant rotations were collected. The response rate was 50 per cent from university and community programs at transplant and nontransplant centers. Although 55 per cent of PDs felt transplant should not be a required rotation, 92 per cent of programs reported having a formal rotation. Transplant rotations should be four months or less, according to 97 per cent of PDs. Most PDs (93%) think there should not be a minimum number of required transplant operations. Whether residencies were based at transplant centers or size of residencies did not affect PDs' responses. Transplant requirements were similar between residency programs regardless of PD opinions. Survey participants provided diverse feedback regarding this controversial topic. The new ACGME requirements have made little impact on program requirements. Most programs still mandate a formal transplant rotation. Diverse opinions exist regarding whether such a rotation should be required, highlighting the controversial nature of this issue. To facilitate education in an era of limited work hours, the ACGME changed requirements of general surgery programs to mandate "a formal transplant experience" rather than a transplant rotation. A survey of program directors revealed that although only 45 per cent of support mandatory transplant rotations, 93 per cent of programs still require transplant rotations despite the more lax ACGME requirements. This finding suggests a lack of suitable alternative to provide exposure to the concepts fundamental to transplant surgery, which are valuable in general surgery education. PMID:25105401

Egle, Jonathan P; Mittal, Vijay K

2014-08-01

362

Effect of the laryngeal mask airway on oesophageal pH: influence of the volume and pressure inside the cuff  

Microsoft Academic Search

We studied gastro-oesophageal reflux (GOR) with a face mask and laryngeal mask airway (LMA), and the effects of inflation pressure and volume of the LMA cuff on oesophageal pH, in 60 patients. Patients were managed with either a face mask (group I) or LMA inflated to obtain a seal in the anaesthesia circuit at 7 cm H2O (group II) or

M. Roux; P. Drolet; M. Girard; Y. Grenier; B. Petit

1999-01-01

363

Tightening force and torque of nonlocking screws in a reverse shoulder prosthesis A. Terrier a,  

E-print Network

is an accepted treatment for glenohumeral arthritis associated to rotator cuff deficiency. For most reversed accepted treatment for rotator cuff arthropathy. The medial displacement of the glenohumeral rotation

Guerraoui, Rachid

364

Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature  

PubMed Central

We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications. PMID:23259121

Yeo, Cheng Hong; Russell, Nick C.; Sharpe, Tom

2012-01-01

365

Power Harvesting from Rotation?  

ERIC Educational Resources Information Center

We show the impossibility of harvesting power from rotational motions by devices attached to the rotating object. The presentation is suitable for students who have studied Lagrangian mechanics. (Contains 2 figures.)

Chicone, Carmen; Feng, Z. C.

2008-01-01

366

Soluble epoxide hydrolase deficiency attenuates neo-intima formation in the femoral cuff model of hyperlipidemic mice  

PubMed Central

Objectives Epoxyeicosatrienoic acids (EETs) have anti-inflammatory effects and are required for normal endothelial function. The soluble epoxide hydrolase (sEH) metabolizes EETs to their less active diols. We hypothesized that knockout and inhibition of sEH prevents neo-intima formation in hyperlipidemic ApoE?/? mice. Methods and Results Inhibition of sEH by 12-(3-adamantan-1-yl-ureido) dodecanoic acid (AUDA) or knockout of the enzyme significantly increased plasma EET levels. sEH activity was detectable in femoral and carotid arteries. sEH knockout or inhibition resulted in a significant reduction of neo-intima formation in the femoral artery cuff model but not following carotid artery ligation. Although macrophage infiltration occurred abundantly at the site of cuff placement in both sEH+/+ and sEH?/?, the expression of pro-inflammatory genes was significantly reduced in femoral arteries from sEH?/?-mice. Moreover, an in vivo-BrdU-assay revealed that SMC-proliferation at the site of cuff placement was attenuated in sEH knockout and sEH inhibitor treated animals. Conclusions These observations suggest that inhibition of sEH prevents vascular remodelling in an inflammatory model but not in a blood-flow dependent model of neo-intima formation. PMID:20224052

Revermann, Marc; Schloss, Manuel; Barbosa-Sicard, Eduardo; Mieth, Anja; Liebner, Stefan; Morisseau, Christophe; Geisslinger, Gerd; Schermuly, Ralph T.; Fleming, Ingrid; Hammock, Bruce D.; Brandes, Ralf P.

2010-01-01

367

Physclips: Rotation, torques, precession  

NSDL National Science Digital Library

This web page provides a multimedia introduction to rotation. It includes topics such as rotational kinetic energy, rotational kinematics, moment of inertia, torques, Newton's laws for rotation, and angular momentum. Short video clips, still images, graphs, and diagrams are integrated with text to promote understanding of important concepts. This tutorial is part of the PhysClip collection of web-based resources on introductory mechanics, electricity, and magnetism.

Wolfe, Joe

2009-06-19

368

Predictors of human rotation  

Microsoft Academic Search

Why some humans prefer to rotate clockwise rather than anticlockwise is not well understood. This study aims to identify the predictors of the preferred rotation direction in humans. The variables hypothesised to influence rotation preference include handedness, footedness, sex, brain hemisphere lateralisation, and the Coriolis effect (which results from geospatial location on the Earth). An online questionnaire allowed us to

Jan Stochl; Tim Croudace

2012-01-01

369

Mechatronics in Rotating Machinery  

Microsoft Academic Search

In this survey paper, we discuss the recent progress in researches on mechatronics in rotating machinery. Even before 'mechatronics' emerged as a new concept in technological advancement, much mechatronization effort has already been made in rotating machinery. Automatic balancer, for example, is a typical mechatronics product in rotating machinery that has a long history of development. When smart actuators such

Chong-Won Lee

370

Rotations with Rodrigues' Vector  

ERIC Educational Resources Information Center

The rotational dynamics was studied from the point of view of Rodrigues' vector. This vector is defined here by its connection with other forms of parametrization of the rotation matrix. The rotation matrix was expressed in terms of this vector. The angular velocity was computed using the components of Rodrigues' vector as coordinates. It appears…

Pina, E.

