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Sample records for rotator cuff surgery

  1. Rotator Cuff Injuries.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    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…

  2. Rotator Cuff Exercises

    MedlinePLUS

    ... muscles of the rotator cuff--the part that helps with circular motion). These exercises should not cause you pain. If you feel any pain, stop exercising. Start again with a lighter weight. Warm up before adding weights. To warm up, stretch your ...

  3. [Ultrasound assessment of reconstructed rotator cuffs].

    PubMed

    Cammerer, U; Habermeyer, P; Plenk, A; Huber, R

    1992-12-01

    The evaluation of recurrent shoulder symptoms in patients who have had rotator cuff repair is a diagnostic challenge. Pain and limitation of motion may be caused by a recurrence of the rotator cuff tear. Arthrography is not considered to be helpful in postoperative cases, since it is false-positive in most of them. Pre-operative ultrasonography of the shoulder is regarded as a highly accurate diagnostic tool for rotator cuff tears. The diagnostic criteria used are: the continuity of the rotator cuff, its contour, its thickness and its echogenicity. Our study was aimed at determining which ultrasonographic criteria were significant for a retear. In addition, the "normal" postoperative sonographic appearance of the rotator cuff was established. Of 133 patients with a full thickness rotator cuff tear, 110 were evaluated 4-48 months (mean in 21 months) after surgery. A total of 85 cuffs were reconstructed, in 46 cases by direct suture, in 33 cases by suture to the major tubercle and in 6 cases by tendon transfer (Cofield technique). In 25 cases cuffs the could not be reconstructed. Subacromial decompression was performed routinely. The patients were evaluated clinically by range of movement, force and isometric and impingement tests. The subjective outcome was assessed by the algo-functional index of Patte. Ultrasonography was performed using a 7.5-MHz linear scanner. Each sonographic criterion was referred to the clinical and subjective findings. Ultrasonographic evaluation of the rotator cuffs that could not be reconstructed revealed non-visualization of the tendons. In 13 of the 85 patients in whom reconstruction of the cuff was possible a normal sonographic pattern was seen.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1287844

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

    E-print Network

    Gill, Harmeet (Harmeet Kaur)

    2007-01-01

    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 ...

  5. Prevalence of rotator cuff tears in operative proximal humerus fractures.

    PubMed

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

    2014-11-01

    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

  6. Proximal Biceps Tendon and Rotator Cuff Tears.

    PubMed

    Virk, Mandeep S; Cole, Brian J

    2016-01-01

    The long head of biceps tendon (LHBT) is frequently involved in rotator cuff tears and can cause anterior shoulder pain. Tendon hypertrophy, hourglass contracture, delamination, tears, and tendon instability in the bicipital groove are common macroscopic pathologic findings affecting the LHBT in the presence of rotator cuff tears. Failure to address LHBT disorders in the setting of rotator cuff tear can result in persistent shoulder pain and poor satisfaction after rotator cuff repair. Tenotomy or tenodesis of the LHBT are effective options for relieving pain arising from the LHBT in the setting of reparable and selected irreparable rotator cuff tears. PMID:26614474

  7. Treatment of lesions of the rotator cuff.

    PubMed

    Saggini, R; Cavezza, T; Di Pancrazio, L; Pisciella, V; Saladino, G; Zuccaro, M C; Bellomo, R G

    2010-01-01

    The impingement syndrome and tendinopathy of the rotator cuff are the most common causes (complaints) of pain and disability of the shoulder. The aim of this study is to evaluate the efficacy of a specific rehabilitative protocol, integrated with the administration of a nutritional supplement, in the conservative rehabilitative treatment, as well as in post-surgery, of patients with lesions of the rotator cuff. Two groups with syndrome of the rotator cuff were formed to follow different therapeutic courses, in relation to the choice of each subject to undergo the conservative treatment (Arm A) or the surgical one (Arm B). In Arm A the study included the association of therapy with ESWT (shock waves) with the proprioceptive Multi Joint System, for rehabilitating joint movement and muscle strength of the shoulder, and a specific nutritional supplement to reduce the pain and conserve the cartilage tissue. Between February 2009 and June 2009, we enrolled 30 subjects (randomized into three homogenous groups A1, A2, A3), average age 45±10 years, with rotator cuff syndrome with calcification of the shoulder, diagnosed through clinical examination and investigative instruments (X-ray, echography or NMR). In Arm B, from September 2009 to January 2010, we enrolled 50 patients (randomized into two groups, B1 and B2), 24 male (average age 58.4: min 28 and max 78) and 26 females (average age 59.5: min 30 and max 80), who had undergone rotator cuff operations and acromionplasty for non-massive lesions without important gleno-humeral instability, with either open or arthroscopic procedures. The analysis of the results of Arm A highlights that in terms of reducing pain the main benefits were found in Group A1 where the supplement was given. From the analysis of the data of Arm B, in both groups an improvement of the first 4 items evaluated was evident. In Group B1, 84 percent of the patients declared to be satisfied and improved and 16 percent were dissatisfied; in Group B2, where the nutritional supplement was given, 92 percent were satisfied and 8 percent were dissatisfied. In conclusion, we retain that in cases of rotator cuff syndrome, an integrated rehabilitative approach, whether conservative or post-surgical, directed at taking total control of the patient, must observe particular attention to the optimization of the articular tissular metabolic balance in order to favour better functional recovery. PMID:21122285

  8. Rotator Cuff Injuries

    MedlinePLUS

    ... cold to the sore area Medicines that reduce pain and swelling Electrical stimulation of muscles and nerves Ultrasound Cortisone injection Surgery NIH: National Institute of Arthritis and Musculoskeletal and Skin Disease

  9. Rotator Cuff Tears

    MedlinePLUS

    ... can stress your rotator cu? muscles and tendons. Baseball, tennis, rowing, and weightli ing are examples of ... vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead ...

  10. Understanding and preventing complications in repairing rotator cuff tears.

    PubMed

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

    2012-01-01

    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

  11. Biomechanical analysis of bursal-sided partial thickness rotator cuff tears

    E-print Network

    Makhsous, Mohsen

    of the supraspinatus tendon to 3/4 tendon width on ten fresh-frozen shoulder specimens. The supra- spinatus muscle of Shoulder and Elbow Surgery Board of Trustees. Keywords: Rotator cuff; rotator cuff tear; supraspinatus contributing to formation of PTCRTs include sub- acromial impingement as a main proponent of bursal sided tears

  12. Rotator cuff tears in the throwing athlete.

    PubMed

    Shaffer, Benjamin; Huttman, Daniel

    2014-06-01

    Tears of the rotator cuff, both partial, and less commonly, full thickness, are relatively common in the throwing athlete. The rotator cuff is subjected to enormous stresses during repetitive overhead activity. The supraphysiological strains, especially when combined with pathology elsewhere in the kinetic chain, can lead to compromise of the cuff fabric, most commonly on the undersurface where tensile overload occurs. Exacerbation by a tight posterior capsular, anterior instability, and internal impingement render the cuff progressively compromised, with intrinsic shear stresses and undersurface fiber failure. Advances in imaging technology, including contrast magnetic resonance imaging, dynamic ultrasound, and arthroscopic visualization have enhanced our understanding of cuff pathology in this athletic population. Unfortunately, this has not yet translated into how to best approach these athletes to return them to their previous level of activity. Nonoperative management remains the mainstay for most throwers, with arthroscopic debridement an effective surgical option for those with refractory symptoms. Despite technological advances in cuff repair in the general population, comparable outcomes have not been achieved in high-level throwers. Widespread appreciation that securing the cuff operatively will likely end an athletes' throwing career has led to adopting a surgical approach that emphasizes debridement over repair for nearly all partial and full-thickness tears. Whether advances in surgical technique will ultimately permit definitive and lasting repairs that allow overhead throwers to return to their previous level of sports remains unknown at this time. PMID:24787724

  13. Rotator cuff tears: An evidence based approach.

    PubMed

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-12-18

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality. PMID:26716086

  14. Rotator cuff tears: An evidence based approach

    PubMed Central

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality. PMID:26716086

  15. Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model

    PubMed Central

    Luan, Tammy; Liu, Xuhui; Easley, Jeremiah T.; Ravishankar, Bharat; Puttlitz, Christian; Feeley, Brian T.

    2015-01-01

    Summary Introduction rotator cuff tears (RCTs) are the most common tendon injury seen in orthopedic patients. Muscle atrophy and fatty infiltration of the muscle are crucial factors that dictate the outcome following rotator cuff surgery. Though less studied in humans, rotator cuff muscle fibrosis has been seen in animal models as well and may influence outcomes as well. The purpose of this study was to determine if the rotator cuff would develop muscle changes even in the setting of an acute repair in a sheep model. We hypothesized that fatty infiltration and fibrosis would be present even after an acute repair six months after initial surgery. Methods twelve female adult sheep underwent an acute rotator cuff tear and immediate repair on the right shoulder. The left shoulder served as a control and did not undergo a tear or a repair. Six months following acute rotator cuff repairs, sheep muscles were harvested to study atrophy, fatty infiltration, and fibrosis by histological analysis, western blotting, and reverse transcription polymerase chain reaction (RT-PCR). Results the repair group demonstrated an increase expression of muscle atrophy, fatty infiltration, and fibrosis related genes. Significantly increased adipocytes, muscle fatty infiltration, and collagen deposition was observed in rotator cuff muscles in the tendon repair group compared to the control group. Conclusions rotator cuff muscle undergoes degradation changes including fatty infiltration and fibrosis even after the tendons are repair immediately after rupture. Level of Evidence Basic Science Study. PMID:26261789

  16. Massive rotator cuff tears: arthroscopy to arthroplasty.

    PubMed

    Singh, Anshu; Jawa, Andrew; Morman, Monica; Sanofsky, Benjamin; Higgins, Laurence

    2010-01-01

    The understanding of rotator cuff disease has increased exponentially since Codman drew attention to this pathology in the early 1900s. Although challenging, the surgical treatment of massive rotator cuff tears is rational, with treatment decisions based on physical examination, imaging, biologic, and patient factors. Arthroscopy can be used to treat ancillary pain generators, débride necrotic tissue, and possibly restore balance to the force couples about the shoulder. Tendon transfers may be effective in restoring functional strength to irreparable, ineffectual muscle units. Arthroplasty is both a primary treatment and a salvage option. PMID:20415384

  17. Biologically based strategies to augment rotator cuff tears

    PubMed Central

    Schaer, M.; Schober, M.; Berger, S.; Boileau, P.; Zumstein, M. A.

    2012-01-01

    Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords “tendon,” “rotator cuff,” “augmentation,” “growth factor,” “platelet-rich fibrin,” and “platelet-rich plasma” for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor. PMID:22787334

  18. Clinical and biological aspects of rotator cuff tears

    PubMed Central

    Giai Via, Alessio; De Cupis, Mauro; Spoliti, Marco; Oliva, Francesco

    2013-01-01

    Summary Rotator cuff tears are common and are a frequent source of shoulder pain and disability. A wide variation in the prevalence of rotator cuff tears has been reported. The etiology of rotator cuff tear remains multifactorial and attempts to unify intrinsic and extrinsic theories tried to explain the etiopathogenesis of rotator cuff tears. Knowledge of the etiopathogenesis of rotator cuff tears is important to improve our therapies, surgical techniques and promote tendon repair. Several strategies have been proposed to enhance tendon healing and recently research has focused on regenerative therapies, such as Growth Factors (GFs) and Plasma Rich Platelet (PRP), with high expectations of success. PMID:23888289

  19. Subacromial volume and rotator cuff tears

    PubMed Central

    Yi, Anthony; Avramis, Ioannis A; Argintar, Evan H; White, Eric R; Villacis, Diego C; Hatch III, George F Rick

    2015-01-01

    Background: Rotator cuff pathology occurs commonly and its cause is likely multifocal in origin. The development and progression of rotator cuff injury, especially in relation to extrinsic shoulder compression, remain unclear. Traditionally, certain acromial morphologies have been thought to contribute to rotator cuff injury by physically decreasing the subacromial space. The relationship between subacromial space volume and rotator cuff tears (RCT) has, however, never been experimentally confirmed. In this study, we retrospectively compared a control patient population to patients with partial or complete RCTs in an attempt to quantify the relationship between subacromial volume and tear type. Materials and Methods: We retrospectively identified a total of 46 eligible patients who each had shoulder magnetic resonance imaging (MRI) performed from January to December of 2008. These patients were stratified into control, partial RCT, and full-thickness RCT groups. Subacromial volume was estimated for each patient by averaging five sequential MRI measurements of subacromial cross-sectional areas. These volumes were compared between control and experimental groups using the Student's t-test. Results: With the numbers available, there was no statistically significant difference in subacromial volume measured between: the control group and patients diagnosed partial RCT (P > 0.339), the control group and patients with complete RCTs (P > 0.431). Conclusion: We conclude that subacromial volumes cannot be reliably used to predict RCT type. PMID:26015629

  20. Regenerative Medicine in Rotator Cuff Injuries

    PubMed Central

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

    2014-01-01

    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. PMID:25184132

  1. The Role of Acromioplasty for Management of Rotator Cuff Problems: Where Is the Evidence?

    PubMed Central

    Shi, Lewis L.; Edwards, T. Bradley

    2012-01-01

    The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease. PMID:23316375

  2. Imaging of the Rotator Cuff With Optical Coherence Tomography.

    PubMed

    Hartshorn, Timothy; Ren, Jian; Vangsness, C Thomas

    2015-09-01

    This study evaluated the utility of optical coherence tomography (OCT) in imaging porcine and human rotator cuff (RTC) tissue, analyzed its effectiveness in identifying clinical pathology, and correlated these findings with histologic examination. Twelve human cadaveric and 6 porcine shoulders were evaluated. Six-millimeter-wide bone sections were harvested from the proximal humerus of each specimen, with each containing the entire enthesis of the respective RTC tendon, as well as 2 cm of tendon medial to the enthesis. Only the supraspinatus tendon was evaluated in the human specimens, whereas the enthesis of multiple RTC tendons were evaluated in the porcine model. All specimens were imaged using OCT and correlated with histologic evaluation. Optical coherence tomography evaluation of macroscopically healthy tissue consistently showed an easily identifiable banding pattern (birefringence) in contrast to a disorganized, homogeneous appearance in grossly diseased tissue. Optical coherence tomography was more effective for qualitative evaluation of RTC tissue, identification of bursal-sided RTC tears, and localization of calcific deposits, whereas intrasubstance tendon delaminations and partial articular-sided tendon avulsion lesions were relatively more difficult to identify. Optical coherence tomography correlated well with histologic evaluation in all specimens. Optical coherence tomography provides high-resolution, subsurface imaging of rotator cuff tissue in real-time to a depth of up to 4 mm with excellent correlation to histology in a cadaveric model. Optical coherence tomography could be an effective adjunctive tool for the identification and localization of rotator cuff pathology. The use of OCT in arthroscopic shoulder surgery potentially provides a minimally invasive modality for qualitative assessment of rotator cuff pathology. This may allow for a decrease in soft tissue dissection, improved qualitative assessment of cuff tissue, and improved patient outcomes. PMID:26375544

  3. Anomalous biceps origin from the rotator cuff

    PubMed Central

    Banerjee, Samik; Patel, Vipul R

    2015-01-01

    Variations in the origin of the long head of biceps tendon (LHBT) have been described in literature; however, its clinical significance remains uncertain. We describe in this report, the history, physical examination and the arthroscopic findings in a patient who had an anomalous origin of the LHBT from the rotator cuff, resulting in restriction of range of motion. This anomalous origin of the long head of biceps tendon causing capsular contracture and restriction of movements leading to secondary internal impingement, has not been extensively reported in the literature. Shoulder arthroscopists should be aware that, although, an uncommon clinical condition, the aberrant congenital origin of the LHBT from the rotator cuff can rarely become pathologic in middle age and lead to shoulder dysfunction. In such cases, release of the anomalous band may be required, along with the treatment of other concomitant intraarticular pathologies in the glenohumeral joint. PMID:25593361

  4. Disability and satisfaction after Rotator Cuff decompression or repair: a sex and gender analysis

    PubMed Central

    2011-01-01

    Background Rotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery. Methods Patients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 months post-operatively. They also rated their satisfaction with surgery at their follow-up appointment. Results and Discussion One hundred and seventy patients entered into the study (85 men and 85 women). One hundred and sixty patients (94%) completed the 6-month assessment. Women reported more disability both prior to and after surgery. Disability at 6 months was associated with pain-limited range of motion, participation limitation, age and strength. Satisfaction with surgery was associated with level of reported disability, expectations for improved pain, pain-limited range of motion and strength. Conclusions The results of this study indicate that women with rotator cuff pathology suffer from higher levels of pre- and post-operative disability and sex and gender qualities contribute to these differences. Gender-sensitive approach will help to identify existing differences between men and women which will help to promote more effective and tailored care by health professionals. PMID:21457534

  5. Delivered growth factor therapy to improve healing after rotator cuff repair

    PubMed Central

    Cheung, Emilie V; Silverio, Luz; Yao, Jeffrey

    2010-01-01

    Background Degenerative rotator cuff tears are a significant cause of shoulder pain in the aging population. Rotator cuff repair surgery may be more successful when growth factors are delivered to the repair site. This study was designed to determine the cellular processes involved in normal bone-to-tendon healing and the current approaches used for biologic augmentation of rotator cuff repair. Methods This review focuses on animal studies of rotator cuff repair and early human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is markedly different from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for endogenous fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells. However, research in extracellular matrices is not conclusive due to intermanufacturer variation and the lack of human subject research. Growth factors and platelet-rich plasma are established in other fields of research and show promise, but have not yet been rigorously tested in rotator cuff repair augmentation. Conclusions Rotator cuff repair can benefit from biologic augmentation. However, research in this field is still young and has not yet demonstrated that the benefits in healing rates are significant enough to merit regular clinical use. Randomized controlled trials will elucidate the use of biologic augmentation in rotator cuff repairs. PMID:24198519

  6. Anterior superior instability with rotator cuff tearing: SLAC lesion.

    PubMed

    Savoie, F H; Field, L D; Atchinson, S

    2001-07-01

    Anterosuperior instability of the shoulder may occur from a variety of pathologic lesions. We describe a specific entity, the SLAC (superior labrum, anterior cuff) lesion that involves an association of anterior-superior labral tear with a partial supraspinatus tear. We retrospectively isolated a group of 40 patients with this lesion. The presenting complaints, physical examination findings, surgical findings, and results were isolated. Overhead activities were the most common etiology; load and shift instability testing and whipple rotator cuff testing were the most common physical examination findings. Surgical repair was successful in 37 of the 40 patients. The SLAC lesion is a definable clinical entity with predictable history, examination, surgical pathology, and satisfactory results from surgery. PMID:11888140

  7. Rotator cuff lesions with shoulder stiffness: updated pathomechanisms and management.

    PubMed

    Ko, Jih-Yang; Wang, Feng-Sheng

    2011-01-01

    Few previous studies have investigated the pathomechanism and managements of rotator cuff lesions with shoulder stiffness. Based on observations by Codman in 1934, frozen shoulder presumably relates to rotator cuff tendenitis. In the past six decades, tended to discriminate primary frozen shoulder from secondary shoulder stiffness due to shoulder disorders such as rotator cuff lesions or trauma. Intrinsic degeneration and outlet acromial spur impingement are reported as pathogenic causes of rotator cuff lesion. Although patients with rotator cuff lesions with shoulder stiffness or adhesive capsulitis (frozen shoulder) may have similar complaints about pain and motion limitation, the pathological reactions in these disorders remain unclear. In our investigation of clinical vignettes of shoulder stiffness, inflammation-mediated adhesions in the subacromial bursa in rotator cuff lesions, and changes in inflammatory cytokine levels have been linked to myofibroblast recruitment in the subacromial bursa. Our study provides the first indication that increased interleukin -1? expression and myofibroblast recruitment in the subacromial bursa are correlated with rotator cuff lesions with shoulder stiffness. Increased inflammatory cytokine concentrations in the lesions also provide new molecular insight into the pathological role of the subacromial bursa in the development of shoulder stiffness in rotator cuff lesions. Although rotator cuff repair is a shoulder-tightening procedure and is not recommended until resolution of the shoulder stiffness in rotator cuff lesions with stiff shoulder, our clinical evidence-based survey suggests that a combined procedure of manipulation, lysis of adhesions, acromioplasty, and rotator cuff repair is a useful procedure if the symptoms do not improve 3 months of aggressive rehabilitation. PMID:21880187

  8. Rotator Cuff Disease and Injury--Evaluation and Management.

    ERIC Educational Resources Information Center

    Williams, Randy

    This presentation considers the incidence, evaluation, and management of rotator cuff disease and injury. Pathogenesis, symptoms, physical findings, treatment (therapeutic and surgical), and prevention are discussed. It is noted that rotator cuff problems, common in athletes, are usually related to an error in training or lack of training. They…

  9. Calcific tendinitis of the rotator cuff: a review.

    PubMed

    Kachewar, Sushil G; Kulkarni, Devidas S

    2013-07-01

    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

  10. THE EFFECT OF TEAR SIZE AND NERVE INJURY ON ROTATOR CUFF MUSCLE FATTY DEGENERATION IN A RODENT ANIMAL MODEL

    PubMed Central

    Kim, H. Mike; Galatz, Leesa M.; Lim, Chanteak; Havlioglu, Necat; Thomopoulos, Stavros

    2011-01-01

    Background Irreversible muscle changes following rotator cuff tears is a well-known negative prognostic factor after shoulder surgery. Currently, little is known about the pathomechanism of fatty degeneration of the rotator cuff muscles after chronic cuff tears. Hypothesis/Purpose The purposes of this study were: 1) to develop a rodent animal model of chronic rotator cuff tears that can reproduce fatty degeneration of the cuff muscles seen clinically, 2) to describe the effects of tear size and concomitant nerve injury on muscle degeneration, and 3) to evaluate the changes in gene expression of relevant myogenic and adipogenic factors following rotator cuff tears using the animal model. Methods Rotator cuff tears were created in rodents with and without transection of the suprascapular nerve. The supraspinatus and infraspinatus muscles were examined 2, 8, and 16 weeks after injury for histological evidence of fatty degeneration and expression of myogenic and adipogenic genes. Results Histological analysis revealed adipocytes, intramuscular fat globules, and intramyocellular fat droplets in the tenotomized and neurotomized supraspinatus and infraspinatus muscles. Changes increased with time and were most severe in the muscles with combined tenotomy and neurotomy. Adipogenic and myogenic transcription factors and markers were upregulated in muscles treated with tenotomy or tenotomy combined with neurotomy compared to normal muscles. Conclusions The present study describes a rodent animal model that produces fatty degeneration of the rotator cuff muscles similar to human muscles after chronic cuff tears. The severity of changes was associated with tear size and concomitant nerve injury. PMID:21831663

  11. Living with a symptomatic rotator cuff tear ‘bad days, bad nights’: a qualitative study

    PubMed Central

    2014-01-01

    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

  12. Rotator Cuff and Shoulder Conditioning Program

    MedlinePLUS

    ... Cuff and Shoulder Conditioning Program Stretching Exercises 1. Pendulum_________________________________________________________________________ Repetitions Main muscles worked: Deltoids, supraspinatus, infraspinatus, subscapularis ...