2011-01-01

371

Macular rotation with and without counter-rotation of the globe in patients with age-related macular degeneration  

Microsoft Academic Search

· Background: Macular rotation to treat exudative age-related macular degeneration (AMD) involves translocation of the fovea\\u000a to a site with intact retinal pigment epithelium. To avoid the inevitable postoperative cyclotropia we combined this procedure\\u000a with torsional muscle surgery.?· Patients and methods: In 30 eyes the macula was rotated upward by 30–50° following complete\\u000a artificial retinal detachment and a 360° retinotomy.

Claus Eckardt; Ute Eckardt; Hans-Georg Conrad

1999-01-01

372

[Surgery without donor's blood].  

PubMed

Complex program "Surgery without blood" was developed and introduced into a broad clinical practice. The main elements of this program are stimulation of erythropoesis, preparing in autoserum and autoblood before surgery with acute normovolemic hemodilution method, precise surgical technique, reinfusion of blood from wound and drainages, adequate anesthesia and correction of hemostasis system. This program permits one to minimize infusion of donor's blood components (DBC) in elective surgery (cardiosurgery, orthopedic surgery, neurosurgery, oncology, general surgery) and reduce significantly transfusion of DBC in urgent surgery. Rejection of DBC transfusion decreases number of postoperative complications and hospital stay, improves results of treatment and is cost-effective. PMID:15477831

Tarichko, Iu V; Ermolov, A S; Nemytin, Iu V; Domrachev, S A; Kurbanov, F S; Khvatov, B V; Ragimov, A A

2004-01-01

373

Predictors of human rotation.  

PubMed

Why some humans prefer to rotate clockwise rather than anticlockwise is not well understood. This study aims to identify the predictors of the preferred rotation direction in humans. The variables hypothesised to influence rotation preference include handedness, footedness, sex, brain hemisphere lateralisation, and the Coriolis effect (which results from geospatial location on the Earth). An online questionnaire allowed us to analyse data from 1526 respondents in 97 countries. Factor analysis showed that the direction of rotation should be studied separately for local and global movements. Handedness, footedness, and the item hypothesised to measure brain hemisphere lateralisation are predictors of rotation direction for both global and local movements. Sex is a predictor of the direction of global rotation movements but not local ones, and both sexes tend to rotate clockwise. Geospatial location does not predict the preferred direction of rotation. Our study confirms previous findings concerning the influence of handedness, footedness, and sex on human rotation; our study also provides new insight into the underlying structure of human rotation movements and excludes the Coriolis effect as a predictor of rotation. PMID:22708777

Stochl, Jan; Croudace, Tim

2013-05-01

374

[Cataract surgery via 1.5 mm microincisions].  

PubMed

A new technique of cataract surgery via two microincisions of 1.5 mm and a phacotip without silicone sleeve is described in this paper. The irrigation is performed via a service incision (port) with a supporting device of the diameter of 20 G. Main problems of this method are discussed: the risk of the wound burns, and the insufficient stability of the anterior chamber. Based on author's own experience from 80 operations performed, and on the data in the literature, the suggestions how to perform this surgery safely using the conventional phaco machine are outlined. The author uses microtip--micro Kelman, pulse mode 5-10 pulses/sec, flow ratio about 20 mL/min, vacuum up to 200 mm Hg, an overpressure cuff to increase the irrigation volume, and a thin walled supporting irrigation device of the inner diameter of 0.7 mm minimum. In the conclusion, it is discussed, if this may be regarded as a progressive method and if it will be widely used. A precondition for its extended use is the wider commercial offer of intraocular lenses, which could be easily implanted trough the micro-incision just described. PMID:15369265

Mazal, Z

2004-07-01

375

Stop Smoking Before Surgery  

MedlinePLUS

... Patient Stories FAQs Anesthesia Topics Smoking and Surgery Video Share PRINT Print Home > What To Expect > Detail ... Anesthesia Topics Quick Links Choose a topic: Featured Video: Smoking and Surgery Learn why stopping smoking before ...

376

Facial Plastic Surgery Today  

MedlinePLUS

... is a really good idea Third Quarter 2011 Cosmetic surgery to ease bullying? Second Quarter 2011 Facial Plastic ... 2014 | AMERICAN ACADEMY OF FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY (AAFPRS) | ALL RIGHTS RESERVED | SITEMAP | CONTACT | PRIVACY Follow us on

377

Anesthesia for Ambulatory Surgery  

MedlinePLUS

Anesthesia for Ambulatory Surgery Share PRINT Print Home > Types Of Anesthesia > Detail Page Anesthesia for Ambulatory Surgery Today the majority of patients ... or supervised by an anesthesiologist. What is ambulatory anesthesia? Ambulatory anesthesia is designed so you can go ...

378

Carotid artery surgery - discharge  

MedlinePLUS

... surgery to restore proper blood flow to your brain. Your surgeon made an incision (cut) in your neck over ... and carefully removed plaque from inside it. The surgeon may have ... surgery, your heart and brain activity were monitored closely.

379

Septoplasty and Turbinate Surgery  

MedlinePLUS

... may be asked to use saline sprays or irrigations after your surgery. Please check with your surgeon ... may be asked to use saline sprays or irrigations after your surgery. Please check with your surgeon ...

380

Complications of Sinus Surgery  

MedlinePLUS

... their physicians before using these medicines before or after surgery. Postoperative bleeding most often occurs within the first ... front upper teeth, lip or nose may occur after surgery but is usually self-limiting and do not ...

381

Robotic liver surgery  

PubMed Central

Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

Leung, Universe

2014-01-01

382

An improved technique for tail-cuff blood pressure measurements with dark-tailed mice.  

PubMed

Study of the genetics of hypertension has been facilitated greatly by the use of mice with modified genes that affect blood pressure. A current successful method for measuring blood pressure in mice relies on detection of light passing through the tail to determine the pressure in a tail-cuff necessary to stop pulsed flow. Success in obtaining reliable blood pressure measurements in light-tailed strains of mice (e.g., C57BL/6J) has been excellent. However, in our and others' experience, mice having highly pigmented tails (e.g., 129S6/SvEvTac) have yielded less consistent measurements. We report here that simple modifications to the channel containing the pulse detection sensor can greatly improve the pulse detection of dark-tailed mice. The first modification--lining the sensor channel with four layers of clear plastic wrap--increased the frequency of successful blood pressure measurements of 129S6/SvEvTac mice twofold and reduced variability by one-third. The second modification--lining the sides of the channel with reflective foil--also improved the success rate with dark-tailed mice. Mean blood pressures were unaffected by these modifications, which enhance detection of the pulse wave and likely will be helpful in diverse applications in which blood pressure is measured in rodent strains with pigmented tails. PMID:16138782

Hagaman, John R; John, Simon; Xu, Lonquan; Smithies, Oliver; Maeda, Nobuyo

2005-09-01

383

Perivascular biodegradable microneedle cuff for reduction of neointima formation after vascular injury.  

PubMed

Restenosis often occurs at the site of vascular grafting and may become fatal for patients. Restenosis at anastomosis sites is due to neointimal hyperplasia (NH) and difficult to treat with conventional treatments. Such abnormal growth of smooth muscle cells in tunica media of vascular tissue can be reduced by delivering anti-proliferation drugs such as paclitaxel (PTX) to the inner vascular layer. Drug eluting stents (DES) or drug eluting balloon (DEB) have been developed to treat such vascular diseases. However, they are less efficient in drug delivery due to the drug loss to blood stream and inadequate to be applied to re-stenotic area in the presence of stent or anastomosis sites. Recently, we have introduced microneedle cuff (MNC) as perivascular delivery devices to achieve high delivery efficiency to tunica media. In this study, we investigated in vivo microneedle insertion and efficacy in treating NH using a rabbit balloon injury model. Microneedle shape was optimized for reliable insertion into tunica media layer. Uniform distribution of PTX in tunica media delivered by MNC devices was also confirmed. Animal study demonstrated significant NH reduction by MNC treatments and much higher delivery efficiency than flat type devices. PMID:25025286

Lee, Kang Ju; Park, Seung Hyun; Lee, Ji Yong; Joo, Hyun Chel; Jang, Eui Hwa; Youn, Young-Nam; Ryu, WonHyoung

2014-10-28

384

Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff.  

PubMed

The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation. PMID:16179048

Levitan, R M; Kinkle, W C

2005-10-01

385

Motion control of the ankle joint with a multiple contact nerve cuff electrode: a simulation study.  

PubMed

The flat interface nerve electrode (FINE) has demonstrated significant capability for fascicular and subfascicular stimulation selectivity. However, due to the inherent complexity of the neuromuscular skeletal systems and nerve-electrode interface, a trajectory tracking motion control algorithm of musculoskeletal systems for functional electrical stimulation using a multiple contact nerve cuff electrode such as FINE has not yet been developed. In our previous study, a control system was developed for multiple-input multiple-output (MIMO) musculoskeletal systems with little prior knowledge of the system. In this study, more realistic computational ankle/subtalar joint model including a finite element model of the sciatic nerve was developed. The control system was tested to control the motion of ankle/subtalar joint angles by modulating the pulse amplitude of each contact of a FINE placed on the sciatic nerve. The simulation results showed that the control strategy based on the separation of steady state and dynamic properties of the system resulted in small output tracking errors for different reference trajectories such as sinusoidal and filtered random signals. The proposed control method also demonstrated robustness against external disturbances and system parameter variations such as muscle fatigue. These simulation results under various circumstances indicate that it is possible to take advantage of multiple contact nerve electrodes with spatial selectivity for the control of limb motion by peripheral nerve stimulation even with limited individual muscle selectivity. This technology could be useful to restore neural function in patients with paralysis. PMID:24939581

Park, Hyun-Joo; Durand, Dominique M

2014-08-01

386

Fascicular anatomy of human femoral nerve: Implications for neural prostheses using nerve cuff electrodes  

PubMed Central

Clinical interventions to restore standing or stepping by using nerve cuff stimulation require a detailed knowledge of femoral nerve neuroanatomy. We harvested eight femoral nerves with all distal branches and characterized the branching patterns and diameters. The fascicular representation of each distal nerve was identified and traced proximally to create fascicle maps of the compound femoral nerve in four cadaver specimens. Distal nerves were consistently represented as individual fascicles or distinct groups of fascicles in the compound femoral nerve. Branch-free length of the compound femoral nerve was 1.50 +/? 0.47 cm (mean +/? standard deviation). Compound femoral nerve cross sections were noncircular with major and minor diameters of 10.50 +/? 1.52 mm and 2.30 +/? 0.63 mm, respectively. In vivo intraoperative measurements in six subjects were consistent with cadaver results. Selective stimulation of individual muscles inner-vated by the femoral nerve may therefore be possible with a single neural prosthesis able to selectively stimulate individual groups of fascicles. PMID:20104420

Gustafson, Kenneth J.; Pinault, Gilles C. J.; Neville, Jennifer J.; Syed, Ishaq; Davis, John A.; Jean-Claude, Jesse; Triolo, Ronald J.

2010-01-01

387

Cylindrical rotating triboelectric nanogenerator.  