  13. Management of Rotator Cuff and Impingement Injuries in the Athlete

    PubMed Central

    Williams, Gerald R.; Kelley, Martin

    2000-01-01

    Objective: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. Data Synthesis: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. Conclusions/Recommendations: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition. ImagesFigure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13. PMID:16558644

  14. Intense focused ultrasound stimulation of the rotator cuff: evaluation of the source of pain in rotator cuff tears and tendinopathy.

    PubMed

    Gellhorn, Alfred C; Gillenwater, Cody; Mourad, Pierre D

    2015-09-01

    The objective of this preliminary study was to evaluate the ability of individual 0.1-s long pulses of intense focused ultrasound (iFU) emitted with a carrier frequency of 2 MHz to evoke diagnostic sensations when applied to patients whose shoulders have rotator cuff tears or tendinopathy. Patients were adults with painful shoulders and clinical and imaging findings consistent with rotator cuff disease. iFU stimulation of the shoulder was performed using B-mode ultrasound coupled with a focused ultrasound transducer that allowed image-guided delivery of precisely localized pulses of energy to different anatomic areas around the rotator cuff. The main outcome measure was iFU spatial average-temporal average intensity (I_SATA), and location required to elicit sensation. In control patients, iFU produced no sensation throughout the range of stimulation intensities (?2000 W/cm(2) I_SATA). In patients with rotator cuff disease, iFU was able to induce sensation in the tendons of the rotator cuff, the subacromial bursa, and the subchondral bone in patients with chronic shoulder pain and rotator cuff disease, with an average ± standard deviation intensity equaling 680 ± 281 W/cm(2) I_SATA. This result suggests a primary role for these tissues in the pathogenesis of shoulder pain related to rotator cuff tendinopathy. PMID:26058842

  15. Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

    PubMed Central

    Tuttle, John R.; Ramos, Paul; DaSilva, Manuel F.

    2014-01-01

    An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications. PMID:25685668

  16. Humeral head cysts: association with rotator cuff tears and age.

    PubMed

    Suluova, Fatih; Kanatli, Ulunay; Ozturk, Burak Yagmur; Esen, Erdinc; Bolukbasi, Selcuk

    2014-07-01

    The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1% (60 patients) in the study population. Anterior GT cysts were found in 56% of patients and were strongly associated with full-thickness (p<.001) and articular-sided partial-thickness rotator cuff tears (p=.02). Posterior GT and lesser tuberosity cysts were found in 27 and 17% of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p=.09). A significant relation was found between patient age and the cyst size (p=.01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age. PMID:23748696

  17. Augmentation of Rotator Cuff Repair With Soft Tissue Scaffolds

    PubMed Central

    Thangarajah, Tanujan; Pendegrass, Catherine J.; Shahbazi, Shirin; Lambert, Simon; Alexander, Susan; Blunn, Gordon W.

    2015-01-01

    Background Tears of the rotator cuff are one of the most common tendon disorders. Treatment often includes surgical repair, but the rate of failure to gain or maintain healing has been reported to be as high as 94%. This has been substantially attributed to the inadequate capacity of tendon to heal once damaged, particularly to bone at the enthesis. A number of strategies have been developed to improve tendon-bone healing, tendon-tendon healing, and tendon regeneration. Scaffolds have received considerable attention for replacement, reconstruction, or reinforcement of tendon defects but may not possess situation-specific or durable mechanical and biological characteristics. Purpose To provide an overview of the biology of tendon-bone healing and the current scaffolds used to augment rotator cuff repairs. Study Design Systematic review; Level of evidence, 4. Methods A preliminary literature search of MEDLINE and Embase databases was performed using the terms rotator cuff scaffolds, rotator cuff augmentation, allografts for rotator cuff repair, xenografts for rotator cuff repair, and synthetic grafts for rotator cuff repair. Results The search identified 438 unique articles. Of these, 214 articles were irrelevant to the topic and were therefore excluded. This left a total of 224 studies that were suitable for analysis. Conclusion A number of novel biomaterials have been developed into biologically and mechanically favorable scaffolds. Few clinical trials have examined their effect on tendon-bone healing in well-designed, long-term follow-up studies with appropriate control groups. While there is still considerable work to be done before scaffolds are introduced into routine clinical practice, there does appear to be a clear indication for their use as an interpositional graft for large and massive retracted rotator cuff tears and when repairing a poor-quality degenerative tendon. PMID:26665095

  18. Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale

    PubMed Central

    Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe

    2014-01-01

    Summary Background: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient’s pain and disability, surgery should be considered. Methods: different surgical techniques are available and the choice of the most appropriate procedure depends on the presenting symptoms, age of the patient, functional demand, medical comorbidities, joint stability and presence of arthritic changes. The transposition of the surrounding muscles to replace the rotator cuff function represents a viable option in the treatment of younger patients without glenohumeral osteoarthritis and with severe functional limitation. Purpose: aim of this study is to give an overview of the currently available evidence regarding tendon transfer procedures for irreparable rotator cuff tears. PMID:25767779

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

    PubMed Central

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

    2014-01-01

    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

  20. Improved apparatus for predictive diagnosis of rotator cuff disease

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    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.

  1. Cup arthroplasty for rotator cuff tear arthropathy.

    PubMed

    Mariscalco, Michael W; Patterson, Ryan W; Seitz, William H

    2011-03-01

    Cup arthroplasty is a conservative bone-sparing option for resurfacing of the humeral head. Earlier reports have shown its effectiveness in appropriately selected patients with osteoarthritis, osteonecrosis, and severe rheumatoid arthritis. Patients with cuff tear arthropathy may also benefit from a modified cup arthroplasty technique. The purpose of this article is to describe the surgical technique involved in humeral cup arthroplasty in cuff tear arthropathy patients. We will review the indications, contraindications, complications, and postoperative rehabilitation. PMID:21358516

  2. Correlation between rotator cuff tear and glenohumeral degeneration.

    PubMed

    Hsu, Horng-Chaung; Luo, Zong-Ping; Stone, James J; Huang, Tze-Hsi; An, Kai-Nan

    2003-02-01

    We studied the occurrence and correlation between a rotator cuff tear and glenohumeral degeneration. 44 cadaveric shoulders (22 right) were obtained from 32 subjects (18 females), mean age 73 (62-86) years and without a history of systemic diseases. Rotator cuffs were exposed and tear size (14 shoulders) was measured after removal of soft tissue and deltoid. Articular cartilage damage of the glenoid and humeral head was recorded by photography. A grading system of 1 (intact), 2 (mild) and 3 (severe) was used to determine the severity of cartilage damage. The area of articular cartilage damage was calculated using the Sonic Digitizer Analyzing System. The area of articular cartilage damage to the glenoid and the humeral head in the rotator cuff tear group was 32% and 36%, respectively. It was greater than that in the groups without a tear, which was 6% in the glenoid and 7% in the humeral head. However, it was not correlated with the size of the tear. Most of the articular cartilage damage in massive and large rotator cuff tears was located in the anterior-inferior portion of the glenoid and in the posterior portion of the humeral head. The articular cartilage damage area of the glenoid was correlated with that of the humeral head. In conclusion, the area of glenohumeral degeneration was greater in the rotator cuff tear group and was located in a specific site. PMID:12635800

  3. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency.

    PubMed

    Franklin, J L; Barrett, W P; Jackins, S E; Matsen, F A

    1988-01-01

    Seven cases of total shoulder arthroplasty exhibiting major glenoid radiolucent lines or actual translation of the glenoid component were evaluated to identify factors associated with glenoid loosening. The average time from arthroplasty was 30 months (range, 14-44 months). Six of the patients had severe, incompletely reconstructable rotator cuff tears present at the time of surgery, and one patient developed a cuff tear within 1 year of surgery. The amount of superior migration of the humeral component was closely correlated with the degree of glenoid loosening. With superior displacement of the humeral component, superior tipping of the glenoid component was observed: a "rocking horse" glenoid. For comparison, a contemporary group of 16 consecutive total shoulder arthroplasty patients with intact rotator cuffs were reviewed. The control group had no glenoid loosening an average of 5 years after operation. Upward riding of the prosthetic humeral head in patients with rotator cuff deficiency may contribute to loosening of the glenoid component in total shoulder arthroplasty. PMID:3361319

  4. Arthroscopic knots and strength sutures for rotator cuff repair.

    PubMed

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

    2011-09-01

    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

  5. The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears

    PubMed Central

    2011-01-01

    Background and purpose Few authors have considered the outcome after acute traumatic rotator cuff tears in previously asymptomatic patients. We investigated whether delay of surgery, age at repair, and the number of cuff tendons involved affect the structural and clinical outcome. Patients and methods 42 patients with pseudoparalysis after trauma and no previous history of shoulder symptoms were included. A full-thickness tear in at least 1 of the rotator cuff tendons was diagnosed in all patients. Mean time to surgery was 38 (6–91) days. Follow-up at a mean of 39 (12–108) months after surgery included ultrasound, plain radiographs, Constant-Murley score, DASH score, and western Ontario rotator cuff (WORC) score. Results At follow-up, 4 patients had a full-thickness tear and 9 had a partial-thickness tear in the repaired shoulder. No correlation between the structural or clinical outcome and the time to repair within 3 months was found. The patients with a tendon defect at follow-up had a statistically significantly lower Constant-Murley score and WORC index in the injured shoulder and were significantly older than those with intact tendons. The outcomes were similar irrespective of the number of tendons repaired. Interpretation A delay of 3 months to repair had no effect on outcome. The patients with cuff defects at follow-up were older and they had a worse clinical outcome. Multi-tendon injury did not generate worse outcomes than single-tendon tears at follow-up. PMID:21434791

  6. Reverse arthroplasty of the shoulder for treating rotator cuff arthropathy???

    PubMed Central

    Amaral, Marcus Vinicius Galvão; de Faria, José Leonardo Rocha; Siqueira, Gláucio; Cohen, Marcio; Brandão, Bruno; Moraes, Rickson; Monteiro, Martim; Motta, Geraldo

    2014-01-01

    Objective to present a retrospective analysis on the clinical-functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder. Methods patients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow-up of one year were selected. Results preoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow-up of 44 months, 17 patients (94%) were satisfied with the result from the procedure. Conclusion reverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities. PMID:26229813

  7. Complications Following Arthroscopic Rotator Cuff Tear Repair

    PubMed Central

    Audigé, Laurent; Blum, Raphael; Müller, Andreas M.; Flury, Matthias; Durchholz, Holger

    2015-01-01

    Background Valid comparison of outcomes after surgical procedures requires consensus on which instruments and parameters should be used, including the recording and evaluation of surgical complications. An international standard outlining the terminology and definitions of surgical complications in orthopaedics is lacking. Purpose This study systematically reviewed the literature for terms and definitions related to the occurrence of negative events or complications after arthroscopic rotator cuff repair (ARCR) with specific focus on shoulder stiffness. Study Design Systematic review; Level of evidence, 4. Methods PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for reviews, clinical studies, and case reports of complications associated with ARCR. Reference lists of selected articles were also screened. The terminology of complications and their definitions were extracted from all relevant original articles by a single reviewer and verified by a second reviewer. Definitions of shoulder stiffness or equivalent terms were tabulated. Results Of 654 references published after 2007 and obtained from the search, 233 full-text papers (44 reviews, 155 studies, 31 case reports, and 3 surgical technique presentations) were reviewed. Twenty-two additional references cited for a definition were checked. One report defined the term surgical complication. There were 242 different terms used to describe local events and 64 to describe nonlocal events. Furthermore, 16 definitions of terms such as frozen shoulder, shoulder stiffness, or stiff painful shoulder were identified. Diagnosis criteria for shoulder stiffness differed widely; 12 various definitions for restriction in range of motion were noted. One definition included a gradation of stiffness severity, whereas another considered the patient’s subjective assessment of motion. Conclusion The literature does not consistently report on complications after ARCR, making valid comparison of the incidence of these events among published reports impossible. Specifically, the variation in criteria used to diagnose shoulder stiffness is problematic for valid and accurate reporting of this event. A standard for reporting this event and other complications after ARCR is needed. Clinical Relevance This review serves as the basis for the development of a uniform documentation process for shoulder stiffness and the standardization of complication definitions in ARCR following international consensus.

  8. Treatment Options for Rotator Cuff Tears: A Guide for Adults

    MedlinePLUS

    ... and Plug-ins EHC Component EPC Project Topic Title Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Full Reports Research Review Jul. 5, 2010 Appendixes Jul. 5, 2010 Related Products for this Topic Disposition of Comments Report ...

  9. Partial rotator cuff injury in athletes: bursal or articular??

    PubMed Central

    Carvalho, Cassiano Diniz; Cohen, Carina; Belangero, Paulo Santoro; Figueiredo, Eduardo Antônio; Monteiro, Gustavo Cará; de Castro Pochini, Alberto; Andreoli, Carlos Vicente; Ejnisman, Benno

    2015-01-01

    A painful shoulder is a very common complaint among athletes, especially in the case of those in sports involving throwing. Partial lesions of the rotator cuff may be very painful and cause significant functional limitation to athletes’ sports practice. The incidence of partial lesions of the cuff is variable (13–37%). It is difficult to make the clinical and radiological diagnosis, and this condition should be borne in mind in the cases of all athletes who present symptoms of rotator cuff syndrome, including in patients who are diagnosed only with tendinopathy. Objective To evaluate the epidemiological behavior of partial lesions of the rotator cuff in both amateur and professional athletes in different types of sports. Methods We evaluated 720 medical files on athletes attended at the shoulder service of the Discipline of Sports Medicine at the Sports Traumatology Center, Federal University of São Paulo. The majority of them were men (65%). Among all the patients, 83 of them were diagnosed with partial lesions of the rotator cuff, by means of ultrasonography or magnetic resonance, or in some cases using both. We applied the binomial test to compare the proportions found. Result It was observed that intra-articular lesions predominated (67.6%) and that these occurred more frequently in athletes in sports involving throwing (66%). Bursal lesions occurred in 32.4% of the athletes, predominantly in those who did muscle building (75%). Conclusion Intra-articular lesions are more frequent than bursal lesions and they occur predominantly in athletes in sports involving throwing, while bursal lesions were more prevalent in athletes who did muscle building. PMID:26417568

  10. Shoulder muscle forces during driving: Sudden steering can load the rotator cuff beyond its repair limit

    PubMed Central

    Pandis, Petros; Prinold, Joe A.I.; Bull, Anthony M.J.

    2015-01-01

    Background Driving is one of the most common everyday tasks and the rotator cuff muscles are the primary shoulder stabilisers. Muscle forces during driving are not currently known, yet knowledge of these would influence important clinical advice such as return to activities after surgery. The aim of this study is to quantify shoulder and rotator cuff muscle forces during driving in different postures. Methods A musculoskeletal modelling approach is taken, using a modified driving simulator in combination with an upper limb musculoskeletal model (UK National Shoulder Model). Motion data and external force vectors were model inputs and upper limb muscle and joint forces were the outputs. Findings Comparisons of the predicted glenohumeral joint forces were compared to in vivo literature values, with good agreement demonstrated (61 SD 8% body weight mean peak compared to 60 SD 1% body weight mean peak). High muscle activation was predicted in the rotator cuff muscles; particularly supraspinatus (mean 55% of the maximum and up to 164 SD 27 N). This level of loading is up to 72% of mean failure strength for supraspinatus repairs, and could therefore be dangerous for some cases. Statistically significant and large differences are shown to exist in the joint and muscle forces for different driving positions as well as steering with one or both hands (up to 46% body weight glenohumeral joint force). Interpretation These conclusions should be a key consideration in rehabilitating the shoulder after surgery, preventing specific upper limb injuries and predicting return to driving recommendations. PMID:26139549

  11. The Effect of Postoperative Passive Motion on Rotator Cuff Healing in a Rat Model

    PubMed Central

    Peltz, Cathryn D.; Dourte, LeAnn M.; Kuntz, Andrew F.; Sarver, Joseph J.; Kim, Soung-Yon; Williams, Gerald R.; Soslowsky, Louis J.