PubMed

We demonstrate a cylindrical rotating triboelectric nanogenerator (TENG) based on sliding electrification for harvesting mechanical energy from rotational motion. The rotating TENG is based on a core-shell structure that is made of distinctly different triboelectric materials with alternative strip structures on the surface. The charge transfer is strengthened with the formation of polymer nanoparticles on surfaces. During coaxial rotation, a contact-induced electrification and the relative sliding between the contact surfaces of the core and the shell result in an "in-plane" lateral polarization, which drives the flow of electrons in the external load. A power density of 36.9 W/m(2) (short-circuit current of 90 ?A and open-circuit voltage of 410 V) has been achieved by a rotating TENG with 8 strip units at a linear rotational velocity of 1.33 m/s (a rotation rate of 1000 r/min). The output can be further enhanced by integrating more strip units and/or applying larger linear rotational velocity. This rotating TENG can be used as a direct power source to drive small electronics, such as LED bulbs. This study proves the possibility to harvest mechanical energy by TENGs from rotational motion, demonstrating its potential for harvesting the flow energy of air or water for applications such as self-powered environmental sensors and wildlife tracking devices. PMID:23799926

Bai, Peng; Zhu, Guang; Liu, Ying; Chen, Jun; Jing, Qingshen; Yang, Weiqing; Ma, Jusheng; Zhang, Gong; Wang, Zhong Lin

2013-07-23

388

Pediatric Surgery Gallengangatresie  

E-print Network

1 Pediatric Surgery Gallengangatresie: eine seltene Erkrankung fällt durch die Maschen eines Versorgungsnetzes C. Petersen, B. M. Ure Pediatric Surgery Warum machen wir so viel Wirbel um eine seltene Surgery Die Gallengangatresie ist ein Problem! Seltene Erkrankung: ca. 1: 18.000 In Deutschland ca. 40

Manstein, Dietmar J.

389

Simulation of Endoscopic Surgery  

E-print Network

Simulation of Endoscopic Surgery Nicholas AYACHE 1 - Stéphane COTIN 1 - Hervé DELINGETTE 1 Jean of therapy. This is particularly true for video-surgery, where the use of video-images during, in order to rehearse a difficult surgical procedure. In the future, we believe that surgery simulators

Boyer, Edmond

390

Ergonomic evaluation of a new rotating, dual position laparoscopic instrument handle  

Microsoft Academic Search

Due to the restricted access of laparoscopic surgery, the surgeon's hand, wrist and arm are often forced into awkward positions. This is leading to cumulative trauma disorders of the wrist and arm. A unique handle design is described which permits the surgeon, without interrupting surgery, to rotate the instrument handle from a standard pistol grip to an in-line grip. This

Joseph Amaral; Andy Levine

1994-01-01

391

Postoperative Instructions Following Facial Surgery  

E-print Network

/Head & Neck Surgery Facial Plastic and Reconstructive Surgery 7. If eyelid surgery is performed there mayPostoperative Instructions Following Facial Surgery 1. Your surgery will be performed in the Surgery Center on the 4th floor of the Center for Health and Healing (CHH) at Oregon Health & Sciences

Chapman, Michael S.

392

The effect of humeral torsion on rotational range of motion in the shoulder and throwing performance  

E-print Network

METHODS The effect of humeral torsion on rotational range of motion in the shoulder and throwing of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 3 Harvard Medical School, Boston, MA 4 of external rotation at the shoulder than non-athletes. How these two parameters are related is debated

Lieberman, Daniel E.

393

The Effect of the Duration and Structure of a Surgery Clerkship on Student Performance  

Microsoft Academic Search

The emphasis on a generalist professional education has led to shortening and restructuring of the surgery clerkship in the curricula of many medical schools. Little data exist regarding the effect of these changes on student performance. Therefore, we examined the effect of the length, timing, and content of the third year surgery rotation on several clerkship and postclerkship performance measures

D. Scott Lind; Tiffany Marum; Daniel Ledbetter; Timothy C. Flynn; Lynn J. Romrell; Edward M. Copeland

1999-01-01

394

Rotation and polarization diversity  

Microsoft Academic Search

In this work, we propose and study the performance of a new transmit diversity technique called rotation and polarization diversity. In this technique, in-phase and quadrature components of the rotated symbols are transmitted over two different polarizations of polarized transmitted antenna. By this way, in-phase and quadrature components are affected by different fading coefficients. Error performance of the proposed technique

Ahmet Yilmaz; Oguz Kucur

2011-01-01

395

Diamagnetism of rotating plasma  

SciTech Connect

Diamagnetism and magnetic measurements of a supersonically rotating plasma in a shaped magnetic field demonstrate confinement of plasma pressure along the magnetic field resulting from centrifugal force. The Grad-Shafranov equation of ideal magnetohydrodynamic force balance, including supersonic rotation, is solved to confirm that the predicted angular velocity is in agreement with spectroscopic measurements of the Doppler shifts.

Young, W. C.; Hassam, A. B.; Romero-Talamas, C. A.; Ellis, R. F.; Teodorescu, C. [IREAP, University of Maryland, College Park, Maryland 20742 (United States)

2011-11-15

396

The aircraft rotation problem  

Microsoft Academic Search

Given a set of flights to be flown for a specific aircraft type, with specified maintenance locations, durations, and needed frequency, the aircraft rotation problem is to determine the specific route flown by each aircraft. The objective is to maximize the benefit derived from making specific connections. In this paper, we present a mathematical formulation for the aircraft rotation problem

Lloyd Clarke; Ellis Johnson; George Nemhauser; Zhongxi Zhu

1997-01-01

397

FORMULATION OF ROTATIONAL SYSTEMS  

E-print Network

, by formulating a rotational equivalent mass called "moment of inertia." 3.1 Newton's Law Revisited Let us begin Figure 3.2: Simple Pendulum with Torsion Spring for T to obtain Newton's law in units of torque: T = (mr2Chapter 3 FORMULATION OF ROTATIONAL SYSTEMS and review of second moments Many engineering problems

398

Mental Rotation Explanation  

NSDL National Science Digital Library

One of the most popular tasks used in measuring individual differences in spatial ability is a mental rotation task introduced by Shepard and Metzler (1971). This page provides information about use of a spatial ability task to illustrate the prinicple of mental rotation.