    2009-01-01

    Background: Surgical repairs of torn rotator cuff tendons frequently fail. Immobilization has been shown to improve tissue mechanical properties in an animal model of rotator cuff repair, and passive motion has been shown to improve joint mechanics in animal models of flexor tendon repair. Our objective was to determine if daily passive motion would improve joint mechanics in comparison with continuous immobilization in a rat rotator cuff repair model. We hypothesized that daily passive motion would result in improved passive shoulder joint mechanics in comparison with continuous immobilization initially and that there would be no differences in passive joint mechanics or insertion site mechanical properties after four weeks of remobilization. Methods: A supraspinatus injury was created and was surgically repaired in sixty-five Sprague-Dawley rats. Rats were separated into three postoperative groups (continuous immobilization, passive motion protocol 1, and passive motion protocol 2) for two weeks before all underwent a remobilization protocol for four weeks. Serial measurements of passive shoulder mechanics (internal and external range of motion and joint stiffness) were made before surgery and at two and six weeks after surgery. After the animals were killed, collagen organization and mechanical properties of the tendon-to-bone insertion site were determined. Results: Total range of motion for both passive motion groups (49% and 45% of the pre-injury values) was less than that for the continuous immobilization group (59% of the pre-injury value) at two weeks and remained significantly less following four weeks of remobilization exercise. Joint stiffness at two weeks was increased for both passive motion groups in comparison with the continuous immobilization group. At both two and six weeks after repair, internal range of motion was significantly decreased whereas external range of motion was not. There were no differences between the groups in terms of collagen organization or mechanical properties. Conclusions: In this model, immediate postoperative passive motion was found to be detrimental to passive shoulder mechanics. We speculate that passive motion results in increased scar formation in the subacromial space, thereby resulting in decreased range of motion and increased joint stiffness. Passive motion had no effect on collagen organization or tendon mechanical properties measured six weeks after surgery. Clinical Relevance: The results of the present study demonstrated a detrimental effect of early controlled passive motion following surgery in a rat model of rotator cuff injury and repair. When considered together with previous studies involving this model that have illustrated the beneficial effects of immobilization and the transient nature of range-of-motion losses associated with immobilization, these findings further support the need for clinical studies designed to investigate the effects of postoperative immobilization on rotator cuff tendon-to-bone healing. PMID:19797578

  12. Diagnostic anatomy and diagnostics of enthesal pathologies of the rotator cuff

    PubMed Central

    2012-01-01

    Detailed anatomy, crucial in modern high-definition diagnostics imaging, is a base for understanding diagnostic images and the nature of the diagnosed disease. The aim of this paper is presentation of a new anatomical model of the rotator cuff, which includes definition of tendinous and capsule-ligamentous layers as equally important to rotator cuff function understanding. Schematic and diagnostic (ultrasonography, magnetic resonance imaging) anatomy of the rotator cuff based on the core tendon concept is presented. Appropriate tissue layers of the cuff are discussed in detail. In the diagnostics part some enthesal pathologies of the rotator cuff are presented. Material and methods New anatomical data was analyzed in the context of rotator cuff layers – their presence, thickness and structure observed on magnetic resonance imaging and ultrasonographic images. Conclusions Rotator cuff should be regarded as a multilayer structure consisting of fused fibers of tendons and capsuloligamentous complex. The thickness of these layers is comparable therefore it is important to realize that capsular pathologies may become a serious obstacle to normal shoulder joint function. Understanding of anatomical rotator cuff layers explains the formation of calcific cavities within the rotator cuff. In fact between layers of the cuff. Calcific cavities are a sequelae of chronic enthesopathy/enthesal tear with hydroxyapatite filling and probably delaminating the tendinous layer from the capsuloligamentous one. PMID:26674384

  13. Open Rotator Cuff Tear Repair Using Deltopectoral Approach

    PubMed Central

    Guity, Mohammad Reza; Eraghi, Amir Sobhani

    2015-01-01

    Background: The goal of this study was to evaluate the outcome of the open repair of rotator cuff tears via the deltopectoral approach in patients unable to afford arthroscopic repair costs. Methods: We evaluated 80 consecutive patients who were treated for full-thickness rotator cuff tears by open repair through the deltopectoral approach. There were 48 men and 32 women at a mean age of 60.1 years (range, 35-80 years). Preoperative and postoperative clinical assessments were performed with the Constant score, American Shoulder and Elbow Surgeons (ASES) score, modified University of California Los Angeles (UCLA) score, and pain visual analog scale. Results: The mean follow-up period was 30.6 months (range, 18-48 months). At final follow-up visits, the ASES, Constant score, and modified UCLA score were found to have improved significantly from 33.56, 39.24, and 13.0 to 85.64, 81.46, and 32.2, respectively (P <0.01). Pain, as measured on a visual analog scale, was improved significantly (P <0.01). The mean time for recovering the full range of motion was 2.5 months. Postoperative pain at 48 hours and at 6 weeks was relatively low. There were no cases of intractable stiffness. Conclusion: The deltopectoral approach for open rotator cuff repair produced satisfactory results and reduces rate of shoulder stiffness and postoperative pain. PMID:26622080

  14. Rotator Cuff Tears: Surgical Treatment Options

    MedlinePLUS

    ... Large or massive tears • Poor patient compliance with rehabilitation and restrictions a er surgery • Patient age (older than 65 years) • Smoking and use of other nicotine products • Workers’ compensation ...

  15. Augmented Fixation With Biodegradable Subacromial Spacer After Repair of Massive Rotator Cuff Tear

    PubMed Central

    Bozkurt, Murat; Akkaya, Mustafa; Gursoy, Safa; Isik, Cetin

    2015-01-01

    Unsuccessful outcomes after repair of massive rotator cuff ruptures accompanied by muscle atrophy and fatty degeneration are frequently associated with inadequate management and secondary tears. We report the functional differences after rotator cuff rupture repair with a biodegradable spacer application. In these patients, rotator cuff rupture repair should provide coverage of the humeral head. Subsequently, acromioplasty should be performed to allow adequate space for the subacromial spacer. Thereafter measurement of the intra-articular space required for application of the biodegradable spacer is performed. Using this method can decrease the rate of tears by providing a safe subacromial space in cases of massive rotator cuff rupture.

  16. Immobilization After Rotator Cuff Repair: What Evidence Do We Have Now?

    PubMed

    Hsu, Jason E; Horneff, John G; Gee, Albert O

    2016-01-01

    Recurrent tears after rotator cuff repair are common. Postoperative rehabilitation after rotator cuff repair is a modifiable factor controlled by the surgeon that can affect re-tear rates. Some surgeons prefer early mobilization after rotator cuff repair, whereas others prefer a period of immobilization to protect the repair site. The tendon-healing process incorporates biochemical and biomechanical responses to mechanical loading. Healing can be optimized with controlled loading. Complete load removal and chronic overload can be deleterious to the process. Several randomized clinical studies have also characterized the role of postoperative mobilization after rotator cuff repair. PMID:26614931

  17. Effect of tamoxifen on fatty degeneration and atrophy of rotator cuff muscles in chronic rotator cuff tear: An animal model study.

    PubMed

    Cho, Edward; Zhang, Yue; Pruznak, Anne; Kim, H Mike

    2015-12-01

    Fatty degeneration of the rotator cuff muscles is an irreversible change resulting from chronic rotator cuff tear and is associated with poor clinical outcomes following rotator cuff repair. We evaluated the effect of Tamoxifen, a competitive estrogen receptor inhibitor, on fatty degeneration using a mouse model for chronic rotator cuff tear. Sixteen adult mice were divided into two diet groups (Tamoxifen vs. Regular) and subjected to surgical creation of a large rotator cuff tear and suprascapular nerve transection in their left shoulder with the right shoulder serving as a control. The rotator cuff muscles were harvested at 16 weeks and subjected to histology and RT-PCR for adipogenic and myogenic markers. Histology showed substantially decreased atrophy and endomysial inflammation in Tamoxifen group, but no significant differences in the amount of intramuscular adipocytes and lipid droplets compared to the Regular group. With RT-PCR, the operated shoulders showed significant upregulation of myogenin and PPAR-?, and downregulation of myostatin compared to the nonsurgical shoulder. No significant differences of gene expression were found between the two diet groups. Our study demonstrated that tamoxifen diet leads to decreased muscle atrophy and inflammatory changes following chronic rotator cuff tear, but has no apparent effect on adipogenesis. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1846-1853, 2015. PMID:26121952

  18. Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury.

    PubMed

    Yamaguchi, Takeshi; Ochiai, Nobuyasu; Sasaki, Yu; Kijima, Takehiro; Hashimoto, Eiko; Sasaki, Yasuhito; Kenmoku, Tomonori; Yamazaki, Hironori; Miyagi, Masayuki; Ohtori, Seiji; Takahashi, Kazuhisa

    2015-12-01

    This study evaluated dorsal root ganglia from C3-C7, analyzed gait, and compared the expression of calcitonin gene-related peptide (CGRP) which was a marker of inflammatory pain in a rat rotator cuff tear model in which the supraspinatus and infraspinatus tendons were detached; comparisons were made to a sham group in which only the tendons were exposed. Fluorogold was injected into the glenohumeral joint 21 days after surgery in both groups, and saline, steroids, or hyaluronic acid was injected into the glenohumeral joint in the rotator cuff tear group 26 days after surgery. The proportions of CGRP-immunoreactive neurons were higher and the gait parameters were impaired in the rotator cuff tear group compared to in the sham group. However, the CGRP expression was reduced and the gait was improved with steroid or hyaluronic acid injection compared to saline, suggesting that both hyaluronic acid and steroid injections suppressed of inflammation which thought to be provided pain relief. While there were no significant differences, the suppression of CGRP expression and the improved gait after hyaluronic acid and steroid injections suggested that both methods were effective for rat rotator cuff tear model. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1861-1867, 2015. PMID:26147720

  19. Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios

    PubMed Central

    Lu, Hsueh-Yi; Huang, Chen-Yuan; Su, Chwen-Tzeng; Lin, Chen-Chiang

    2014-01-01

    Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears. PMID:24733553

  20. Classification of rotator cuff tendinopathy using high definition ultrasound

    PubMed Central

    Hinsley, Hannah; Nicholls, Alex; Daines, Michael; Wallace, Gemma; Arden, Nigel; Carr, Andrew

    2014-01-01

    Summary Background: ultrasound is a valid cost effective tool in screening for rotator cuff pathology with high levels of accuracy in detecting full-thickness tears. To date there is no rotator cuff tendinopathy classification using ultrasound. The aims of this study are to define a valid high-definition ultrasound rotator cuff tendinopathy classification, which has discriminate validity between groups based upon anatomical principles. Methods: 464 women, aged 65–87, from an established general population cohort underwent bilateral shoulder ultrasound and musculoskeletal assessment. Sonographer accuracy was established in a separate study by comparing ultrasound findings to the gold standard intra-operative findings. Results: there were 510 normal tendons, 217 abnormal tendons, 77 partial tears, and 124 full-thickness tears. There was no statistical difference in age or the proportion with pain between the abnormal enthesis and partial tear groups, however both groups were statistically older (p<0.001) and had a greater proportion with pain (p<0.001 & p=0.050) than normal tendons. The full-thickness tears were statistically older than normal tendons (p<0.001), but not abnormal/partially torn tendons. The proportion with pain was significantly greater than both groups (p<0.001 & p=0.006). Symptomatic shoulders had a larger median tear size than asymptomatic shoulders (p=0.006). Using tear size as a predictor of pain likelihood, optimum sensitivity and specificity occurred when dividing tears into groups up to 2.5cm and >2.5cm, which corresponds with anatomical descriptions of the width of the supraspinatus tendon. Conclusion: the classification system is as follows: Normal Tendons; Abnormal enthesis/Partial-thickness tear; Single tendon full-thickness tears (0–2.5cm); Multi-tendon full-thickness tears (>2.5cm). PMID:25489559

  1. Novel Nanofiber-Based Scaffold for Rotator Cuff Repair and Augmentation

    E-print Network

    Lu, Helen H.

    Novel Nanofiber-Based Scaffold for Rotator Cuff Repair and Augmentation Kristen L. Moffat, M.S.,1 and augmentation. To address this challenge, we have designed a poly(lactide-co-glycolide) (PLGA) nanofiber of human rotator cuff fibroblasts on aligned and unaligned PLGA nanofiber scaffolds. Additionally

  2. Comma Sign–Directed Repair of Anterosuperior Rotator Cuff Tears

    PubMed Central

    Dilisio, Matthew F.; Neyton, Lionel

    2014-01-01

    The comma sign was described as an arthroscopic landmark to identify the torn subscapularis stump to mobilize and repair the tendon in anterosuperior rotator cuff tears. It was hypothesized that it is composed of the humeral attachments of the superior glenohumeral and coracohumeral ligaments. This arthroscopic finding has since become accepted orthopaedic nomenclature pathognomonic for subscapularis tears and a key component of subscapularis tear classification. We propose an alternative theory of the pathoanatomy of the comma sign in anterosuperior rotator cuff tears and present the technique of comma sign–directed repairs of combined subscapularis and supraspinatus lesions. After appropriate releases, tendon-to-tendon repair of the distal-superior aspect of the comma sign to the upper border of the remnant subscapularis results in anatomic re-creation of the intra-articular portion of the torn subscapularis with concomitant reduction of the anterior leading edge of the supraspinatus and reconstitution of the rotator cable complex. A tension-free, single-anchor subscapularis repair is then performed to secure the tendon to the lesser tuberosity. After subscapularis repair, the supraspinatus that was previously retracted to the glenoid rim takes the appearance of a crescent-type tear that is easily approximated to its anatomic insertion. PMID:25685676

  3. A Comparison of Conventional Ultrasonography and Arthrosonography in the Assessment of Cuff Integrity after Rotator Cuff Repair

    PubMed Central

    Lee, Kwang Won; Chun, Tong Jin; Bae, Kyoung Wan; Choy, Won Sik; Park, Hyeon Jong

    2014-01-01

    Background This study was designed to perform conventional ultrasonography, magnetic resonance arthrography (MRA) and arthrosonography exams after rotator cuff repair to compare the results of conventional ultrasonography and arthrosonography with those of MRA as the gold standard. Methods We prospectively studied 42 consecutive patients (14 males, 28 females; average age, 59.4 years) who received arthroscopic rotator cuff repair due to full-thickness tears of the supraspinatus tendon from 2008 to 2010. The integrity assessment of the repaired rotator cuff was performed 6 months postoperatively using conventional ultrasonography, MRA, and arthrosonography. Results The diagnostic accuracy of the conventional ultrasonography compared to MRA was 78.6% and the McNemar test results were 0.016 in full-thickness tear and 0.077 in partial-thickness tear. The diagnostic accuracy of arthrosonography compared to MRA was 92.9% and the McNemar test results were 0.998 in full-thickness tear and 0.875 in partial-thickness tear. Conclusions It was found that the integrity assessment of the repaired rotator cuff by ultrasonography must be guarded against and that arthrosonography is an effective alternative method in the postoperative integrity assessment. Also, an arthrosonography seems to be a suitable modality to replace the conventional ultrasonography. PMID:25177461

  4. Return to driving after arthroscopic rotator cuff repair: patient-reported safety and maneuverability.

    PubMed

    Gholson, J Joseph; Lin, Albert; McGlaston, Timothy; DeAngelis, Joseph; Ramappa, Arun

    2015-01-01

    This survey investigated patients' return to driving after rotator cuff surgery, to determine whether pain, weakness, sling use, and narcotics correlate with self-assessed safety and maneuvering. Fifty-four patients (80.6% of those eligible) were surveyed 4 months after surgery. Return to driving ranged widely from same day to 4 months, with two not driving at 4 months; 12% reported narcotics use and 33% reported sling use. Drivers reporting weakness were more likely to feel unsafe (p = .02) and more likely to report difficulty maneuvering (p <.01). Drivers reporting pain were more likely to feel unsafe (p < .01) and more likely to report difficulty maneuvering their vehicle (p < .01). Patient-reported return to driving does not correspond to perceived safety; pain and weakness correspond with feeling unsafe and difficulty maneuvering. Although subjective, clinicians may find these self-assessments predictive when counseling patients on return to driving. PMID:25988695

  5. Tissue engineering for rotator cuff repair: an evidence-based systematic review.

    PubMed

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

    2012-01-01

    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

  6. Application of Pain Quantitative Analysis Device for Assessment of Postoperative Pain after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Mifune, Yutaka; Inui, Atsuyuki; Nagura, Issei; Sakata, Ryosuke; Muto, Tomoyuki; Harada, Yoshifumi; Takase, Fumiaki; Kurosaka, Masahiro; Kokubu, Takeshi

    2015-01-01

    Purpose : The PainVision™ system was recently developed for quantitative pain assessment. Here, we used this system to evaluate the effect of plexus brachialis block on postoperative pain after arthroscopic rotator cuff repair. Methods : Fifty-five patients who underwent arthroscopic rotator cuff repair were included in this study. First 26 cases received no plexus brachialis block (control group), and the next 29 cases received the plexus brachialis block before surgery (block group). Patients completed the visual analog scale at 4, 8, 16, and 24 hours after surgery, and the intensity of postoperative pain was assessed with PainVision™ at 16 hours. The postoperative use of non-steroidal anti-inflammatory agents was also recorded. Results : The pain intensity at 16 hours after surgery assessed by PainVision™ was significantly lower in the block group than in the control group (block, 252.0 ± 47.8, control, 489.0 ± 89.1, P < 0.05). However, there were no differences in the VAS values at 16 hours between the 2 groups (block, 4.3 ± 0.6, control, 5.7 ± 0.4, P = N.S.). The pain intensity and VAS at 16 hours after surgery were highly correlated (r = 0.59, P = 0.006 in the block group and r = 0.62, P = 0.003 in the control group). The effect size of the assessment by PainVision™ was bigger than that of VAS (r=0.31 in VAS and 0.51 in Pain vision). Conclusion : The PainVision™ system could be useful to evaluate postoperative pain because it enables the quantification and comparison of pain intensity independent of individual pain thresholds. PMID:26157522

  7. The relationship between greater tuberosity osteopenia and the chronicity of rotator cuff tears.

    PubMed

    Cadet, Edwin R; Hsu, Jennifer W; Levine, William N; Bigliani, Louis U; Ahmad, Christopher S

    2008-01-01

    This study investigated whether a relationship exists between greater tuberosity osteopenia and chronicity of rotator cuff tears. In a retrospective study, anteroposterior radiographs of 28 shoulders in 27 patients who had undergone surgical repair for rotator cuff tears were reviewed. Greater tuberosity osteopenia scores were created using National Institutes of Health digital image software. There was no significant difference in the mean age between patients with minimal to mild rotator cuff tear retraction (63.1 +/- 6.14 years) and patients with moderate to severe rotator cuff tear retraction (63.4 +/- 9.76 years; P = .77). Of the 13 patients with minimal to mild rotator cuff tear retraction, 10 (77%) were women and 3 (23%) were men. Of 14 patients (50%) with moderate to severe rotator cuff tear retraction, 7 were men and 7 were women. The mean greater tuberosity osteopenia score in the 15 patients with moderate to severe retraction (0.48 +/- 0.095) was significantly less than the greater tuberosity osteopenia score in the 13 patients with minimal to mild retraction (0.58 +/- 0.135; P < .05). Furthermore, the mean greater tuberosity osteopenia score in 6 patients with chronic retracted rotator cuff tears (0.48 +/- 0.125) was significantly less than in the 6 patients with acute minimally retracted tears (0.64 +/- 0.119, P < .05). There were significantly greater osteopenic changes in the greater tuberosity in patients with chronic retracted rotator cuff tears. The greater tuberosity osteopenia may affect anchor pullout strength and the healing biology that influences overall rotator cuff repair healing rates. PMID:18036841

  8. Labrum and rotator cuff injuries in the throwing athlete.

    PubMed

    Menge, Travis J; Byram, Ian R; Boykin, Robert E; Bushnell, Brandon D

    2015-02-01

    Abstract The large amount of force imparted across the shoulder during the act of throwing makes the glenohumeral joint highly susceptible to injury in the athlete performing overhead throwing motions. The bony incongruity of the shoulder enables greater range of motion than any other joint in the body, but it also results in significant strain on the surrounding soft tissues during the throwing motion. Throwers can present with acute injuries, but more commonly they suffer from chronic overuse conditions resulting from repetitive overload. Proper management requires early recognition with treatment directed toward the athlete's safe return to sports. Failure to institute an appropriate management strategy may result in significant complications, including prolonged disability, progression of symptoms, and further injury. We discuss the functional anatomy, pathophysiology, clinical presentation, evaluation, and treatment of common injuries of the glenoid labrum and rotator cuff in the overhead throwing athlete. PMID:25599876

  9. Assessment of the canine model of rotator cuff injury and repair

    PubMed Central

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

    2007-01-01

    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

  10. Gene polymorphism of IL-6 and MMP-3 decreases passive range of motion after rotator cuff repair

    PubMed Central

    Ling, Yan; Peng, Cheng; Liu, Chenguang; Zhang, Na; Yue, Shouwei

    2015-01-01

    Objectives: Post-operative stiffness is common after rotator cuff repair, given the difference in susceptibility and severity, the genetic factors may be involved. Interleukin 6 (IL-6) and Matrix metalloproteinases 3 (MMP-3) were previous found as key cytokines in the pathologies of adhesive capsulitis. The present study aims to investigate whether variants within the IL-6 and MMP-3 gene contributed to post-operative stiffness in a Chinese Han population. Methods: A total of 188 patients diagnosed with rotator cuff tears treated with mini-open surgery were enrolled in this study, among which 87 patients were diagnosed as post-operative stiffness and the remaining 101 patients as controls. All subjects were genotyped for IL-6 and MMP-3 SNPs. Results: The rs1800796 of IL-6 and rs679620 of MMP-3 were found significantly associated with increased susceptibility and severity of post-operative stiffness. Conclusion: The rs1800796 SNP of IL-6 and rs650108 SNP of MMP-3 were associated with increased risk of post-operative stiffness susceptibility and severity. This finding can be used in guiding the rehabilitation procedure after rotator cuff surgery, in another word, those with the genetic susceptibility factors should receive a more radical rehabilitation procedure and those without the susceptibility factors can be more conservative. PMID:26191285

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

    PubMed Central

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

    2009-01-01

    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

  12. Post-operative rehabilitation after surgical repair of the rotator cuff.

    PubMed

    Conti, Marco; Garofalo, Raffaele; Delle Rose, Giacomo; Massazza, Giuseppe; Vinci, Enzo; Randelli, Mario; Castagna, Alessandro

    2009-04-01

    Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different kinds of sports, and who have widely different expectations in terms of recovery of functions and pain relief. A large number of factors must be taken into account before implementing a rehabilitation protocol after rotator cuff surgery. These mainly include the technique (materials and procedure) used by the surgeon. Moreover, tissue quality, retraction, fatty infiltration and time from rupture are important biological factors while the patient's work or sport or daily activities after surgery and expectations of recovery must also be assessed. A rehabilitation protocol should also take into account the timing of biological healing of bone to tendon or tendon to tendon interface, depending on the type of rupture and repair. This timing should direct the therapist's choice of correct passive or assisted exercise and mobilisation manoeuvres and the teaching of correct active mobilisation movements the patient has to do. Following accepted knowledge about the time of biological tissue healing, surgical technique and focused rehabilitation exercise, a conceptual protocol in four phases could be applied, tailoring the protocol for each patient. It starts with sling rest with passive small self-assisted arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the patient dry or in water, integrated with scapular mobilisation and stabiliser reinforcement, are done. Phase three consists of progressive active arm mobilisation dry or in water integrated with proprioceptive exercise and "core" stabilisation. In phase four full strength recovery integrated with the recovery of work or sports movements will complete the protocol. Because of the multi-factorial aspects of the problem, the best results can be obtained through a full transfer of information from the surgeon to the therapist to optimise timing and sizing of the individual rehabilitation protocol for each patient. PMID:19711171

  13. Effects of rotator cuff tears on muscle moment arms: a computational study.

    PubMed

    Adams, Corinne R; Baldwin, Mark A; Laz, Peter J; Rullkoetter, Paul J; Langenderfer, Joseph E

    2007-01-01

    Rotator cuff tears cause morphologic changes to cuff tendons and muscles, which can alter muscle architecture and moment arm. The effects of these alterations on shoulder mechanical performance in terms of muscle force and joint strength are not well understood. The purpose of this study was to develop a three-dimensional explicit finite element model for investigating morphological changes to rotator cuff tendons following cuff tear. The subsequent objectives were to validate the model by comparing model-predicted moment arms to empirical data, and to use the model to investigate the hypothesis that rotator cuff muscle moment arms are reduced when tendons are divided along the force-bearing direction of the tendon. The model was constructed by extracting tendon, cartilage, and bone geometry from the male Visible Human data set. Infraspinatus and teres minor muscle and tendon paths were identified relative to the humerus and scapula. Kinetic and kinematic boundary conditions in the model replicated experimental protocols, which rotated the humerus from 45 degrees internal to 45 degrees external rotation with constant loads on the tendons. External rotation moment arms were calculated for two conditions of the cuff tendons: intact normal and divided tendon. Predicted moment arms were within the 1-99% confidence intervals of experimental data for nearly all joint angles and tendon sub-regions. In agreement with the experimental findings, when compared to the intact condition, predicted moment arms were reduced for the divided tendon condition. The results of this study provide evidence that one potential mechanism for the reduction in strength observed with cuff tear is reduction of muscle moment arms. The model provides a platform for future studies addressing mechanisms responsible for reduced muscle force and joint strength including changes to muscle length-tension operating range due to altered muscle and tendon excursions, and the effects of cuff tear size and location on moment arms and muscle forces. PMID:17597135

  14. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears.

    PubMed

    Badhe, Sachin P; Lawrence, Tom M; Smith, F D; Lunn, P G

    2008-01-01

    Porcine dermal collagen (Zimmer Patch, formerly known as Permacol; Tissue Science Laboratories plc, Aldershot, Hampshire, UK) has been used for reinforcement of several human body tissues with success and has been shown to act as a durable, permanent tissue scaffold that assists healing. The purpose of this study was to determine the effectiveness of porcine dermal collagen as a tendon augmentation graft in the repair of extensive rotator cuff tears. This prospective study evaluated the clinical, ultrasound, and magnetic resonance imaging outcome 4.5 years (range, 3-5 years) after the treatment of extensive rotator cuff tears with porcine dermal collagen tendon augmentation grafting. The study group consisted of 10 patients (5 men, 5 women) with a mean age of 66 years (range, 46-80 years). Patients were evaluated clinically using the Constant score preoperatively, at 1 year, and at final follow-up when ultrasound and magnetic resonance imaging scans were performed to assess for graft and rotator cuff integrity. Average Constant scores improved from 41 preoperatively to 62 at final follow-up (P = .0003). Pain, abduction power, and range of motion significantly improved after surgery (P < .05), and patient satisfaction levels were high. Imaging studies identified intact grafts in 8 patients and graft detachment in 2. No adverse side effects were reported during the study period. The use of porcine dermal collagen as an augmentation graft in the treatment of massive rotator cuff tears is safe and, in most patients, is associated with improved clinical outcome. Randomized trials are required to assess any benefit over standard current surgical treatment regimens. PMID:18201655

  15. Arthroscopic Implantation of a Bio-Inductive Collagen Scaffold for Treatment of an Articular-Sided Partial Rotator Cuff Tear

    PubMed Central

    Ryu, Richard K.N.; Ryu, Jessica H.J.; Abrams, Jeffrey S.; Savoie, Felix H.

    2015-01-01

    The treatment of articular-sided partial rotator cuff tears remains a challenge to the treating orthopaedic surgeon. Treatment algorithms have included nonoperative management, debridement alone, and debridement and subacromial decompression, as well as articular-sided rotator cuff repair and completion of the tear on the bursal side followed by a traditional arthroscopic rotator cuff repair. Implantation of a bio-inductive collagen scaffold on the bursal side of the rotator cuff to potentially heal an articular-sided tear represents a novel approach to this difficult clinical entity. PMID:26697308

  16. Assessment and characterization of in situ rotator cuff biomechanics

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

    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.

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

    PubMed Central

    2012-01-01

    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

  18. Correlation of acromial morphology with impingement syndrome and rotator cuff tears

    PubMed Central

    2013-01-01

    Background and purpose Indications for acromioplasty are based on clinical symptoms and are generally supported by typical changes in acromial morphology on standard radiographs. We evaluated 5 commonly used radiographic parameters of acromial morphology and assessed the association between different radiographic characteristics on the one hand and subacromial impingement or rotator cuff tears on the other. Patients and methods We measured acromial type (Bigliani), acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), and acromion index (AI) on standard radiographs from 50 patients with full-thickness supraspinatus tendon tears, 50 patients with subacromial impingement, and 50 controls without subacromial pathology. Results The acromial type according to Bigliani was not associated with any particular cuff lesion. A statistically significant difference between controls and impingement patients was found for AS. AT of controls was significantly smaller than that of impingement patients and cuff-tear patients. LAA of cuff-tear patients differed significantly from that of controls and impingement patients, but LAA of controls was not significantly different from that of impingement patients. Differences between impingement patients and cuff-tear patients were also significant. AI of controls was significantly lower than of impingement patients and of cuff-tear patients. A good correlation was found between acromial type and AS. Interpretation A low lateral acromial angle and a large lateral extension of the acromion were associated with a higher prevalence of impingement and rotator cuff tears. An extremely hooked anterior acromion with a slope of more than 43° and an LAA of less than 70° only occurred in patients with rotator cuff tears. PMID:23409811

  19. Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease

    PubMed Central

    Oliva, Francesco; Osti, Leonardo; Padulo, Johnny; Maffulli, Nicola

    2014-01-01

    Summary Background: in the last years the incidence of rotator cuff tears increased and one main cause still waiting to be clarified. Receptors for thyroid hormones in rotator cuff tendons suggest possible effects on tendons metabolism and status. We undertook a retrospective, observational cohort study of 441 patients who underwent arthroscopic and mini-open repair for non traumatic degenerative rotator cuff tears. Methods: all the patients, predominantly females (63%), were interview to assess the relationship (frequency for class age “20 yrs” and factor analysis) between lesions of the rotator cuff with the following variables: gender, thyroid disease, smoker, taking medications for diabetes, hypertension or high cholesterol; presence of associated conditions (diabetes, hypertension, hypercholesterolemia). Results: thyroid disease is highly frequently (until 63% for 60<80 yrs) in females group independent to the age. Conversely, males showed a high frequency for smoker 37<62% until 80 yrs and 50% hypercholesterolemia over 80 yrs for the clinical variable studied. Conclusions: this is the first clinical report that shown a relationship between thyroid pathologies and non-traumatic rotator cuff tear as increased risk factors. PMID:25489548

  20. Shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears

    PubMed Central

    2011-01-01

    Background Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair. Purposes To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears. Subjects and methods Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera. Results During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05). Conclusion RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides. PMID:21323485

  1. The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study.

    PubMed

    Geng, Guiqi; Hu, Jingyi; Huang, Shaoqiang

    2015-02-01

    Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness. The aim of the study was to examine the effects of endotracheal tube cuff pressure changes during gynecological laparoscopic surgery on postoperative sore throat rates. Thirty patients who underwent gynecological laparoscopic surgery and 30 patients who underwent laparotomy under general anesthesia with endotracheal intubation were included. After induction of general anesthesia and endotracheal intubation, the cuff was inflated to 25 mmHg. At 5, 15, 30, 45 and 60 min after endotracheal intubation, cuff pressure and peak airway pressure were recorded. At 2 and 24 h after surgery, the patients were assessed for complaints of a sore throat. In patients who underwent laparotomy, cuff pressure and peak airway pressure did not change significantly at different time points after intubation. In patients who received laparoscopic surgery, cuff pressure and peak airway pressure were significantly increased compared to initial pressure at all examined time points. In both groups, the endotracheal tube cuff pressure and peak airway pressure were significantly correlated (R=0.9431, P<0.01; R=0.8468, P<0.01). Compared to patients who had undergone laparotomy, patients who had undergone laparoscopic surgery showed significantly higher sore throat scores at both 2 and 24 h after surgery (P<0.01). Pneumoperitoneum and Trendelenburg position may increase airway pressure and cuff pressure, resulting in increased incidence of postoperative sore throat. PMID:24748551

  2. A Bizarre, Unexplained, and Progressive External Rotation of the Shoulder as a Presentation of a Metastatic Deposit in the Rotator Cuff

    PubMed Central

    El-Tawil, Sherif; Prinja, Aditya; Stanton, Jeremy

    2015-01-01

    We describe the first reported case of a tumour deposit within the rotator cuff presenting as a bizarre, progressive, and fixed external rotation deformity of the shoulder. It is also the first reported case to our knowledge of an oesophageal primary metastasising to the rotator cuff. PMID:26543658

  3. [The course of historical development of treatment approaches to rotator cuff-related problems].

    PubMed

    Akalin, Yilmaz; Atalar, Ata Can

    2003-01-01

    Rotator cuff-related issues and problems first appeared in the medical literature in the eighteenth century. A significant amount of knowledge was obtained on diagnosis and treatment over the twentieth century, most of which is the result of pioneering work of Codman and Neer. In this review, a chronological course of development is tracked to better understand future venues. PMID:14578659

  4. Differential ubiquitin-proteasome and autophagy signaling following rotator cuff tears and suprascapular nerve injury.

    PubMed

    Joshi, Sunil K; Kim, Hubert T; Feeley, Brian T; Liu, Xuhui

    2014-01-01

    Previous studies have evaluated role of Akt/mTOR signaling in rotator cuff muscle atrophy and determined that there was differential in signaling following tendon transection (TT) and suprascapular nerve (SSN) denervation (DN), suggesting that atrophy following TT and DN was modulated by different protein degradation pathways. In this study, two muscle proteolytic systems that have been shown to be potent regulators of muscle atrophy in other injury models, the ubiquitin-proteasome pathway and autophagy, were evaluated following TT and DN. In addition to examining protein degradation, this study assessed protein synthesis rate following these two surgical models to understand how the balance between protein degradation and synthesis results in atrophy following rotator cuff injury. In contrast to the traditional theory that protein synthesis is decreased during muscle atrophy, this study suggests that protein synthesis is up-regulated in rotator cuff muscle atrophy following both surgical models. While the ubiquitin-proteasome pathway was a major contributor to the atrophy seen following DN, autophagy was a major contributor following TT. The findings of this study suggest that protein degradation is the primary factor contributing to atrophy following rotator cuff injury. However, different proteolytic pathways are activated if SSN injury is involved. PMID:24018537

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

    PubMed Central

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

    2014-01-01

    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

  6. Effect of methylprednisolone use on the rotator cuff in rats: biomechanical and histological study?

    PubMed Central

    Ghellioni, Gustavo Vinícius; da Silva, Lucas Souto; Piovezan, Anna Paula; Martins, Rafael Olívio

    2015-01-01

    Objective To evaluate the influence of treatment with different doses of methylprednisolone on the mechanical resistance and possible histological alterations of the rotator cuff tendon in rats. Methods Male Wistar rats were divided randomly into four treatment groups: sham, vehicle or 0.6 mg/kg or 6.0 mg/kg of methylprednisolone. Changes to mechanical resistance (in N) and histological parameters (fibrillar appearance, presence of collagen, edema and vascular proliferation) of the rotator cuff tendon were evaluated. The analyses were conducted after administration of one treatment (24 h afterwards), two treatments (7 days afterward) or three treatments (14 days afterwards), into the subacromial space. Results Seven and fourteen days after the treatments were started, it was found that in a dose-dependent manner, methylprednisolone reduced the mechanical resistance of the rotator cuff tendon (p < 0.05 in relation to the vehicle group). Modifications to the histological parameters were observed on the 7th and 14th days after the first infiltration, especially regarding the presence of collagen and vascular proliferation, for the dose of 0.6 mg/kg of methylprednisolone, and also regarding the presence of collagen, edema and vascular proliferation for the dose of 6.0 mg/kg of corticoid. Conclusion The results obtained demonstrated a relationship between methylprednisolone use through infiltration into the subacromial space and reduction of the mechanical resistance of and histological modifications to the rotator cuff tendon in rats. PMID:26229927

  7. Bone morphogenetic protein signaling in rotator cuff muscle atrophy and fatty infiltration

    PubMed Central

    Liu, Xuhui; Joshi, Sunil; Ravishankar, Bharat; Laron, Dominique; Kim, Hubert T.; Feeley, Brian T.

    2015-01-01

    Summary Background reduced mass (atrophy) and increased fat content (fatty infiltration) of rotator cuff muscles are common complications of large or massive rotator cuff (RC) tears, and are believed to be irreversible even after tendon repairs. Clinically, both muscle atrophy and fatty infiltration are important factors contributing to poor functional outcomes after tendon repairs. The molecular mechanism of RC muscle atrophy and FI remains undefined. In this study, we investigated the role of bone morphogenetic proteins (BMP) signaling in RC muscle atrophy and fatty infiltration using a rat model. Methods unilateral massive RC tears was induced in adult rats. RC muscles were harvested at 2 and 6 weeks after injury for BMP signaling analysis. In a separate experiment, BMP inhibitor (LDN-193189) was injected to rats through daily intraperitoneal injection. RC muscles from rats in the treated and control groups were harvested at 6 weeks after injury for biochemistry and histology analysis. Results we found significantly increased BMP-14 and BMP-7 expression in rotator cuff muscles after RCT. Inhibiting BMP signaling resulted in increased muscle atrophy and reduced fatty infiltration in rotator cuff muscle after RC tears. Conclusion this result suggests that BMP signaling inhibits RC muscle atrophy but promotes fatty infiltration. PMID:26261790

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

    PubMed Central

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

    2014-01-01

    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

  9. Rotator cuff tendinopathy: is there a role for polyunsaturated Fatty acids and antioxidants?

    PubMed

    Lewis, Jeremy S; Sandford, Fiona M

    2009-01-01

    Despite the lack of robust evidence, there has been a steady increase in the use of dietary supplements, including Omega 3 fatty acids and antioxidants, in the management of musculoskeletal conditions. One reason for this is that unsatisfactory outcomes with conventional treatments have lead sufferers to seek alternative solutions including the use of nutritional supplements. In the United Kingdom alone, the current supplement market is estimated to be over 300 pounds million per annum. One target market for nutritional supplements is tendinopathies including conditions involving the rotator cuff. This condition is debilitating and associated with considerable morbidity. Incidence increases with advancing age. High levels of cytokines, such as the pro-inflammatory interleukin 1 beta and vascular endothelial growth factor, have been reported within the bursa of patients with rotator cuff disease. There is also evidence that high concentrations of free-radical oxidants may also be involved in tendon pathology. Therefore, the possibility exists that dietary supplements may have a beneficial effect on tendon pathology, including that of the rotator cuff. A review was conducted to synthesize the available research literature on the histopathology of rotator cuff disease and the effectiveness of polyunsaturated fatty acids (PUFAs) and antioxidants on tendinopathies. A search was conducted using the MEDLINE, CINAHL, AMED, EMBASE, Cochrane, and PEDro databases using the terms "rotator cuff" and "tear/s" and "subacromial impingement syndrome," "burase," "bursitis," "tendinopathy," "tendinitis," "tendinosis," "polyunsaturated fatty acids," "PUFA," "Omega 3," "histopathology," "etiology," and "antioxidants." English language was an inclusion criterion. There were no randomized clinical trials found relating specifically to the rotator cuff. Only one trial was found that investigated the efficacy of PUFAs and antioxidants on tendinopathies. The findings suggest that some (low level) evidence exists to support the supplementation in the management of tendinopathies. Any conclusions based on this one article should be reached with caution. Subsequently, there is a distinct and clear need for well-planned randomized controlled trials that aim to investigate the efficacy of supplements in the management of tendinopathies including those of the rotator cuff. PMID:18950988

  10. Pulsed electromagnetic fields after rotator cuff repair: a randomized, controlled study.

    PubMed

    Osti, Leonardo; Buono, Angelo Del; Maffulli, Nicola

    2015-03-01

    The current study tested the hypothesis that the use of pulsed electromagnetic fields after rotator cuff repair is effective in the short term as an adjuvant treatment to reduce local inflammation, postoperative joint swelling, and recovery time, as well as to induce pain relief. Sixty-six patients who underwent shoulder arthroscopy for repair of small to medium rotator cuff tears were randomly divided into 2 groups with a block randomization procedure. Thirty-two patients underwent arthroscopic rotator cuff repair and application of pulsed electromagnetic fields postoperatively; 34 patients underwent rotator cuff repair and placebo treatment (placebo group). All patients had the same postoperative rehabilitation protocol. At 3 months from the index procedure, visual analog scale, range of motion, and University of California at Los Angeles and Constant scores were significantly better in the pulsed electromagnetic fields group than in the placebo group (P<.05). Three patients in the pulsed electromagnetic fields group and 7 patients in the placebo group had mild to moderate capsulitis (P=.2). Severe capsulitis occurred in 1 patient in the pulsed electromagnetic fields group and 2 patients in the placebo group (P=.6). At the last follow-up (minimum, 2 years), clinical and functional outcomes were further improved in both groups, with no significant intergroup differences. Application of pulsed electromagnetic fields after rotator cuff repair is safe and reduces postoperative pain, analgesic use, and stiffness in the short term. At 2 years, no difference was seen in outcomes in patients who did or did not undergo treatment with pulsed electromagnetic fields. PMID:25760511

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

    PubMed Central

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

    2013-01-01

    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

  12. In-vitro reconstruction of massive rotator cuff ruptures with triceps tendon or coracoacromial ligament.

    PubMed

    Schlepckow, P; Sigg, A

    2001-05-01

    The possibility of reconstructing a massive rotator cuff rupture with a free graft of the triceps tendon or the coracoacromial ligament was tested experimentally in an anatomical and biophysical cadaver investigation. After dissection of the rotator cuff, a section of the supraspinatus tendon was removed to simulate a defect in the cuff. In dissection of the grafts, a bony squama was incorporated by osteotomy. The rotator cuff was reconstructed by suturing the free grafts into the defect. In addition, the bony squama was refixed in a prepared bone groove in the greater tuberosity of the humerus. The tensile strength and the elasticity of the grafts were compared with that of the supraspinatus tendon in rupture tests. The mean value of the maximum load determined (FRm) was greatest for the triceps tendon (706.451 N), while very much lower values were found for the coracoacromial ligament (395.836 N) and the supraspinatus tendon (496.792 N). The mean value of the maximum elasticity (LAm) was lowest for the coracoacromial ligament (4.701%); the supraspinatus tendon (7.047%) and the triceps tendon (8.250%) showed very much greater elasticity. PMID:11409561

  13. Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device

    PubMed Central

    Derwin, Kathleen A.; Codsi, Michael J.; Milks, Ryan A.; Baker, Andrew R.; McCarron, Jesse A.; Iannotti, Joseph P.