399

A portable Halbach magnet that can be opened and closed without force: The NMR-CUFF  

NASA Astrophysics Data System (ADS)

Portable equipment for nuclear magnetic resonance (NMR) is becoming increasingly attractive for use in a variety of applications. One of the main scientific challenges in making NMR portable is the design of light-weight magnets that possess a strong and homogeneous field. Existing NMR magnets can provide such magnetic fields, but only for small samples or in small regions, or are rather heavy. Here we show a simple yet elegant concept for a Halbach-type permanent magnet ring, which can be opened and closed with minimal mechanical force. An analytical solution for an ideal Halbach magnet shows that the magnetic forces cancel if the structure is opened at an angle of 35.3° relative to its poles. A first prototype weighed only 3.1 kg, and provided a flux density of 0.57 T with a homogeneity better than 200 ppm over a spherical volume of 5 mm in diameter without shimming. The force needed to close it was found to be about 20 N. As a demonstration, intact plants were imaged and water (xylem) flow measured. Magnets of this type (NMR-CUFF = Cut-open, Uniform, Force Free) are ideal for portable use and are eminently suited to investigate small or slender objects that are part of a larger or immobile whole, such as branches on a tree, growing fruit on a plant, or non-metallic tubing in industrial installations. This new concept in permanent-magnet design enables the construction of openable, yet strong and homogeneous magnets, which aside from use in NMR or MRI could also be of interest for applications in accelerators, motors, or magnetic bearings.

Windt, Carel W.; Soltner, Helmut; Dusschoten, Dagmar van; Blümler, Peter

2011-01-01

400

A Rotating Holographic Superconductor  

E-print Network

In this paper we initiate the study of SSB in 3+1 dimensional rotating, charged, asymptotically AdS black holes. The theory living on their boundary, R x S^2, has the interpretation of a 2+1 dimensional rotating holographic superconductor. We study the appearance of a marginal mode of the condensate as the temperature is decreased. We find that the transition temperature depends on the rotation. At temperatures just below T_c, the transition temperature at zero rotation, there exists a critical value of the rotation, which destroys the superconducting order. This behaviour is analogous to the emergence of a critical applied magnetic field and we show that the superconductor in fact produces the expected London field in the planar limit.

Julian Sonner

2009-03-03

401

The Educational Value of Community Preceptorships in Surgery.  

ERIC Educational Resources Information Center

A comparison of the experiences of 683 surgery students taking preceptorships in community hospitals and 696 taking only university-based rotations found no significant differences in individual characteristics, academic performance, choice of specialty for the first postgraduate year, or program director evaluations. The preceptorships were…

Rambo, William M.; And Others

1989-01-01

402

Robotic surgery for cancer.  

PubMed

Currently, robot-assisted surgery is the most common type of robotic surgery used. In robot-assisted surgery, the operator is a surgeon, not a robotic system. Robotic systems assist the surgeons, but do not operate automatically. In this section, we focus on the master-slave type, which is the predominant type of robotic surgery used in cancer treatment, and discuss the role, present status, and the future of surgical robotic system in cancer treatment. In addition, the advantages and disadvantages of a robotic system are discussed, but further development of technologies and equipment is necessary to allow the safe, widespread introduction of a robotic system in more advanced surgery for malignant tumors. Such advances in the surgical robotic system will hopefully overcome the remaining problems and provide the ultimate minimally invasive surgery for cancer treatment. PMID:23528720

Ohuchida, Kenoki; Hashizume, Makoto

2013-01-01

403

American Society for Surgery of the Hand 155 Acute Scapholunate and  

E-print Network

American Society for Surgery of the Hand 155 CHAPTER 10 Acute Scapholunate and Lunotriquetral translation, whereas the more obliquely oriented volar fibers are more critical in constraining rotation. When and lunate may be rendered translationally and rotationally unstable, leading to a widened SL gap, as well

Oliver, Douglas L.

404

Ophthalmic Plastic Surgery  

Microsoft Academic Search

In the family of ophthalmology subspecialties, ophthalmic plastic surgery is the adopted child. There are probably more differences\\u000a than there are similarities with the other subspecialties. The diseases that oculoplastic surgeons treat are unique, and the\\u000a surgeries they perform are quite different from those of ophthalmology colleagues. These unique attributes of ophthalmic plastic\\u000a surgery warrant special consideration in the study

Tanuj Nakra; Norman Shorr

405

[Crohn's disease surgery].  

PubMed

Surgery of Crohns disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohns disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries. PMID:25130639

Kala, Zden?k; Marek, Filip; Válek, Vlastimil A; Bartušek, Daniel

2014-01-01

406

Hyperoxaluria and Bariatric Surgery  

NASA Astrophysics Data System (ADS)

Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

Asplin, John R.

2007-04-01

407

Rotatable seal assembly. [Patent application; rotating targets  

DOEpatents

An assembly is provided for rotatably supporting a rotor on a stator so that vacuum chambers in the rotor and stator remain in communication while the chambers are sealed from ambient air, which enables the use of a ball bearing or the like to support most of the weight of the rotor. The apparatus includes a seal device mounted on the rotor to rotate therewith, but shiftable in position on the rotor while being sealed to the rotor as by an O-ring. The seal device has a flat face that is biased towards a flat face on the stator, and pressurized air is pumped between the faces to prevent contact between them while spacing them a small distance apart to avoid the inflow of large amounts of air between the faces and into the vacuum chambers.

Logan, C.M.; Garibaldi, J.L.

1980-11-12

408

Rotational Quantum Friction  

E-print Network

We investigate the frictional forces due to quantum fluctuations acting on a small sphere rotating near a surface. At zero temperature, we find the frictional force near a surface to be several orders of magnitude larger than that for the sphere rotating in vacuum. For metallic materials with typical conductivity, quantum friction is maximized by matching the frequency of rotation with the conductivity. Materials with poor conductivity are favored to obtain large quantum frictions. For semiconductor materials that are able to support surface plasmon polaritons, quantum friction can be further enhanced by several orders of magnitude due to the excitation of surface plasmon polaritons.

Rongkuo Zhao; Alejandro Manjavacas; F. Javier García de Abajo; J. B. Pendry

2012-08-21

409

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine  

E-print Network

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine Trauma and Post______________________________: This letter is to welcome you to the University of California, Davis Department of Orthopaedic Surgery

Leistikow, Bruce N.

410

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine  

E-print Network

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine Trauma and Post Department of Orthopaedic Surgery 4860 Y Street, 1700 Sacramento, CA 95817 P: 916.734.2700 F: 916

Leistikow, Bruce N.

411

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine  

E-print Network

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine Trauma and Post OF CALIFORNIA, DAVIS Department of Orthopaedic Surgery 4860 Y Street, Suite 3800 Sacramento, CA 95817 P: 916

Leistikow, Bruce N.

412

Different mental rotation strategies reflected in the rotation related negativity.  

PubMed

In a mental rotation task of objects, typically, reaction time (RT) increases and the rotation related negativity (RRN) increases in amplitude with increasing angles of rotation. However, in a mental rotation task of hands, different RT profiles can be observed for outward and inward rotated hands. In the present study, we examined the neurophysiological correlates of these asymmetries in the RT profiles. We used a mental rotation task with stimuli of left and right hands. In line with previous studies, the behavioral results showed a linear increase in RT for outward rotations, but not for inward rotations as a function of angular disparity. Importantly, the ERP results revealed an RRN for outward rotated stimuli, but not for inward rotated stimuli. This is the first study to show that the behaviorally observed differences in a mental rotation task of hands is also reflected at the neurophysiological level. PMID:22091978

ter Horst, Arjan C; Jongsma, Marijtje L A; Janssen, Lieneke K; van Lier, Rob; Steenbergen, Bert

2012-04-01

413

Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25?cmH?O: prospective, blind, and randomised study.  

PubMed

To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60?cmH?O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25?cmH?O, L group) and high (at 60?cmH?O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25?cmH?O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334. PMID:24778598

Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

2014-01-01

414

Silicone rubber cuff and patch electrodes with multiple contacts were im-planted along the sciatic-tibial-plantar nerves in cat for repeated studies of  

E-print Network

and the Division of Neurology, Brigham and Women's Hospital and Depart- ment of Neurology, Harvard Medical School cuff electrodes, Mr. W. Yee for writing the computer programs used in the morphometric analysis of nerve, Mr. A. Rindos for assistance in per- forming early laminectomies, and Mrs. Michele Manley

Loeb, Gerald E.

415

Early results of a prospective randomized trial of spliced vein versus polytetrafluoroethylene graft with a distal vein cuff for limb-threatening ischemia  

Microsoft Academic Search

Objective: Single-piece vein remains the conduit of choice in patients who need bypass grafting for limb salvage. When this option is not available, two of the remaining options are prosthetic bypass graft or several segments of vein spliced together. In this study, we compare spliced vein bypass grafting versus polytetrafluoroethylene grafting with a distal vein cuff in patients with limb-threatening

Paul B. Kreienberg; R. Clement Darling; Benjamin B. Chang; Bradley J. Champagne; Philip S. K. Paty; Sean P. Roddy; William E. Lloyd; Kathleen J. Ozsvath; Dhiraj M. Shah

2002-01-01

416

Rotating mobile launcher  

NASA Technical Reports Server (NTRS)

Apparatus holds remotely piloted arm that accelerates until launching speed is reached. Then vehicle and counterweight at other end of arm are released simultaneously to avoid structural damage from unbalanced rotating forces.

Gregory, T. J.

1977-01-01

417

The Earth's rotation problem  

NASA Astrophysics Data System (ADS)

The aim of the present paper is to find the trigonometric solution of the equations of the Earth's rotation around its centre of mass in the form of polynomial trigonometric series (Poisson series) without secular and mixed therms. For that the techniques of the General Planetary Theory (GPT) ( Brumberg, 1995) and the Poisson Series Processor (PSP) (Ivanova, 1995) are used. The GPT allows to reduce the equations of the translatory motion of the major planets and the Moon and the equations of the Earth's rotation in Euler parameters to the secular system describing the evolution of the planetary and lunar orbits (independent of the Earth's rotation) and the evolution of the Earth's rotation (depending on the planetary and lunar evolution).

Brumberg, V. A.; Ivanova, T. V.

2008-09-01

418

Synchronous Rotation of Moon  

NSDL National Science Digital Library

The representation is an animation of the moon's orbit around the Earth. This animation and accompanying text explain that the same side of the moon always faces Earth because of the moon's rotation. The animation begins with a demonstration of how the moon would appear if it did not rotate on its axis, and shows that all sides would be visible from Earth at some point in that orbit. The animation then shows the synchronous rotation of the moon and explains this rotation is the reason for our only seeing one side of the moon. The sun is shown at the right side of the diagram and the Earth and moon are shown with an illuminated side facing the sun and a dark side facing away from the sun. Colored "craters" on opposite sides of the moon are used as reference points for the animation.

419

Mental Rotation Experiment  

NSDL National Science Digital Library

This is the entry page for the Mental Rotation Experiment. This experiment presents 16 different pairs of three dimensional objects. Users judge whether the objects are the same or different. Responses are timed.