    2009-01-01

    Background: Despite advances in surgical treatment options, failure rates of rotator cuff repair have continued to range from 20% to 90%. Hence, there is a need for new repair strategies that provide effective mechanical reinforcement of rotator cuff repair as well as stimulate and enhance the intrinsic healing potential of the patient. The purpose of this study was to evaluate the extent to which augmentation of acute repair of rotator cuff tendons with a newly designed poly-L-lactide repair device would improve functional and biomechanical outcomes in a canine model. Methods: Eight adult, male mongrel dogs (25 to 30 kg) underwent bilateral shoulder surgery. One shoulder underwent tendon release and repair only, and the other was subjected to release and repair followed by augmentation with the repair device. At twelve weeks, tendon retraction, cross-sectional area, stiffness, and ultimate load of the repair site were measured. Augmented repairs underwent histologic assessment of biocompatibility. In addition, eight pairs of canine cadaver shoulders underwent infraspinatus injury and repair with and without device augmentation with use of identical surgical procedures and served as time-zero biomechanical controls. Eight unpaired, canine cadaver shoulders were included as normal biomechanical controls. Results: At time zero, repair augmentation significantly increased the ultimate load (23%) (p = 0.034) but not the stiffness of the canine infraspinatus tendon repair. At twelve weeks, the poly-L-lactide scaffold was observed to be histologically biocompatible, and augmented repairs demonstrated significantly less tendon retraction (p = 0.008) and significantly greater cross-sectional area (137%), stiffness (26%), and ultimate load (35%) than did repairs that had not been augmented (p < 0.001, p = 0.002, and p = 0.009, respectively). Conclusions: While limiting but not eliminating tendon repair retraction, the augmentation device provided a tendon-bone bridge and scaffold for host tissue deposition and ingrowth, resulting in improved biomechanical function of the repair at twelve weeks. Clinical Relevance: The augmentation device, applied in a similar manner as described in the present study, might offer a functional benefit to patients undergoing rotator cuff repair. PMID:19411465

  14. Effect of highly purified capsaicin on articular cartilage and rotator cuff tendon healing: An in vivo rabbit study.

    PubMed

    Friel, Nicole A; McNickle, Allison G; DeFranco, Michael J; Wang, FanChia; Shewman, Elizabeth F; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R; Chubinskaya, Susan; Kramer, Susan M; Wang, Vincent M

    2015-12-01

    Highly purified capsaicin has emerged as a promising injectable compound capable of providing sustained pain relief following a single localized treatment during orthopedic surgical procedures. To further assess its reliability for clinical use, the potential effect of highly purified capsaicin on articular cartilage metabolism as well as tendon structure and function warrants clarification. In the current study, rabbits received unilateral supraspinatus transection and repair with a single 1?ml injection of capsaicin (R?+?C), PEG-only placebo (R?+?P), or saline (R?+?S) into the glenohumeral joint (GHJ). An additional group received 1?ml capsaicin onto an intact rotator cuff (I?+?C). At 18 weeks post-op, cartilage proteoglycan (PG) synthesis and content as well as cell viability were similar (p?>?0.05) across treatment groups. Biomechanical testing revealed no differences (p?>?0.05) among tendon repair treatment groups. Similarly, histologic features of both cartilage and repaired tendons showed minimal differences across groups. Hence, in this rabbit model, a single injection of highly purified capsaicin into the GHJ does not induce a deleterious response with regard to cartilage matrix metabolism and cell viability, or rotator cuff healing. These data provide further evidence supporting the use of injectable, highly purified capsaicin as a safe alternative for management of postoperative pain following GHJ surgery. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1854-1860, 2015. PMID:26135547

  15. Structural Characteristics Are Not Associated With Pain and Function in Rotator Cuff Tears

    PubMed Central

    Curry, Emily J.; Matzkin, Elizabeth E.; Dong, Yan; Higgins, Laurence D.; Katz, Jeffrey N.; Jain, Nitin B.

    2015-01-01

    Background: Structural characteristics of rotator cuff tears are used in surgical decision making. However, data on the association of tear size with patient-reported pain and function are sparse. Purpose: To assess the association of tear size, fatty infiltration, and muscle atrophy with shoulder pain/function in patients with cuff tears undergoing operative and nonoperative treatment. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 67 patients with rotator cuff tears were recruited for this longitudinal cohort study. Patients were determined to have a cuff tear using clinical assessment and blinded magnetic resonance imaging review. The Shoulder Pain and Disability Index (SPADI) was used as a measure of shoulder pain and function. Results: Tear size and thickness were not significantly associated with pain (SPADI pain score, 60.6 [95% CI, 49.8-71.5] for partial-thickness tear; 56.8 [95% CI, 42.8-70.7] for <2 cm full-thickness tear; 60.4 [95% CI, 51.7-69.0] for ?2 cm full-thickness tear). Tear size and thickness were not associated with function (SPADI disability score, 42.7 [95% CI, 29.8-55.6] for partial-thickness tear; 37.6 [95% CI, 23.9-51.4] for <2 cm full-thickness tear; 45.1 [95% CI, 35.4-54.8] for ?2 cm full-thickness tear). Fatty infiltration, muscle atrophy, and tendon retraction were also not significantly associated with SPADI pain and disability scores. A Mental Health Index score of <68 as well as age ?60 years were significantly associated with a higher SPADI pain score. Female sex, increased number of comorbidities, Mental Health Index score of <68, and age <60 years were significantly associated with a higher SPADI disability score. Conclusion: In patients with rotator cuff tears undergoing operative and nonoperative treatment, pain and functional status were not associated with tear size and thickness, fatty infiltration, and muscle atrophy. Conversely, factors unrelated to cuff anatomy such as mental health, comorbidities, age, and sex were associated with pain/function. These findings have clinical implications during surgical decision making and suggest that pain and functional disability in patients with rotator cuff tears is multifactorial and should not solely be attributed to structural characteristics. PMID:26675985

  16. The MRI geyser sign: acromioclavicular joint cysts in the setting of a chronic rotator cuff tear.

    PubMed

    Cooper, H John; Milillo, Ralph; Klein, Devon A; DiFelice, Gregory S

    2011-06-01

    We present the case of a 71-year-old man with a large acromioclavicular (AC) joint cyst successfully managed with surgical excision. AC joint cysts are soft tissue masses generally signifying underlying rotator cuff pathology. Traditionally, these cysts were identified with shoulder arthrography as a "geyser" of fluid escaping through the AC joint. Magnetic resonance imaging (MRI) is today's preferred imaging modality; we describe the MRI equivalent of the "geyser sign," signifying synovial fluid escaping through the cuff defect, across the subacromial bursa, and decompressing superiorly through a degenerated AC joint. Surgical management is preferred for symptomatic cysts. Based on a review of limited retrospective case series, recommendations for management of these lesions are as follows. Repair of the rotator cuff is preferable whenever possible. In the case of an irreparable defect, good results can be achieved through excisional AC joint arthroplasty and resection of the cyst base. Aspiration of these cysts should not be attempted, due to the high recurrence rate and potential for a draining sinus. Hemiarthroplasty also may be effective in indirectly decompressing these cysts; but given the invasive nature of this procedure, it should be reserved for patients who are also symptomatic from cuff arthropathy. PMID:21869946

  17. Systematic Review: What Surgical Technique Provides the Best Outcome for Symptomatic Partial Articular-Sided Rotator Cuff Tears?

    PubMed Central

    Bollier, Matthew; Shea, Kevin

    2012-01-01

    Purpose There is no consensus in the literature regarding the optimal surgical treatment of symptomatic partial rotator cuff tears. We attempted to determine the optimal surgical treatment for partial articular-sided rotator cuff tears through a systematic review of appropriate studies. Methods Medline®, PubMed, Ovid, and the cochrane register of controlled trials were searched for all studies published between January 1991 to March 2010 that used the key words “shoulder”, “partial rotator cuff tear”, “PASTA”, “articularsided rotator cuff tear”, “incomplete rotator cuff tear”, “arthroscopic” and “repair”. Inclusion criteria were studies (Level I to IV) that reported clinical outcomes in patients who had arthroscopic evaluation and arthroscopic or mini-open treatment of a symptomatic partial articular-sided rotator cuff tear. One of three surgical treatments was used: debridement with or without acromioplasty; transtendon arthroscopic repair; or tear completion with repair. Exclusion criteria included studies with over 50% overhead throwers or athletes, studies that involved an open approach to the rotator cuff without arthroscopy, and data presented in technical notes or review papers. Data abstracted from the studies included patient demographics, tear characteristics, surgical procedure(s), and clinical outcomes. Results Of 588 studies involving partial rotator cuff tears, 14 studies were identified which met our inclusion and exclusion criteria. All studies were Level IV retrospective case-series studies. Seven studies reported outcomes after rotator cuff debridement. Tear completion and repair was performed in three studies. Transtendon repair of a partial articular-sided rotator cuff tear was performed in three studies. Although different outcome measures were used, each study reported subjective and objective improvement postoperatively. One study compared outcomes in patients who underwent arthroscopic debridement versus another group where patients had tear completion and mini-open repair. Improved long-term results and decreased reoperation rates were reported in the tear completion and repair group. Conclusion On the basis of the available evidence, no single technique provides superior clinical outcomes. Level I and II comparison studies are needed to determine the optimal treatment of partial articular-sided rotator cuff tears. PMID:23576937

  18. Relationship of Radiographic Acromial Characteristics and Rotator Cuff Disease: A Prospective Investigation of Clinical, Radiographic, and Sonographic Findings

    PubMed Central

    Hamid, Nady; Omid, Reza; Yamaguchi, Ken; Steger-May, Karen; Stobbs, Georgia; Keener, Jay D

    2013-01-01

    Background Many studies have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Therefore, the purpose of this study was to determine the relationship between rotator cuff disease and development of symptoms with different radiographic acromial characteristics including shape, index, and presence of a spur. Materials and Methods The records of 216 patients enrolled in an ongoing prospective, longitudinal study investigating asymptomatic rotator cuff tears were reviewed. All patients underwent standardized radiographic evaluation, clinical evaluation, and shoulder ultrasonography at regularly scheduled surveillance visits. Three blinded observers reviewed all radiographs to determine the acromial morphology, presence and size of an acromial spur, and acromial index. These findings were analyzed to determine an association with the presence of a full-thickness rotator cuff tear. Results The three observers demonstrated poor agreement for acromial morphology, substantial agreement for the presence of an acromial spur, and excellent agreement for acromial index (kappa= 0.41, 0.65, and 0.86 respectively). The presence of an acromial spur was highly associated with the presence of a full-thickness rotator cuff tear (p=0.003) even after adjusting for age. No association was found between acromial index and rotator cuff disease (p=0.92). Conclusion The presence of an acromial spur is highly associated with the presence of a full-thickness rotator cuff tear in both the symptomatic and asymptomatic patient. The acromial morphology classification system is an unreliable method to assess the acromion. The acromial index shows no association with the presence of rotator cuff disease. PMID:22217644

  19. Treatment options for irreparable postero-superior cuff tears in young patients

    PubMed Central

    Galasso, Olimpio; Familiari, Filippo; Gasparini, Giorgio

    2015-01-01

    Rotator cuff tears (RCTs) occur more commonly with advanced age, with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs. Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population, and the incidence of irreparable RCTs in young patients is still unknown. Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs, such as rotator cuff debridement, partial rotator cuff repair, biceps tenotomy/tenodesis, rotator cuff grafting, latissimus dorsi tendon transfer, and reverse shoulder arthroplasty. After being thoroughly investigated in open surgery, arthroscopic techniques for latissimus dorsi tendon transfer have been recently described. They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management. PMID:26601058

  20. Greater tuberosity notch: an important indicator of articular-side partial rotator cuff tears in the shoulders of throwing athletes.

    PubMed

    Nakagawa, S; Yoneda, M; Hayashida, K; Wakitani, S; Okamura, K

    2001-01-01

    We examined the location of rotator cuff tears, associated labral injuries, and notches on the greater tuberosity of the humeral head in shoulders of throwing athletes. Arthroscopic findings (rotator cuff tear, labral condition, and greater tuberosity notch) as well as other factors (duration of playing baseball, range of motion, and joint laxity) of 61 baseball players were retrospectively studied. The presence of a greater tuberosity notch was also evaluated for by plain radiographs. Forty patients had articular-side partial rotator cuff tears, most of which occurred in the interval between the supraspinatus and infraspinatus tendons. The existence of a rotator cuff tear was not related to the range of motion, joint laxity, the detachment of the superior glenoid labrum, or posterosuperior labral injury. Greater tuberosity notches were recognized in 38 shoulders by arthroscopy and most were detected on plain radiographs. The presence of a notch was significantly related to the existence of a rotator cuff tear, while the size of the notch was significantly related to the depth and width of the tear. The greater tuberosity notch seems to be one of the most important diagnostic indicators for a rotator cuff tear in throwing athletes. PMID:11734490

  1. Quantitative assessment of rotator cuff muscle elasticity: Reliability and feasibility of shear wave elastography.

    PubMed

    Hatta, Taku; Giambini, Hugo; Uehara, Kosuke; Okamoto, Seiji; Chen, Shigao; Sperling, John W; Itoi, Eiji; An, Kai-Nan

    2015-11-01

    Ultrasound imaging has been used to evaluate various shoulder pathologies, whereas, quantification of the rotator cuff muscle stiffness using shear wave elastography (SWE) has not been verified. The purpose of this study was to investigate the reliability and feasibility of SWE measurements for the quantification of supraspinatus (SSP) muscle elasticity. Thirty cadaveric shoulders (18 intact and 12 with torn rotator cuff) were used. Intra- and inter-observer reliability was evaluated on an established SWE technique for measuring the SSP muscle elasticity. To assess the effect of overlying soft tissues above the SSP muscle, SWE values were measured with the transducer placed on the skin, on the subcutaneous fat after removing the skin, on the trapezius muscle after removing the subcutaneous fat, and directly on the SSP muscle. In addition, SWE measurements on 4 shoulder positions (0°, 30°, 60°, and 90° abduction) were compared in those with/without rotator cuff tears. Intra- and inter-observer reliability of SWE measurements were excellent for all regions in SSP muscle. Also, removing the overlying soft tissue showed no significant difference on SWE values measured in the SSP muscle. The SSP muscle with 0° abduction showed large SWE values, whereas, shoulders with large-massive tear showed smaller variation throughout the adduction-abduction positions. SWE is a reliable and feasible tool for quantitatively assessing the SSP muscle elasticity. This study also presented SWE measurements on the SSP muscle under various shoulder abduction positions which might help characterize patterns in accordance to the size of rotator cuff tears. PMID:26472309

  2. A Canine Non-Weight-Bearing Model with Radial Neurectomy for Rotator Cuff Repair

    PubMed Central

    Ji, Xiaoxi; Bao, Nirong; An, Kai-Nan; Amadio, Peter C.; Steinmann, Scott P.; Zhao, Chunfeng

    2015-01-01

    Background The major concern of using a large animal model to study rotator cuff repair is the high rate of repair retears. The purpose of this study was to test a non-weight-bearing (NWB) canine model for rotator cuff repair research. Methods First, in the in vitro study, 18 shoulders were randomized to 3 groups. 1) Full-width transections repaired with modified Mason-Allen sutures using 3-0 polyglactin suture, 2) Group 1 repaired using number 2 (#2) polyester braid and long-chain polyethylene suture, and 3) Partial-width transections leaving the superior 2 mm infraspinatus tendon intact without repair. In the in vivo study of 6 dogs, the infraspinatus tendon was partially transected as the same as the in vitro group 3. A radial neurectomy was performed to prevent weight bearing. The operated limb was slung in a custom-made jacket for 6 weeks. Results In the in vitro study, mean ultimate tensile load and stiffness in Group 2 were significantly higher than Group 1 and 3 (p<0.05). In the in vivo study, gross inspection and histology showed that the preserved superior 2-mm portion of the infraspinatus tendon remained intact with normal structure. Conclusions Based on the biomechanical and histological findings, this canine NWB model may be an appropriate and useful model for studies of rotator cuff repair. PMID:26107616

  3. Effects of therapeutic ultrasound and exercise on pain, function, and isokinetic shoulder rotator strength of patients with rotator cuff disease

    PubMed Central

    Analan, P?nar Doruk; Leblebici, Berrin; Adam, Mehmet

    2015-01-01

    [Purpose] The aim of this prospective, double-blind, randomized, placebo-controlled study was to evaluate the effects of therapeutic continuous ultrasound (US) on patients with rotator cuff disease. [Subjects and Methods] Twenty-two patients were treated with a standard physiotherapy program consisting of a hot-pack, transcutaneous electrical nerve stimulation (TENS), exercises, and US that was supervised by the same physiotherapist. The patients were randomly assigned to either a group that received true US (n=11) or one that received sham US (n=11). [Results] There were significant differences between the pre- and post-intervention UCLA Shoulder Rating Scale and Constant-Murley Shoulder Outcome scores, VAS, and external rotation (ER) peak torque 60°/second values for both the true and sham US groups. However, the between-group differences were not statistically significant. [Conclusion] In patients with rotator cuff disease, physiotherapy interventions effectively treat the pain, improve the clinical status, and increase the muscle strength of the shoulder ER at a low constant angular velocity, with functional improvement being seen immediately after treatment. However, at the end of the intervention, the US had yielded no additional efficacy to the physiotherapy treatment regimen of the patients with rotator cuff disease. PMID:26644656

  4. Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears

    PubMed Central

    Strickland, Justin P.; Fleckenstein, Cassie M.; Ducker, Al; Hasan, Samer S.