420

LeBonheur Children's Hospital/Aesthetic Surgery Plastic Surgery Rotation  

E-print Network

of dermatomes, management of graft donor sites, and care of graft recipient sites � Surgical procedures using procedures including but not limited to: � Rhytidectomy, suction lipectomy, brow lift, blepharoplasty � Aesthetic procedures on patients with massive weight loss � Surgical and nonsurgical procedures of common

Cui, Yan

421

Smoking and Surgery  

MedlinePLUS

Q&A: Stop Smoking Share PRINT Print Home > Anesthesia Topics > Detail Page Q: Why should I quit smoking before I have surgery? A: By quitting smoking, ... especially important to the anesthesiologist that I quit smoking before my surgery? A: Anesthesiologists are the heart ...

422

Cosmetic vulvovaginal surgery  

Microsoft Academic Search

Cosmetic vulvovaginal surgery arouses considerable media interest. There are significant ethical and technical challenges posed by such procedures, which may not be justified on medical grounds. Many such operations are performed without adequate evidence of either safety or psychosocial benefit. The best established female genital cosmetic procedure is reduction labioplasty. Women request reduction surgery for their labia for two distinct

Rufus Cartwright; Linda Cardozo

2008-01-01

423

Cervix Uteri Surgery Codes  

Cancer.gov

Cervi x Uteri C530–C539 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) [SEER Note: Do not code dilation and curettage (D&C) as Surgery of Primary Site for invasive cancers] Codes 00 None; no surgery

424

What Is Refractive Surgery?  

MedlinePLUS

... steeper cornea to increase the eye's focusing power. Images that are focused beyond the retina, due to a short eye or flat cornea, will be pulled closer to or directly onto the retina after surgery. Astigmatism can be corrected with refractive surgery techniques ...

425

Heart valve surgery - discharge  

MedlinePLUS

... surgery to repair or replace one of your heart valves. Your surgery may have been done through a large incision ( ... 118:e523-e661. Fullerton DA, Harken AH. Acquired heart disease: ... . 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap ...

426

Gallbladder Cancer: Surgery  

MedlinePLUS

... the results of earlier surgeries show there is a good chance that the surgeon can remove all of the cancer. Doctors use the term resectable to describe cancers they believe ... are in too difficult a place to be removed by surgery. Unfortunately, only ...

427

Refractive surgery survey 2001  

Microsoft Academic Search

In February 2001, a questionnaire on the practice of refractive surgery was sent worldwide to all 8196 members of the American Society of Cataract and Refractive Surgery; 1511 responses (18.4%) were received. Although laser in situ keratomileusis (LASIK) was the most common refractive procedure reported, phakic intraocular lenses, clear lens extraction, and photorefractive keratectomy were also widespread. Nineteen percent of

Kerry D Solomon; Mike P Holzer; Helga P Sandoval; Luis G Vargas; Liliana Werner; David T Vroman; Terrance J Kasper; David J Apple

2002-01-01

428

Cosmetic Breast Surgery Simulation  

Microsoft Academic Search

Cosmetic breast surgery is a surgical procedure to alter or revise the size or shape of the breasts. It is one of the most frequently performed surgical procedures in plastic surgery today. New surgical techniques and devices are continuously created making possible for surgeons to shape a breast in many different ways. For each case the patient have often many

Remis Balaniuk; Ivan Costa; Jairo Melo

429

Corpus Uteri Surgery Codes  

Cancer.gov

Corpus Uteri C540–C559 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) [SEER Note: Do not code dilation and curettage (D&C) as Surgery of Primary Site for invasive cancers] Codes 00 None; no surgery

430

Hybrid Pediatric Cardiac Surgery  

Microsoft Academic Search

Minimally invasive strategies can be expanded by combining standard surgical and interventional techniques. We performed a longitudinal prospective study of all pediatric patients who have undergone hybrid cardiac surgery at the University of Chicago Children's Hospital. Hybrid cardiac surgery was defined as combined catheter-based and surgical interventions in either one setting or in a planned sequential fashion within 24 hours.

E. A. Bacha; Z. M. Hijazi; Q. L. Cao; R. Abdulla; J. P. Starr; J. Quinones; P. Koenig; B. Agarwala

2005-01-01

431

Economics of epilepsy surgery  

PubMed Central

Objective: Surgical decision-making is a complex process. First, a medical decision is made to determine if surgery is necessary. Second, another medical decision is made to determine the type of surgery. Third, a corporate decision is made if such a surgery is financially feasible. Finally, a legal decision is made to proceed or refuse the chosen surgery. This paper examines these issues in the case of surgery for medically intractable epilepsy and proposes a method of decision analysis to guide epilepsy surgery. Materials and Methods: A stochastic game of imperfect information using techniques of game theory and decision analysis is introduced as an analytical tool for surgical decision-making. Results: Surgery for appropriately chosen patients suffering from medically intractable epilepsy may not only be feasible, but may be the best medical option and the best financial option for the patient, families, society and the healthcare system. Such a situation would then make it legally or ethically difficult to reject or postpone surgery for these patients. Conclusions: A process to collect data to quantify the parameters used in the decision analysis is hereby proposed. PMID:24791079

Sadanand, Venkatraman

2014-01-01

432

Gastric bypass surgery - discharge  

MedlinePLUS

Bariatric surgery - gastric bypass - discharge; Roux-en-Y gastric bypass - discharge; Gastric bypass- Roux-en-Y - discharge ... Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the ... Med Clin North Am . 2007;91:353-381. Mechanick JI, Kushner RF, ...

433

Instability in Rotating Machinery  

NASA Technical Reports Server (NTRS)

The proceedings contain 45 papers on a wide range of subjects including flow generated instabilities in fluid flow machines, cracked shaft detection, case histories of instability phenomena in compressors, turbines, and pumps, vibration control in turbomachinery (including antiswirl techniques), and the simulation and estimation of destabilizing forces in rotating machines. The symposium was held to serve as an update on the understanding and control of rotating machinery instability problems.