    2010-01-01

    Background: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. Purpose: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. Study Design: Case series. Methods: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. Results: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. Conclusions: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing. PMID:23015981

  5. Circumferential rotator cuff repair with the n+4 portal, subclavian portal, and high posteromedial portal.

    PubMed

    Nord, Keith D; Khan, Maher W; Wright, Garth B; Taylor, Jonathon B

    2015-02-01

    Passing suture during a rotator cuff repair requires proper orientation and purchase of the rotator cuff tendon. Our technique uses a new portal to improve access to the supraspinatus and infraspinatus and uses additional portals for a circumferential repair of the tear, thereby restoring the footprint. Using a penetrating suture passer through the anterior, posterior, and superomedial portals allows 270° of coverage. The lateral anchors complete the circumferential repair. Sutures from the medial anchors are passed in a retrograde fashion using 3 small incisions with no cannula. A spinal needle is used to localize the orientation of each portal. The N+4 portal is the workhorse portal, allowing access to the supraspinatus and infraspinatus. The suture retriever enters the trapezius 5 cm from the medial border of the acromion and 1 cm anterior to the spine of the scapula. It enters the subacromial space on top of the supraspinatus. This provides protection to the suprascapular nerve in the supraspinatus fossa. The cuff is lifted with a grasper to allow perpendicular passage of suture. The suture is retrieved for tying. The tissue purchase and location of suture placement help restore the footprint of the supraspinatus and infraspinatus. Additional sutures are passed anteriorly through the subclavian portal and posteriorly through the high posteromedial portal. The repair is completed with lateral-row anchors as needed. PMID:25973377

  6. Biological augmentation of rotator cuff repair using bFGF-loaded electrospun poly(lactide-co-glycolide) fibrous membranes

    PubMed Central

    Zhao, Song; Zhao, Jingwen; Dong, Shikui; Huangfu, Xiaoqiao; Li, Bin; Yang, Huilin; Zhao, Jinzhong; Cui, Wenguo

    2014-01-01

    Clinically, rotator cuff tear (RCT) is among the most common shoulder pathologies. Despite significant advances in surgical techniques, the re-tear rate after rotator cuff (RC) repair remains high. Insufficient healing capacity is likely the main factor for reconstruction failure. This study reports on a basic fibroblast growth factor (bFGF)-loaded electrospun poly(lactide-co-glycolide) (PLGA) fibrous membrane for repairing RCT. Implantable biodegradable bFGF–PLGA fibrous membranes were successfully fabricated using emulsion electrospinning technology and then characterized and evaluated with in vitro and in vivo cell proliferation assays and repairs of rat chronic RCTs. Emulsion electrospinning fabricated ultrafine fibers with a core-sheath structure which secured the bioactivity of bFGF in a sustained manner for 3 weeks. Histological observations showed that electrospun fibrous membranes have excellent biocompatibility and biodegradability. At 2, 4, and 8 weeks after in vivo RCT repair surgery, electrospun fibrous membranes significantly increased the area of glycosaminoglycan staining at the tendon–bone interface compared with the control group, and bFGF–PLGA significantly improved collagen organization, as measured by birefringence under polarized light at the healing enthesis compared with the control and PLGA groups. Biomechanical testing showed that the electrospun fibrous membrane groups had a greater ultimate load-to-failure and stiffness than the control group at 4 and 8 weeks. The bFGF–PLGA membranes had the highest ultimate load-to-failure, stiffness, and stress of the healing enthesis, and their superiority compared to PLGA alone was significant. These results demonstrated that electrospun fibrous membranes aid in cell attachment and proliferation, as well as accelerating tendon–bone remodeling, and bFGF-loaded PLGA fibrous membranes have a more pronounced effect on tendon–bone healing. Therefore, augmentation using bFGF–PLGA electrospun fibrous membranes is a promising treatment for RCT. PMID:24868155

  7. Effect of subacromial sodium hyaluronate injection on rotator cuff disease: A double-blind placebo-controlled clinical trial

    PubMed Central

    Moghtaderi, Alireza; Sajadiyeh, Sepideh; Khosrawi, Saeid; Dehghan, Farnaz; Bateni, Vahid

    2013-01-01

    Background: Rotator cuff disease is a common cause of shoulder pain. There are studies about the effectiveness of sodium hyaluronate injection on shoulder and knee pain, but few studies demonstrating the efficacy of sodium hyaluronate ultrasonography guided injection for rotator cuff disease. This study evaluates effectiveness of ultrasonography guided subacromial sodium hyaluronate injection in patients with impingment syndrome without rotator cuff complete tear. Materials and Methods: This prospective, double-blind, placebo controlled clinical trial study was performed among 40 patients with subacromial impingement syndrome without complete tear of rotator cuff. Patients randomly injected ultrasonography guided in 2 groups: Case group by 20 mg of sodium hyaluronate (Fermathron™) and control group by 0.9% normal saline. Both groups received 3 weekly injections. The pain score (100 mm visual analogue score [VAS]) was evaluated before first injection and one week after each injection. The constant score was evaluated before first and 12 week after last injection. Data was analyzed statistically by Independent t-test. Results: In both groups mean VAS has decreased, but more significantly in case group (P < 0.001). Mean constant score was significantly higher in case group 12 weeks after last injection (P < 0.001). The constant score improved 12 weeks after the last injection in both groups with a significantly better result in case group (P < 0.001). Conclusion: Subacromial injections of sodium hyaluronate are effective in treating rotator cuff disease without complete tears. PMID:24524035

  8. The lateral Jobe test: A more reliable method of diagnosing rotator cuff tears

    PubMed Central

    Gillooly, John Joseph; Chidambaram, Ramiah; Mok, Daniel

    2010-01-01

    Purpose: The most reliable clinical investigations to diagnose rotator cuff tears reported in the literature is a triad of weakness on resisted external rotation, pain on impingement, and weakness on supraspinatus testing, or a combination of two of the above in a patient over 60 years of age. We present a simple new clinical test “The lateral Jobe Test” and compare it to these combined tests. The lateral Jobe test is performed with the patient’s shoulder abducted 90° in the coronal plane and internally rotated so that with the elbows flexed 90° the fingers point inferiorly and thumbs medially. A positive test is pain or weakness on resisting an inferiorly directed force applied to the distal arms or an inability to perform the test. Materials and Methods: A consecutive series of 175 patients undergoing shoulder arthroscopy were reviewed prospectively and examined by two independent orthopedic surgeons blinded to the diagnosis. The results of the clinical tests were validated against arthroscopic findings. Results: The lateral Jobe test had a significantly higher sensitivity (81 vs. 58%) than the combined tests. The specificity of both was similar at 89 and 88%, respectively. Conslusion: The lateral Jobe test is a simple single test which can help in the clinical diagnosis of rotator cuff tears. Level of Evidence: Level IIb PMID:21072147

  9. Shoulder kinematics in patients with full-thickness rotator cuff tears after a subacromial injection.

    PubMed

    Scibek, Jason S; Mell, Amy G; Downie, Brian K; Carpenter, James E; Hughes, Richard E

    2008-01-01

    The purpose of this study was to test the hypothesis that scapulohumeral rhythm (SHR) is altered in patients with full-thickness rotator cuff tears due to pain. Fifteen subjects (mean age, 60.2 +/- 8.9 years; mean height, 1.72 +/- 0.10 m; mean weight, 85.43 +/- 18.32 kg) performed humeral elevation in the 3 planes before and after a lidocaine injection. Pain was assessed by use of a visual analog scale, and data were collected with an electromagnetic tracking system. Three-dimensional scapular kinematics (scapulothoracic motion) and glenohumeral elevation were assessed. A linear regression model was used to calculate SHR (ratio of scapulothoracic motion to glenohumeral elevation) for equal phases of elevation (I, II, and III) and lowering (IV, V, and VI). Pain was significantly reduced (P rotation for humeral motion. As SHR decreased, the contribution of glenohumeral elevation increased significantly whereas scapular upward and downward rotation tended to decrease. Differences in anterior-posterior and medial-lateral tilting of the scapula did not correspond with changes in SHR. The findings provide evidence of compensatory increases in SHR due to pain associated with full-thickness rotator cuff tear. PMID:18036839

  10. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

    PubMed Central

    2009-01-01

    Background Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. Methods Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US) scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later) the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder) using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved by consensus. Results Twenty-six patients agreed to participate and formed the study population. Of these, 6 subjects were not included in the final assessment following the pre-scan clinical investigation. This is because one subject had complete cessation of symptoms between the time of the referral and entry into the trial. Another five had developed bilateral shoulder pain during the same period. The mean age of the 20 subjects forming the study population was 50.2 (range 32-69) years (SD = 10.9) and the mean duration of symptoms was 22.6 (range .75 to 132) months (SD = 40.1). Of the 20 subjects included in the formal analysis, 13 subjects (65%) demonstrated neovascularity in the symptomatic shoulder and 5 subjects (25%) demonstrated neovascularity in the asymptomatic shoulder. The subject withdrawn due to complete cessation of symptoms was not found to have neovascularity in either shoulder and of the 5 withdrawn due to bilateral symptoms; two subjects were found to have signs of bilateral neovascularity, one subject demonstrated neovascularity in one shoulder and two subjects in neither shoulder. Conclusions This study demonstrated that neovascularity does occur in subjects with a clinical diagnosis of rotator cuff tendinopathy and to a lesser extent in asymptomatic shoulders. In addition, the findings of this investigation did not identify an association between the presence of neovascularity; and pain, duration of symptoms or shoulder function. Future research is required to determine the relevance of these findings. PMID:20025761

  11. Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips & tricks.

    PubMed

    Sconfienza, Luca Maria; Viganò, Sara; Martini, Chiara; Aliprandi, Alberto; Randelli, Pietro; Serafini, Giovanni; Sardanelli, Francesco

    2013-01-01

    Rotator cuff calcific tendinitis is a very common disease and may result in a very painful shoulder. Aetiology of this disease is still poorly understood. When symptoms are mild, this disease may be treated conservatively. Several treatment options have been proposed. Among them, ultrasound-guided procedures have been recently described. All procedures use one or two needles to inject a fluid, to dissolve calcium and to aspirate it. In the present article, we review some tips and tricks that may be useful to improve performance of an ultrasound-guided double-needle procedure. PMID:22710923

  12. Arthroscopic Changes of the Biceps Pulley in Rotator Cuff Tear and Its Clinical Significance in Relation to Treatment

    PubMed Central

    Choi, Chang Hyuk; Kim, Se Sik; Lee, Ju Hwan

    2015-01-01

    Background In the case of rotator cuff tears, the biceps pulley can be stressed by the unstable biceps tendon, and this can subsequently affect the stability of the subscapularis tendon. Therefore, it is important to distinguish between normal variations and lesions of the biceps pulley that affect anterosuperior lesions in cases of rotator cuff tears. Methods From January 2002 through November 2010, we observed biceps pulley and associated anterosuperior lesions in 589 of 634 cases (93%) of arthroscopic rotator cuff repair, including 72 cases (12.2%) of small tears, 219 cases (37.2%) of medium tears, 134 cases (22.8%) of large tears, and 164 cases (27.8%) of massive tears. We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV. Results We were able to classify 589 cases of biceps pulleys as type I, II, III, or IV associated lesions in rotator cuff tears. Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%). Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases. Conclusions Biceps pulley lesions with more than partial tears were identified in 48% of rotator cuff tear cases. The incidence and severity of pulley lesions were related to the rotator cuff tear size, the status of the long head of the biceps tendon and subscapularis tendon lesion, and the treatment methods. PMID:26330960

  13. Stem cell therapy in the management of shoulder rotator cuff disorders.

    PubMed

    Valencia Mora, Maria; Ruiz Ibán, Miguel A; Díaz Heredia, Jorge; Barco Laakso, Raul; Cuéllar, Ricardo; García Arranz, Mariano

    2015-05-26

    Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy. PMID:26029341

  14. Stem cell therapy in the management of shoulder rotator cuff disorders

    PubMed Central

    Mora, Maria Valencia; Ibán, Miguel A Ruiz; Heredia, Jorge Díaz; Laakso, Raul Barco; Cuéllar, Ricardo; Arranz, Mariano García

    2015-01-01

    Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy. PMID:26029341

  15. Rotator Cuff Metastases: A Report of Two Cases with Literature Review

    PubMed Central

    Soker, Gokhan; Soker, Eda; Gulek, Bozkurt; Acikalin, Arbil; Asut, Elife; Kaya, Omer; Dilek, Okan; Yilmaz, Cengiz

    2014-01-01

    Context: Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far. Case Report: The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper. Conclusion: Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered. PMID:25599056

  16. The effect of head rotation on efficiency of ventilation and cuff pressure using the PLMA in pediatric patients

    PubMed Central

    Park, Hahck Soo; Kim, Youn Jin

    2011-01-01

    Background This study examined whether changing the head position from neutral to side can affect expiratory tidal volume (TV) and cuff pressure when the appropriate sizes of a Proseal™ Laryngeal Mask Airway (PLMA)-depending on the body weight -are used in pediatric patients during pressure controlled ventilation (PCV). Methods Seventy-seven children (5-30 kg) were divided into three groups according to their body weight, PLMA#1.5 (group I, n = 24), #2 (group II, n = 26), and #2.5 (group III, n = 27). After anesthesia induction, a PLMA was placed with a cuff-pressure of 60 cmH2O. The TV and existence of leakage at the peak inspiratory pressure (PIP) of 20 cmH2O, and the appropriate PIP for TV 10 ml/kg were examined. Upon head rotation to the left side, the TV, PIP, cuff pressure changes, and the appropriate PIP to achieve a TV 10 ml/kg were evaluated. Results Head rotation of 45 degrees to the left side during PCV caused a significant increase in cuff pressure and a decrease in TV, and there was no definite leakage. Changes in PIP and TV were similar in the three groups. The cuff pressure increased but there was no significant difference between the three groups. Conclusions Although cuff pressure and TV of the PLMA were changed significantly after turning the head from the neutral position to the side, a re-adjustment of the cuff pressure and PIP to maintain a TV of 10 ml/kg can make the placed PLMA useful and successful in pediatric patients under general anesthesia. PMID:22025944

  17. Surgery Clerkship MID-ROTATION EVALUATION

    E-print Network

    Sherman, S. Murray

    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

  18. Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

    PubMed Central

    Chen, Xiaobin; Giambini, Hugo; Ben-Abraham, Ephraim; An, Kai-Nan; Nassr, Ahmad; Zhao, Chunfeng

    2015-01-01

    Introduction An increased bone mineral density (BMD) in the proximity to tendon insertion can improve rotator cuff repair and healing. However, how a decrease of BMD in the humeral head affects the biomechanical properties of the rotator cuff tendon is still unclear. Previous studies have demonstrated ovariectomy in animals to lead to osteoporosis and decreased BMD, and Teriparatide (PTH) administration to improve BMD and strength of bone. This study aimed to explore the correlation between humeral head BMD and infraspinatus (ISP) tendon insertion strength, and if an increase in bone quantity of the humeral head can improve the strength of the rotator cuff. Materials and Methods Eighteen New England white rabbits were divided into the 3 groups: Control, Ovariectomy-Saline (OVX-Saline), and Ovariectomy-PTH (OVX-PTH). The OVX-Saline group and the OVX-PTH were administered daily saline and Teriparatide injections for 8 weeks starting at 17 weeks of OVX. BMD of the humeral head was measured, the ISP tendon failure load was tested and the failure stress was calculated. One specimen from each group was used for histological analysis. Linear regression analysis was used to derive equations for the BMD and failure stress. Results Significant differences were observed in the measured humeral head BMD of the Control and OVX-PTH groups compared to the OVX-Saline group (P = 0.0004 and P = 0.0024, respectively). No significant difference was found in failure stress among the three groups, but an expected trend with the control group and OVX-PTH group presenting higher failure strength compared to the OVX-Saline group. BMD at the humeral head showed a positive linear correlation with stress (r2 = 0.54). Histology results showed the superiority in OVX-PTH group ISP enthesis compared to the OVX-Saline group. Conclusion Bone loss of the humeral head leads to decreased tendon/bone insertion strength of the infraspinatus tendon enthesis. Teriparatide administration can increase bone density of the humeral head and may improve the mechanical properties of the infraspinatus tendon enthesis. PMID:26466092

  19. Proteomics Perspectives in Rotator Cuff Research: A Systematic Review of Gene Expression and Protein Composition in Human Tendinopathy

    PubMed Central

    Sejersen, Maria Hee Jung; Frost, Poul; Hansen, Torben Bæk; Deutch, Søren Rasmussen; Svendsen, Susanne Wulff

    2015-01-01

    Background Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics – the comprehensive study of protein composition - in tendon research. Materials and Methods We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue. Results We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies) and III (13 of 14), metalloproteinase (MMP)-1 (6 of 12), -9 (7 of 7), -13 (4 of 7), tissue inhibitor of metalloproteinase (TIMP)-1 (4 of 7), and vascular endothelial growth factor (4 of 7), and a decrease in MMP-3 (10 of 12). Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro. Conclusions Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins) that characterise specific tendon disorders or stages of tendinopathy. Thus, our results suggested an untapped potential for proteomics in tendon research. PMID:25879758

  20. Atrophy, inducible satellite cell activation, and possible denervation of supraspinatus muscle in injured human rotator-cuff muscle.

    PubMed

    Gigliotti, Deanna; Leiter, Jeff R S; Macek, Bryce; Davidson, Michael J; MacDonald, Peter B; Anderson, Judy E

    2015-09-15

    The high frequency of poor outcome and chronic pain after surgical repair of shoulder rotator-cuff injury (RCI) prompted this study to explore the potential to amplify muscle regeneration using nitric oxide (NO)-based treatment. After preoperative magnetic resonance imaging (MRI), biopsies of supraspinatus and ipsilateral deltoid (as a control) were collected during reparative surgery for RCI. Muscle fiber diameter, the pattern of neuromuscular junctions observed with alpha-bungarotoxin staining, and the ?:? subunit ratio of acetylcholine receptors in Western blots were examined in tandem with experiments to determine the in vitro responsiveness of muscle satellite cells to activation (indicated by uptake of bromodeoxyuridine, BrdU) by the NO-donor drug, isosorbide dinitrate (ISDN). Consistent with MRI findings of supraspinatus atrophy (reduced occupation ratio and tangent sign), fiber diameter was lower in supraspinatus than in deltoid. ISDN induced a significant increase over baseline (up to 1.8-fold), in the proportion of BrdU+ (activated) Pax7+ satellite cells in supraspinatus, but not in deltoid, after 40 h in culture. The novel application of denervation indices revealed a trend for supraspinatus muscle to have a higher ?:? subunit ratio than deltoid (P = 0.13); this ratio inversely with both occupancy ratio (P < 0.05) and the proportion of clusters at neuromuscular junctions (P = 0.05). Results implicate possible supraspinatus denervation in RCI and suggest NO-donor treatment has potential to promote growth in atrophic supraspinatus muscle after RCI and improve functional outcome. PMID:26135801

  1. Infusion Methods for Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Byeon, Gyeong Jo; Yoon, Ji Uk; Kim, Eun Jung; Baek, Seung Hoon; Ri, Hyun Su

    2015-01-01

    Background Infusion methods during regional analgesia using perineural catheters may influence the quality of postoperative analgesia. This study was conducted to compare the effects of combined or bolus-only infusion of 0.2% ropivacaine on the postoperative analgesia in interscalene brachial plexus block (ISBPB) with perineural catheterization. Methods Patients scheduled for arthroscopic rotator cuff repair were divided into two groups, one that would receive a combined infusion (group C, n = 32), and one that would receive intermittent infusion (group I, n = 32). A perineural catheter was inserted into the interscalene brachial plexus (ISBP) using ultrasound (US) and nerve stimulation, and 10 ml of 0.2% ropivacaine was administered. After the operation, group C received a continuous infusion of 4 ml/h, and a 4 ml bolus with a lockout interval of 60 min. Group I received only a 4 ml bolus, and the lockout interval was 30 min. Postoperative pain by the numeric rating scale (NRS) and the forearm muscle tone by the manual muscle test (MMT) were checked and evaluated at the following timepoints: preoperative, and postoperative 1, 4, 12, 24, 36, and 48 h. Supplemental opioid requirements, total consumed dose of local anesthetic, and adverse effects were compared between the two groups. Results Sixty-four patients completed the study and the postoperative values such as operation time, time to discharge, and operation site were comparable. There were no differences in NRS scores and supplemental opioid requirements between the two groups. The MMT scores of group I at 4 and 12 h after surgery were significantly higher than those of group C (P < 0.05). The total consumed dose of local anesthetic was significantly lower in group I than in group C (P < 0.05). The adverse effects were not different between the groups. Conclusions The bolus-only administration of 0.2% ropivacaine provided a similar analgesic effect with a lower total volume of local anesthetic and decreased motor weakness compared to combined infusion. Therefore, bolus-only administration is an effective postoperative analgesic method in ISBPB with perineural catheterization after rotator cuff repair. PMID:26175882

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

    PubMed Central

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

    2004-01-01

    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

  3. Differential growth on sutures of tendon cells derived from torn human rotator cuff.

    PubMed

    Hakimi, Osnat; Chaudhury, Salma; Murphy, Richard; Carr, Andrew

    2012-04-01

    Rotator cuff tendon pathology is proposed to account for 30-70% of all shoulder pain and surgical repair with a nonabsorbable suture is the common option for painful rotator cuff tears that have failed conservative treatment. A number of studies have suggested the beneficial effect of augmenting the repair with implants constructed from polymers used for sutures. Thus, it was of interest to investigate the affinity of tendon-derived fibroblasts, often thought to be the repairing agents of torn tendons, to commonly used sutures. The aim of this comparative study was to evaluate the suitability of these sutures for the construction of a patch by measuring cell survival, proliferation, and migration of human tendon-derived fibroblasts on different sutures. To ensure relevance to the target tissue, cells used in this study were obtained from torn human supraspinatus tendons. An initial comparison of cell proliferation on suture mats showed an overall positive proliferation on polyester (Ethibond) and polydioxanone (PDSII) mats and a reduction of proliferation on vicryl (polyglactin 910) compared to day one. The results also showed that the degradation products of vicryl had a negative effect on cell growth over 10 weeks. Of the commercial sutures selected and tested, Ethibond showed the best performance in terms of cell attachment and increase in biomass. The degradable PDSII also showed good interaction with cells in vitro, but relatively poor cell adhesion. This study provides useful and clinically relevant information, which could help to guide future considerations for candidate materials from which to construct tissue repair patches. PMID:22121052

  4. Results of reconstruction of massive irreparable rotator cuff tears using a fascia lata allograft

    PubMed Central

    Dimitrios, Varvitsiotis; Athanasios, Papaspiliopoulos; Eleni, Antipa; Xenofon, Papacharalampous; George, Flevarakis; John, Feroussis

    2015-01-01

    Background: Despite the advances in surgical treatment options, massive rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. This study assesses the effectiveness of fascia lata allograft in reconstruction of massive and irreparable r-c tear and to evaluate the healing and functional outcomes. Materials and Methods: 68 patients (38 men, 30 women, mean age 64.9 years) with massive or irreparable r-c tears were treated with placement of fascia lata allograft to fill the defect between February 2006 and February 2010. At 43 months followup they were evaluated clinically using the constant score, preoperatively and postoperatively. Magnetic resonance imaging (MRI) and ultrasound were used postoperatively, to assess the integrity of the allograft at the repair site. Postoperatively, standard rehabilitation protocol was followed with gradual restoration. Results: Postoperative constant score increased from 32.5 preoperatively to 88.7 postoperatively. The most important was the pain relief from 2.4 preoperatively to 14.1 postoperatively and range of motion. The results of the MRI were not reliable, but the ultrasound was satisfactory. Finally, there was no infection or rejection of the graft in any of the patients. Conclusions: Despite advances in surgical methods, there is still not a universally accepted treatment for massive and irreparable rotator cuff tears, because the standard methods have dubious results, with excessive retear rates and poor outcomes, necessitating the need for new repair strategies. We documented significant clinical improvement using fascia lata allograft in the repair of massive irreparable r-c tear, acting as scaffold to bridge the defect, enhancing the healing at the repair site. PMID:26015630

  5. 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

    2013-01-01

    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

  6. An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation

    PubMed Central

    Kedgley, Angela E.; Shore, Benjamin J.; Athwal, George S.; Johnson, James A.; Faber, Kenneth J.