1985-01-01

434

Rotational vertebral artery syndrome  

Microsoft Academic Search

Whether the rotational vertebral artery syndrome (RVAS), consisting of attacks of vertigo, nystagmus and tinnitus elicited\\u000a by head-rotation induced compression of the dominant vertebral artery (VA), reflects ischemic dysfunction of uni- or bilateral\\u000a peripheral or central vestibular structures, is still debated. We report on a patient with bilateral high-grade carotid stenoses,\\u000a in whom rightward headrotation led to RVAS symptoms including

Sarah Marti; Stefan Hegemann; Hans-Christian von Büdingen; Ralf W. Baumgartner; Dominik Straumann

2008-01-01

435

Faraday rotation in graphene  

E-print Network

We study magneto--optical properties of monolayer graphene by means of quantum field theory methods in the framework of the Dirac model. We reveal a good agreement between the Dirac model and a recent experiment on giant Faraday rotation in cyclotron resonance. We also predict other regimes when the effects are well pronounced. The general dependence of the Faraday rotation and absorption on various parameters of samples is revealed both for suspended and epitaxial graphene.

I. V. Fialkovsky; D. V. Vassilevich

2012-03-20

436

The Physics of Rotation  

NSDL National Science Digital Library

This web site contains media-illustrated articles on various physical phenomena related to the Coriolis effect. Almost all of the articles are illustrated with animations and java simulations. The main subjects covered include the Coriolis and Centrifugal effects, rotation-vibration coupling, the consequences of Earth's rotation on oceanography and weather, the Foucault pendulum, and angular momentum conservation. There are also articles on the Eötvös effect and special and general relativity.

Teunissen, Cleon

2009-01-12

437

Electromagnetic rotational actuation.  

SciTech Connect

There are many applications that need a meso-scale rotational actuator. These applications have been left by the wayside because of the lack of actuation at this scale. Sandia National Laboratories has many unique fabrication technologies that could be used to create an electromagnetic actuator at this scale. There are also many designs to be explored. In this internship exploration of the designs and fabrications technologies to find an inexpensive design that can be used for prototyping the electromagnetic rotational actuator.

Hogan, Alexander Lee

2010-08-01

438

Arterial blood oxygen saturation during blood pressure cuff-induced hypoperfusion  

NASA Astrophysics Data System (ADS)

Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO2) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Pulse oximeters estimate arterial oxygen saturation by shining light at two different wavelengths, red and infrared, through vascular tissue. In this method the ac pulsatile photoplethysmographic (PPG) signal associated with cardiac contraction is assumed to be attributable solely to the arterial blood component. The amplitudes of the red and infrared ac PPG signals are sensitive to changes in arterial oxygen saturation because of differences in the light absorption of oxygenated and deoxygenated haemoglobin at these two wavelengths. From the ratios of these amplitudes, and the corresponding dc photoplethysmographic components, arterial blood oxygen saturation (SpO2) is estimated. Hence, the technique of pulse oximetry relies on the presence of adequate peripheral arterial pulsations, which are detected as photoplethysmographic (PPG) signals. The aim of this study was to investigate the effect of pressure cuff-induced hypoperfusion on photoplethysmographic signals and arterial blood oxygen saturation using a custom made finger blood oxygen saturation PPG/SpO2 sensor and a commercial finger pulse oximeter. Blood oxygen saturation values from the custom oxygen saturation sensor and a commercial finger oxygen saturation sensor were recorded from 14 healthy volunteers at various induced brachial pressures. Both pulse oximeters showed gradual decrease of saturations during induced hypoperfusion which demonstrate the direct relation between blood volumes (PPG amplitudes), arterial vessel stenosis and blood oxygen saturation. The custom made pulse oximeter was found to be more sensitive to SpO2 changes than the commercial pulse oximeter especially at high occluding pressures.

Kyriacou, P. A.; Shafqat, K.; Pal, S. K.

2007-10-01

439

Rotational Spectrum of Sarin  

NASA Astrophysics Data System (ADS)

As part of an effort to examine the possibility of using molecular-beam Fourier-transform microwave spectroscopy to unambiguously detect and monitor chemical warfare agents, we report the first observation and assignment of the rotational spectrum of the nerve agent Sarin (GB) (Methylphosphonofluoridic acid 1-methyl-ethyl ester, CAS #107-44-8) at frequencies between 10 and 22 GHz. Only one of the two low-energy conformers of this organophosphorus compound (C 4H 10FO 2P) was observed in the rotationally cold ( Trot<2 K) molecular beam. The experimental asymmetric-rotor ground-state rotational constants of this conformer are A=2874.0710(9) MHz, B=1168.5776(4) MHz, C=1056.3363(4) MHz (Type A standard uncertainties are given, i.e., 1?), as obtained from a least-squares analysis of 74 a-, b-, and c-type rotational transitions. Several of the transitions are split into doublets due to the internal rotation of the methyl group attached to the phosphorus. The three-fold-symmetry barrier to internal rotation estimated from these splittings is 677.0(4) cm -1. Ab initio electronic structure calculations using Hartree-Fock, density functional, and Moller-Plesset perturbation theories have also been made. The structure of the lowest-energy conformer determined from a structural optimization at the MP2/6-311G ** level of theory is consistent with our experimental findings.

Walker, A. R. Hight; Suenram, R. D.; Samuels, Alan; Jensen, James; Ellzy, Michael W.; Lochner, J. Michael; Zeroka, Daniel

2001-05-01

440

Reverse shoulder arthroplasty using an implant with a lateral center of rotation: outcomes, complications, and the influence of experience.  

PubMed

Reverse shoulder arthroplasty (RSA) has revolutionized treatment of arthritis and rotator cuff insufficiency and is performed using implants with either a medial or a lateral center of rotation. We conducted a study of the outcomes and the effect of surgeon learning after the first