    2013-01-01

    Purpose: Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Materials and Methods: Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Results: Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. Conclusions: This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ? 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Clinical Relevance: Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease. PMID:23960362

  7. The Use of an Intra-Articular Depth Guide in the Measurement of Partial Thickness Rotator Cuff Tears

    PubMed Central

    Carroll, Michael J.; More, Kristie D.; Sohmer, Stephen; Nelson, Atiba A.; Sciore, Paul; Boorman, Richard; Hollinshead, Robert; Lo, Ian K. Y.

    2013-01-01

    Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears. PMID:23533789

  8. Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia?

    PubMed Central

    Almeida, Alexandre; Atti, Vinícius; Agostini, Daniel Cecconi; Valin, Márcio Rangel; de Almeida, Nayvaldo Couto; Agostini, Ana Paula

    2015-01-01

    Objective To analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia. Method 138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n = 16); those with osteopenia, group 2 (n = 33); and normal individuals, group 3 (n = 55). Results In analyzing the University of California at Los Angeles (UCLA) scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p = 0.070). Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p = 0.027). Conclusion The results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry. PMID:26229899

  9. A systematic review of the histological and molecular changes in rotator cuff disease

    PubMed Central

    Dean, B. J. F.; Franklin, S. L.; Carr, A. J.

    2012-01-01

    Introduction The pathogenesis of rotator cuff disease (RCD) is complex and not fully understood. This systematic review set out to summarise the histological and molecular changes that occur throughout the spectrum of RCD. Methods We conducted a systematic review of the scientific literature with specific inclusion and exclusion criteria. Results A total of 101 studies met the inclusion criteria: 92 studies used human subjects exclusively, seven used animal overuse models, and the remaining two studies involved both humans and an animal overuse model. A total of 58 studies analysed supraspinatus tendon exclusively, 16 analysed subacromial bursal tissue exclusively, while the other studies analysed other tissue or varying combinations of tissue types including joint fluid and muscle. The molecular biomarkers that were altered in RCD included matrix substances, growth factors, enzymes and other proteins including certain neuropeptides. Conclusions The pathogenesis of RCD is being slowly unravelled as a result of the significant recent advances in molecular medicine. Future research aimed at further unlocking these key molecular processes will be pivotal in developing new surgical interventions both in terms of the diagnosis and treatment of RCD. PMID:23610686

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

    PubMed Central

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

    2014-01-01

    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

  11. Rates of carpal tunnel syndrome, epicondylitis, and rotator cuff claims in Ontario workers during 1997.

    PubMed

    Zakaria, Dianne

    2004-01-01

    The primary objective of this research was the calculation of crude and specific rates of first-allowed, lost-time carpal tunnel syndrome (CTS), epicondylitis, and rotator cuff syndrome/tear (RCS/RCT) claims in Ontario workers during 1997. A secondary objective was to determine if results related to these diagnoses were consistent with findings for all cumulative trauma disorders affecting the specific part of upper extremity region. Rates were calculated by combining claim counts and population "at-risk" estimates derived from the Ontario Workplace Safety and Insurance Board databases and Canadian Labour Force Survey, respectively. The prevention index was used to prioritize occupations for intervention. Gender-specific rates declined as one moved proximally along the upper extremity. Similarly, female to male claim rate ratios declined from 1.61 for CTS to 0.47 for RCS/RCT. Frequently occurring highest rate and prevention index occupational categories across gender and diagnoses included "textiles, furs & leathergoods" and "other machining occupations". Diagnosis-specific findings were consistent with previously reported part of upper extremity findings. PMID:15554610

  12. Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears

    PubMed Central

    Lee, Ji Hyun; Jee, Sukkyung; Kwon, Jong Won; Cha, Jang Gyu; Yoo, Jae Chul

    2014-01-01

    Objective To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. Materials and Methods The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Results Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. Conclusion 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears. PMID:25469089

  13. Patch-Augmented Latissimus Dorsi Transfer and Open Reduction–Internal Fixation of Unstable Os Acromiale for Irreparable Massive Posterosuperior Rotator Cuff Tear

    PubMed Central

    Petri, Maximilian; Greenspoon, Joshua A.; Bhatia, Sanjeev; Millett, Peter J.

    2015-01-01

    Latissimus dorsi transfer is a reasonable treatment option for massive posterosuperior rotator cuff tears that can substantially improve chronically painful and dysfunctional shoulders. This report and accompanying video describe the treatment of an active 43-year-old man with severe pain and weakness in the right shoulder after 3 failed rotator cuff repairs. Preoperative imaging showed a massive posterosuperior rotator cuff tear retracted to the glenoid as well as a hypermobile os acromiale likely causing dynamic impingement and recurrent rotator cuff tears. After diagnostic arthroscopy, the latissimus tendon is harvested and augmented with a 3-mm human acellular dermal patch (ArthroFlex; Arthrex, Naples, FL). The native rotator cuff tissue is repaired as much as possible, and the latissimus tendon is passed underneath the deltoid and posterior to the teres minor. The patch-augmented tendon is then integrated into a double-row SpeedBridge repair of eight 4.75-mm BioComposite SwiveLock anchors (Arthrex). The bony surface of the os acromiale is prepared and then fixed to the acromion with 2 cannulated partially threaded screws and additional tension-band wiring. Postoperative rehabilitation initially focuses on early passive range of motion, followed by active and active-assisted motion and a biofeedback program starting at 6 weeks postoperatively. PMID:26697309

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

    PubMed Central

    2014-01-01

    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?

  15. Rotator cuff arthropathy: what functional results can be expected from reverse arthroplasty??

    PubMed Central

    Fávaro, Rodrigo Caldonazzo; Abdulahad, Michel; Filho, Salim Mussi; Valério, Rafael; Superti, Mauro José

    2015-01-01

    Objective To evaluate the functional results from reverse arthroplasty and its complications and relationships with types of injury. Methods Twenty-seven shoulders (26 women and one man) were treated. The patients were assessed using the UCLA functional scale. The implant used was the Delta Xtend Depuy® model. The injuries were classified using the Seebauer method for the degree of arthroplasty and the Nerot method for notching. Result The mean age was 77.4 years (range: 67–89) and the follow-up was 25.8 months (range: 6–51). The preoperative UCLA score was 10.1 (range: 6–15) and the postoperative UCLA score was 29.8 (range: 22–35), which was a statistically significant improvement (p < 0.001). According to the Seebauer classification, five patients were 1B, 19 were 2A and three were 2B. Fifteen cases presented complications (55.5%) and notching was the commonest of these, occurring in 14 patients (nine with grade 1 and five with grade 2), but this did not cause instability in any of them. Only one patient (3.7%) had a major complication, consisting of dislocation in the immediate postoperative period. Two patients (7.4%) said that they would undergo the procedure again. One patient (3.7%) underwent a revision procedure. Conclusion Reverse arthroplasty was shown to be an excellent option for treating patients with rotator cuff arthropathy, with a low rate of major complications. Notching was a frequent complication, but in the majority of the cases, it did not present clinical repercussions. PMID:26535197

  16. Long-term functional evaluation of videoarthroscopic treatment of partial injuries of the rotator cuff?

    PubMed Central

    Godinho, Glaydson Gomes; França, Flávio de Oliveira; Freitas, José Márcio Alves; Lago e Santos, Flávio Márcio; Resende, Danilo Santos; Wageck, João Pedro Zambrano; Portela, Sara Fortes Barbosa

    2015-01-01

    Objective To compare the functional results from high and low-grade isolated partial lesions of the supraspinatus tendon of bursal and articular types, after arthroscopic treatment. Methods Sixty-four patients with isolated partial lesions of the supraspinatus tendon were evaluated. The mean length of follow-up was 76 months (range: 29–193). The mean age was 59 years (range: 36–82). The dominant side was affected in 44 patients (68.8%). There were 35 bursal lesions (54.7%) and 29 articular lesions (45.3%). We used the Ellman classification and characterized the lesions as low or high-grade according to whether they affected less than or more than 50% of the tendon thickness, respectively. Debridement was performed in 15 patients (23.5%), repair without completing the lesion in 11 (17%) and repair after completing the lesion in 38 (59.5%). The functional assessments on the patients were done using the Constant & Murley and UCLA scores. Results The mean Constant & Murley score among the patients with bursal lesions was 82.64 ± 6.98 (range: 59.3–99) and among those with articular lesions, 83.57 ± 7.58 (range: 66–95), while the mean UCLA score in the bursal lesions was 33.37 ± 2.85 (range: 21–35) and in the articular lesions, 32.83 ± 2.95 (range: 22–35). Conclusion Videoarthroscopic treatment of partial lesions of the rotator cuff presents good or excellent results when the low-grade lesions are debrided and the high-grade lesions are completed and repaired. These results are maintained over the long term, with a high satisfaction rate and few complications. PMID:26229917

  17. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis

    PubMed Central

    Centeno, Christopher J; Al-Sayegh, Hasan; Bashir, Jamil; Goodyear, Shaun; Freeman, Michael D

    2015-01-01

    Introduction Shoulder pain is a common musculoskeletal complaint in the general population. Bone marrow concentrate (BMC) injections offer promising potential as a minimally invasive approach for treatment of shoulder pain in degenerative disease. In this study, we investigated the clinical outcomes of the BMC injections for treatment of shoulder pain and disability due to osteoarthritis (OA) and rotator cuff tears in a treatment registry population. Methods A total of 115 shoulders in 102 patients were treated with autologous BMC injections for symptomatic OA at the glenohumeral joint and/or rotator cuff tears. Data were collected for factors potentially influencing outcome, including age, sex, body mass index, and the type of condition treated (ie, OA or rotator cuff tear). Clinical outcomes were assessed serially over time using the disabilities of the arm, shoulder and hand score (DASH), the numeric pain scale (NPS), and a subjective improvement rating scale. Baseline scores were compared to the most recent outcome scores at the time of the analysis and adjusted for demographic differences. We reported comparisons of pre- and post-treatment scores, the differences between osteoarthritis and rotator cuff groups, and the predictive effects on the clinical outcomes. Results At the most current follow-up assessment after treatment, the average DASH score decreased (improved) from 36.1 to 17.1 (P<0.001) and the average numeric pain scale value decreased (improved) from 4.3 to 2.4 (P<0.001). These changes were associated with an average subjective improvement of 48.8%. No differences were observed between outcomes among the shoulders treated for OA versus rotator cuff tears, nor did age, sex, or body mass index influence pain or functional outcomes. There were no significant treatment-related adverse events reported. Discussion We observed preliminarily encouraging results following BMC injections for shoulder OA and rotator cuff tears. These results serve as basis for the design of an adequately powered randomized controlled trial. PMID:26089699

  18. Identification of Suitable Reference Genes for Gene Expression Studies in Tendons from Patients with Rotator Cuff Tear

    PubMed Central

    Leal, Mariana Ferreira; Belangero, Paulo Santoro; Figueiredo, Eduardo Antônio; Cohen, Carina; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; de Castro Pochini, Alberto; Ejnisman, Benno; Cohen, Moises

    2015-01-01

    Rotator cuff tear is one of the most common causes of shoulder dysfunction. Gene expression analysis may be a useful tool for understanding tendon tears and the failure of cuff healing, and reverse-transcription quantitative polymerase chain reaction (RT-qPCR) has become an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluate the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1 and TBP) using samples from the rotator cuff tendons of 28 individuals with tendon tears (3 tendons regions) and 8 controls (2 tendon regions); for the tear patients, we evaluated ruptured and non-ruptured tendon samples. The stability of the candidate reference genes was determined using the NormFinder, geNorm, BestKeeper and DataAssist software packages. Overall, HPRT1 was the best single reference gene, and HPRT1+TBP composed the best pair and HPRT1+TBP+ACTB composed the best trio of reference genes from the analysis of different groups, including the simultaneous analysis of all tissue samples. To identify the optimal combination of reference genes, we evaluated the expression of COL1A1 and COL3A1, and no obvious differences were observed when using 2, 3 or 4 reference genes for most of the analyses. However, COL3A1 expression differed between ruptured and non-ruptured (posterior superior region) tendons of patients only when normalized by HPRT1+TBP+B2M and HPRT1+TBP. On the other hand, the comparison between these two groups using the best trio of reference genes (HPRT1+TBP+ACTB) and 4 reference genes did not revealed a significant difference in COL3A1 expression. Consequently, the use of suitable reference genes for a reliable gene expression evaluation by RT-qPCR should consider the type of tendon samples investigated. HPRT1+TBP+ACTB seems to be the best combination of reference genes for the analysis of involving different tendon samples of individuals with rotator cuff tears. PMID:25768100

  19. The geyser sign and torn rotator cuff: clinical significance and pathomechanics.

    PubMed

    Craig, E V

    1984-12-01

    The geyser radiographic sign on shoulder arthrogram is characterized by leakage of dye from the glenohumeral joint into the subdeltoid bursa. The dye outlines the acromioclavicular joint. It is usually an indication of a full-thickness cuff tear of long duration. The clinical occurrence and pathomechanics of this finding indicate that repair is generally difficult. PMID:6499313

  20. Preliminary investigation of a biological augmentation of rotator cuff repairs using a collagen implant: a 2-year MRI follow-up

    PubMed Central

    Bokor, Desmond John; Sonnabend, David; Deady, Luke; Cass, Ben; Young, Allan; Van Kampen, Craig; Arnoczky, Steven

    2015-01-01

    Summary Background the inability to restore the normal tendon footprint and limit strains on the repair site are thought to contribute to re-tearing following rotator cuff repair. The purpose of this study was to use a collagen implant to augment rotator cuff repairs through the restoration of the native tendon footprint and the induction of new tissue to decrease overall tendon strain. Methods repairs of full-thickness rotator cuff lesions in 9 adult patients were augmented with a novel collagen implant placed over the bursal surface of the repair. Tendon thickness and footprint anatomy were evaluated using MRI at 3, 6, 12, and 24 months. Clinical results were assessed using standard outcome metrics. Mean follow-up for all patients was 25.8 months. Results the implant induced significant new tissue formation in all patients by 3 months. This tissue matured over time and became indistinguishable from the underlying tendon. At 24 months all repairs remained intact and normal footprint anatomy of the tendon was restored in all patients. All clinical scores improved significantly over time. Conclusion the ability of a collagen implant to induce new host tissue formation and restore the normal footprint anatomy may represent a significant advancement in the biological augmentation and ultimate durability of rotator cuff repairs. PMID:26605186

  1. Effect of mechanical stimulation on bone marrow stromal cell-seeded tendon slice constructs: a potential engineered tendon patch for rotator cuff repair.

    PubMed

    Qin, Ting-Wu; Sun, Yu-Long; Thoreson, Andrew R; Steinmann, Scott P; Amadio, Peter C; An, Kai-Nan; Zhao, Chunfeng

    2015-05-01

    Cell-based tissue engineered tendons have potential to improve clinical outcomes following rotator cuff repair, especially in large or massive rotator cuff tears, which pose a great clinical challenge. The aim of this study was to develop a method of constructing a functional engineered tendon patch for rotator cuff repair with cyclic mechanical stimulation. Decellularized tendon slices (DTSs) were seeded with BMSCs and subjected to cyclic stretching for 1, 3, or 7 days. The mechanical properties, morphologic characteristics and tendon-related gene expression of the constructs were investigated. Viable BMSCs were observed on the DTS after 7 days. BMSCs penetrated into the DTSs and formed dense cell sheets after 7 days of mechanical stretching. Gene expression of type I collagen, decorin, and tenomodulin significantly increased in cyclically stretched BMSC-DTS constructs compared with the unstrained control group (P < 0.05). The ultimate tensile strength and stiffness of the cyclically stretched tendon constructs were similar to the unstrained control group (P > 0.05). In conclusion, mechanical stimulation of BMSC-DTS constructs upregulated expression of tendon-related proteins, promoted cell tenogenic differentiation, facilitated cell infiltration and formation of cell sheets, and retained mechanical properties. The patch could be used as a graft to enhance the surgical repair of rotator cuff tears. PMID:25770996

  2. A simple technique to restore needle patency during percutaneous lavage and aspiration of calcific rotator cuff tendinopathy.

    PubMed

    Jelsing, Elena J; Maida, Eugene; Smith, Jay

    2013-03-01

    Calcific rotator cuff tendinopathy caused by symptomatic calcium hydroxyapatite crystal deposition is a well-established cause of shoulder pain. In refractory or acutely symptomatic cases, sonographically guided percutaneous lavage and aspiration can significantly reduce pain in approximately 60%-92% of cases. Although the complication rate of sonographically guided percutaneous lavage and aspiration is apparently low, needle clogging attributable to impacted calcific debris has been described by several authors and in our experience can occur in daily practice. Traditionally, an inability to relieve the obstruction via needle repositioning or increased syringe plunger pressure has required needle removal and replacement. In this article, we outline a simple technique that can be used to restore patency of the obstructed lavage needle without necessitating needle removal and replacement. PMID:23399296

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

    PubMed Central

    Del Castillo-González, Federico; Ramos-Álvarez, Juan José; Rodríguez-Fabián, Guillermo; González-Pérez, José; Calderón-Montero, Javier

    2014-01-01

    Summary Purpose: 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: 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 10cm 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. Conclusion: 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:25767776

  4. All-Arthroscopic versus Mini-Open Repair of Small to Large Sized Rotator Cuff Tears: A Meta-Analysis of Clinical Outcomes

    PubMed Central

    Chen, Kai; Cai, Zhengdong; Li, Guodong

    2014-01-01

    Purpose The purpose of this study was to compare clinical outcomes of patients with full-thickness small to large sized tears undergoing all-arthroscopic versus mini-open rotator cuff repair. Method A literature search for electronic databases and references for eligible studies was conducted through Medline, Embase and Cochrane library between 1969 and 2013. Results A total of 12 comparative studies (n?=?770 patients) were included. Pooled results showed: there were no differences in function outcome, pain scores, retear rate or the incidence of adhesive capsulitis between all arthroscopic and mini-open repair groups. Conclusions There were no differences in outcomes between the arthroscopic and mini-open rotator cuff repair techniques, they should be considered alternative treatment options. Level of Evidence Level IV, Meta analysis. PMID:24728326

  5. [Lifting osteotomy of the acromion as a new principle in treatment of impingement syndrome, especially in correlation with reconstruction of large rotator cuff lesions].

    PubMed

    Thür, C; Jülke, M; Bircher, H P

    1998-03-01

    There are many different causes leading to impingement lesions of the shoulder (e.g., architecture of the acromion, arthritis of the acromioclavicular joint, bursitis subacromialis, chronic instability). There are also different ways of treating it. Neer described his technique of anterior acromioplasty in 1972. With this technique there is sometimes a limitation in the amount of resection possible because of the anatomical findings (i.e., very curved or small acromion). We developed a new technique: the lift-up osteotomy of the acromion (LOA). This technique allows us to gain as much subacromial space as needed (e.g., for large anterior deltoid flaps). Osteotomy of the acromion gives an excellent view of the rotator cuff. Even large lesions can easily be repaired. After the cuff repair is done, the acromion is refixed with two canulated screws. So far, we have used this LOA technique in more than 100 patients in impingement operations, cuff repairs and anterior deltoid flaps all with good results. PMID:9577213

  6. The accuracy of “subacromial grind test” in diagnosis of supraspinatus rotator cuff tears

    PubMed Central

    Sawalha, Seif; Fischer, Jochen

    2015-01-01

    Purpose: The aim of this study is to assess the accuracy of a simple clinical test (subacromial grind test) in diagnosing supraspinatus tendon tears. Patients and Methods: The test is considered positive if palpable crepitus or grinding is detected on passive internal and external rotation of the shoulder while abducted in the scapular plane. Data were collected prospectively on 47 patients undergoing shoulder arthroscopy, and the results of the test and arthroscopy compared. Results: During arthroscopy, 17 patients had full thickness (FT) tears of supraspinatus tendon and 10 had partial thickness tears. For any supraspinatus tear, the sensitivity of the test was 63%, specificity 95%, positive predictive value 94%, negative predictive value 66% and overall accuracy 79%. For FT tears, the sensitivity was 82%, specificity 87%, positive predictive value 78%, negative predictive value 90% and overall accuracy 85%. Conclusion: We found that this is a useful single test for diagnosing FT supraspinatus tears. Level of Evidence: Level IV diagnostic study. PMID:25937713

  7. Influence of corticoids on healing of the rotator cuff of rats – biomechanical study???

    PubMed Central

    Dau, Leonardo; Abagge, Marcelo; Fruehling, Vagner Messias; Sola Junior, Wilson; Lavrador, José Marcos; da Cunha, Luiz Antônio Munhoz

    2014-01-01

    Objective to compare healing strength of the infraspinatus tendon of rats with corticoid inoculation, regarding maximum tension, maximum force and rupture force, after injury and experimental repair. Methods a total of 60 Wistar rats were subjected to tenotomy of the infraspinatus tendon, which was then sutured. Before the surgery, they were divided into a control group (C) inoculated with serum and a study group (S) inoculated with corticoids over the tendon. After repair, the rats were sacrificed in groups of 10 individuals in the control group and 10 in the study group at the times of one week (C1 and S1), three weeks (C3 and S3) and five weeks (C5 and S5). The rats were dissected, separating out the infraspinatus tendon with the humerus. The study specimens were subjected to a traction test, with evaluation of the maximum tension (kgf/cm2), maximum force (kgf) and rupture force (kgf), comparing the study group with the respective control groups. Results among the rats sacrificed one week after the procedure, we observed greater maximum tension in group C1 than in group S1. The variables of maximum force (kgf) and rupture force did not differ statistically between the groups investigated. In the same way, among the rats sacrificed three weeks after the procedure, group C3 only showed greater maximum tension than group S3 (p = 0.007), and the other variables did not present differences. Among the rats sacrificed five weeks after the procedure (C5 and S5), none of the parameters studied presented statistical differences. Conclusion we concluded that corticoid diminished the resistance to maximum tension in the groups sacrificed one and three weeks after the procedure, in comparison with the respective control groups. The other parameters did not show differences between the study and control groups. PMID:26229831

  8. Lysylhydroxylation and non-reducible crosslinking of human supraspinatus tendon collagen: changes with age and in chronic rotator cuff tendinitis

    PubMed Central

    Bank, R.; TeKoppele, J.; Oostingh, G.; Hazleman, B.; Riley, G.

    1999-01-01

    OBJECTIVES—To investigate age related and site specific variations in turnover and chemistry of the collagen network in healthy tendons as well as the role of collagen remodelling in the degeneration of the supraspinatus tendon (ST-D) in rotator cuff tendinitis.?METHODS—Collagen content and the amount of hydroxylysine (Hyl), hydroxylysylpyridinoline (HP), lysylpyridinoline (LP), and the degree of non-enzymatic glycation (pentosidine) were investigated in ST-D and in normal human supraspinatus (ST-N) and biceps brachii tendons (BT-N) by high-performance liquid chromatography.?RESULTS—In BT-N, tendons that served as control tissue as it shows rarely matrix abnormalities, pentosidine levels rise linearly with age (20-90 years), indicating little tissue remodelling (resulting in an undisturbed accumulation of pentosidine). A similar accumulation was observed in ST-N up to 50 years. At older ages, little pentosidine accumulation was observed and pentosidine levels showed large interindividual variability. This was interpreted as remodelling of collagen in normal ST after age 50 years because of microruptures (thus diluting old collagen with newly synthesised collagen). All degenerate ST samples showed decreased pentosidine levels compared with age matched controls, indicating extensive remodelling in an attempt to repair the tendon defect. Collagen content and the amount of Hyl, HP, and LP of ST-N and BT-N did not change with age. With the exception of collagen content, which did not differ, all parameters were significantly (p<0.001) lower in BT-N. The ST-D samples had a reduced collagen content and had higher Hyl, HP, and LP levels than ST-N (p<0.001).?CONCLUSIONS—Inasmuch as Hyl, HP, and LP levels in ST-N did not change with age, tissue remodelling as a consequence of microruptures does not seem to affect the quality of the tendon collagen. On the other hand, the clearly different profile of post-translational modifications in ST-D indicates that the newly deposited collagen network in degenerated tendons is qualitatively different. It is concluded that in ST-D the previously functional and carefully constructed matrix is replaced by aberrant collagen. This may result in a mechanically less stable tendon; as the supraspinatus is constantly subjected to considerable forces this could explain why tendinitis is mostly of a chronic nature.?? Keywords: collagen; tendons; crosslinks; pentosidine PMID:10343538

  9. Rotator cuff problems

    MedlinePLUS

    A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. ... your health care provider if you have ongoing shoulder pain. Also call if symptoms do not improve with ...

  10. Rotator cuff repair

    MedlinePLUS

    ... means you will be asleep and unable to feel pain. Or, you will have regional anesthesia. Your arm ... will be numbed so that you do not feel any pain. If you receive regional anesthesia, you will also ...

  11. Rotator Cuff Repair

    MedlinePLUS Videos and Cool Tools

    ... REPAIR DOCTORS HOSPITAL CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE CORAL GABLES, FLORIDA June 18, 2008 00:00: ... Gables, Florida. I'm Dr. John Zvijac, sports medicine and shoulder surgeon here at Doctors Hospital, and ...

  12. Rotator cuff exercises

    MedlinePLUS

    Shoulder exercises ... A key part in your recovery is doing exercises to make the muscles and tendons in your ... for everyday tasks or sports activities Before doing exercises at home, ask your doctor or physical therapist ...

  13. Effect of Platelet-Rich Plasma and Bioactive Glass Powder for the Improvement of Rotator Cuff Tendon-to-Bone Healing in a Rabbit Model

    PubMed Central

    Wu, Yang; Dong, Yu; Chen, Shiyi; Li, Yunxia

    2014-01-01

    To test the hypothesis that a platelet-rich plasma (PRP) plus bioactive glass (BG) mixture could shorten the tendon-bone healing process in rotator cuff tendon repair, thirty mature male New Zealand white rabbits were randomly divided into three groups, Control, PRP, and PRP + BG. All groups underwent a surgical procedure to establish a rotator cuff tendon healing model. Mechanical examinations and histological assays were taken to verify the adhesion of the tendon-bone. Real-time PCR was adopted to analyze Bone Morphogenetic Protein-2 (BMP-2). The maximum load-to-failure value in mechanical examinations was significantly higher in the PRP + BG group than that in the control group after six weeks (Control 38.73 ± 8.58, PRP 54.49 ± 8.72, PRP + BG 79.15 ± 7.62, p < 0.001), but it was not significantly different at 12 weeks (PRP 74.27 ± 7.74, PRP + BG 82.57 ± 6.63, p = 0.145). In histological assays, H&E (hematoxylin-eosin) staining showed that the interface between the tendon-bone integration was much sturdier in the PRP + BG group compared to the other two groups at each time point, and more ordered arranged tendon fibers can be seen at 12 weeks. At six weeks, the mRNA expression levels of BMP-2 in the PRP + BG group were higher than those in the other groups (PRP + BG 0.65 ± 0.11, PRP 2.284 ± 0.07, Control 0.12 ± 0.05, p < 0.05). However, there was no significant difference in the mRNA expression levels of BMP-2 among the three groups at 12 weeks (p = 0.922, 0.067, 0.056). BMP-2 levels in PRP and PRP+BG groups were significantly lower at 12 weeks compared to six weeks (p = 0.006, <0.001).We found that the PRP + BG mixture could enhance tendon-bone healing in rotator cuff tendon repair. PMID:25464384

  14. The central nervous system--an additional consideration in 'rotator cuff tendinopathy' and a potential basis for understanding response to loaded therapeutic exercise.

    PubMed

    Littlewood, Chris; Malliaras, Peter; Bateman, Marcus; Stace, Richmond; May, Stephen; Walters, Stephen

    2013-12-01

    Tendinopathy is a term used to describe a painful tendon disorder but despite being a well-recognised clinical presentation, a definitive understanding of the pathoaetiology of rotator cuff tendinopathy remains elusive. Current explanatory models, which relate to peripherally driven nocioceptive mechanisms secondary to structural abnormality, or failed healing, appear inadequate on their own in the context of current literature. In light of these limitations this paper presents an extension to current models that incorporates the integral role of the central nervous system in the pain experience. The role of the central nervous system (CNS) is described and justified along with a potential rationale to explain the favourable response to loaded therapeutic exercises demonstrated by previous studies. This additional consideration has the potential to offer a useful way to explain pain to patients, for clinicians to prescribe appropriate therapeutic management strategies and for researchers to advance knowledge in relation to this clinically challenging problem. PMID:23932100

  15. The use of low-level laser therapy (LLLT) in the treatment of trigger points that are associated with rotator cuff tendonitis

    NASA Astrophysics Data System (ADS)

    Al-Shenqiti, A.; Oldham, J.

    2003-12-01

    The purpose of this study was to investigate the efficacy of LLLT in the treatment of trigger points (TrPs) that are associated with rotator cuff tendonitis. A double-blind randomized controlled trail was conducted. Sixty patients were randomly allocated to one of two groups: sham or laser therapy. The laser (Excel, Omega Universal Technologies Ltd, London, UK) parameters used were a wavelength of 820 nm, a power output of 100 mW, a frequency of 5000 Hz (modulated) and energy density of 32 J/cm2. The two groups received a course of 12 treatment sessions for four weeks (3 sessions per week). Pain, functional activities (as measured using the Shoulder Pain and Disability Index, SPADI), pressure pain threshold (PPT) and range of motion (ROM) were assessed pre and post treatment, with a three month follow-up assessment. Significant improvements in pain (p < 0.001) were observed for the laser group (6 cm median improvement on a 10 cm VAS) compared to the sham group (2 cm median improvement) immediately post treatment. The improvements in the laser group continued post treatment with a 7 cm median improvement observed at three month follow-up. Similar between group differences were observed for ROM (p < 0.01), functional activities (p <= 0.001) and PPT (p <= 0.05). The findings of the current study suggested that LLLT is effective in treating patients with TrPs associated with rotator cuff tendonitis, when using the parameters described. However, the mechanism of its action is not yet clear, and will require further investigation.

  16. Imaging of the shoulder after surgery.

    PubMed

    McMenamin, Drew; Koulouris, George; Morrison, William B

    2008-10-01

    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. PMID:18457932

  17. [Plastic surgery for losses of facial substance by cheek rotation].

    PubMed

    Timo?ca, G; Vicol, C; Popescu, E; Zolfaghari, A

    1990-01-01

    New diversified plastic surgery methods have been introduced into practice in the last decades, aimed at repairing the loss of facial tissues involving the upper lip (with or without co-involvement of the lateral parts of the nose), and the lower eyelid area, that cannot be repaired by flaps prepared in the surrounding regions. In view of avoiding the disadvantages of 2- or 3-stage techniques the authors have re-evaluated the method introduced by Esser in 1918 for plastic repair of the facial tissues by rotation of the cheek, which is economical, efficient, rapid, and elegant, providing fully satisfactory esthetic results. Two cases are presented, one with loss of facial tissue following removal of an achromic recidivating melanoma, and another one following removal of a recidivating baso-cellular carcinoma, in which this method was employed with excellent results. PMID:2101267

  18. Full thickness tears: retaining the cuff.

    PubMed

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

    2011-12-01

    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

  19. The Tendon-to-Bone Transition of the Rotator Cuff: A Preliminary Raman Spectroscopic Study Documenting the Gradual Mineralization Across the Insertion in Rat Tissue Samples

    PubMed Central

    WOPENKA, BRIGITTE; KENT, ALISTAIR; PASTERIS, JILL D.; YOON, YOUNG; THOMOPOULOS, STAVROS

    2009-01-01

    We applied Raman spectroscopy to monitor the distribution of minerals and the degree of mineralization across the tendon–bone insertion site in the shoulders of five rats. We acquired Raman spectra from 100 to 4000 ?cm-1 on individual 1 ?m points across the 120 ?m wide transition zone of each tissue sample and identified all the peaks detected in pure tendon and in pure bone, as well as in the transition zone. The intensity of the 960 ?cm-1 P–O stretch for apatite (normalized to either the 2940 ?cm-1 C–H stretch or the 1003 ?cm-1 C–C stretch for collagen) was used as an indicator of the abundance of mineral. We relate the observed histological morphology in the tissue thin section with the observed Raman peaks for both the organic component (mostly collagen) and the inorganic component (a carbonated form of the mineral apatite) and discuss spectroscopic issues related to peak deconvolution and quantification of overlapping Raman peaks. We show that the mineral-to-collagen ratio at the insertion site increases linearly (R2 = 0.8 for five samples) over the distance of 120 ?m from tendon to bone, rather than abruptly, as previously inferred from histological observations. In addition, narrowing of the 960 ?cm-1 band across the traverse indicates that the crystalline ordering within the apatite increases concomitantly with the degree of mineralization. This finding of mineral gradation has important clinical implications and may explain why the uninjured tendon-to-bone connection of the rotator cuff can sustain very high stress concentrations without failure. Our finding is also consistent with recent mechanical models and calculations developed to better understand the materials properties of this unusually strong interface. PMID:19094386

  20. Rotator cuff - self-care

    MedlinePLUS

    ... night can also help relieve some of your shoulder pain: When you sleep, lie either on the side ... shoulder joint Good range of motion of your shoulder blade and upper spine No pain during certain physical exam tests that are meant ...

  1. International rotations during residency: spine deformity surgery in Ghana.

    PubMed

    Daniels, Alan H

    2013-05-01

    International elective rotations are becoming increasingly common in residency training programs. These experiences offer a tremendous opportunity to help patients in medically underserved nations, and can enhance training by exposing participants to pathology not often encountered in developed countries. Additionally, there is emerging evidence that international training exposure develops a broader appreciation of cultural diversity in patient care, offers personal and professional development, and teaches residents to use limited resources more efficiently, giving them a unique perspective on the ordering of tests and delivery of care when they return. This paper highlights the author's experience on a volunteer trip to Ghana that was focused on treating pediatric spinal deformity, and reviews notable international medical volunteers, and highlights the evidence supporting the benefits of international residency rotations. PMID:23641456

  2. Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture

    PubMed Central

    Cha, Seung-Do; Gwak, Heui-Chul; Ha, Dong-Jun; Kim, Jong-Yup; Kim, Ui-Cheol; Jang, Yue-Chan

    2015-01-01

    Background The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. Methods A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. Results Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. Conclusions Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes. PMID:26640633

  3. Successful early mobilization of major cuff repair using a suture post.

    PubMed

    Atkinson, Robert N; Comley, Andrew S; Van Essen, John; Hallam, Peter J; Ashwood, Neil; Fogg, Quentin A

    2006-01-01

    Repair of massive rotator cuff tears in the elderly can be challenging because of degenerative, retracted, and contracted tendons producing an extensive defect. The quality of the tendon and particularly the bone of the proximal humerus is an inherent weakness in the repaired construct. We report a method that secures the rotator cuff to a fixation post placed in cortical bone at the surgical neck of the humerus, bypassing the weakest point. This is an evolution of techniques designed to fix to the greater tuberosity. We reviewed 32 repairs (16 men and 14 women; mean age, 68 years) with a minimum of 2 years' follow-up (mean, 4.3 years). Constant scores improved from a mean of 27.9 preoperatively to 78.2 postoperatively. Pain scores improved from 8.2 to 1.9, with 87% of patients being satisfied with the results of surgery. This is a robust construct that is easily learned and able to solve a technical problem. PMID:16517361

  4. Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial

    PubMed Central

    Komasawa, Nobuyasu; Mihara, Ryosuke; Imagawa, Kentaro; Hattori, Kazuo; Minami, Toshiaki

    2015-01-01

    The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP) and taper-shaped (taper) cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n = 20; HVLP group) or taper-shaped (n = 20; Taper group) cuffs. Initial cuff pressure was adjusted to 15, 20, or 25?cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119. PMID:26509152

  5. Special report: Occlusive cuff controller

    NASA Technical Reports Server (NTRS)

    Baker, J. T.

    1975-01-01

    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.

  6. Rolling cuff flexible bellows

    DOEpatents

    Lambert, Donald R. (Livermore, CA)

    1985-01-01

    A flexible connector apparatus used to join two stiff non-deformable members, such as piping. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

  7. Efficacy of Various Analgesics on Shoulder Function and Rotator Cuff Tendon-to-Bone Healing in a Rat (Rattus norvegicus) Model

    PubMed Central

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

    2014-01-01

    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

  8. Femtosecond laser combined with non-chopping rotation phacoemulsification technique for soft-nucleus cataract surgery: a prospective study.

    PubMed

    Chen, Hui; Lin, Haotian; Chen, Wan; Zhang, Bo; Xiang, Wu; Li, Jing; Chen, Weirong; Liu, Yizhi

    2016-01-01

    Soft-lens cataract surgeries are becoming increasingly common for cataract surgeons and chopping the soft nucleus using conventional techniques is problematic. We introduced a femtosecond laser combined with a non-chopping rotation phacoemulsification technique for soft-nucleus cataract surgery and evaluated the safety and efficacy of using this technique. Sixty-six patients with soft-nucleus cataracts ranging from grade 1~3 were divided into 3 groups based on nuclear staging. Those groups were further divided into three subgroups: femtosecond laser pretreatment combined with a non-chopping rotation phacoemulsification technique (subgroup 1), conventional manual cataract surgery with a non-chopping rotation technique (subgroup 2) and conventional manual cataract surgery with a quick-chop technique (subgroup 3).Patients were followed up at 1, 7, and 30 days after surgery. There was an 84.6% and a 63.34% reduction in ultrasound time and cumulative dissipated energy, respectively, between the subgroup 1 and the subgroup 3; and this was associated with a 36.1% and 29.7% reduction in endothelial cell loss and aqueous flare. There were no adverse events at the follow-up times. With its reduced ultrasound energy, endothelial cell loss and aqueous flare, the femtosecond laser pretreatment combined with a non-chopping rotation technique was more efficient than conventional manual cataract surgery for soft-nucleus cataracts. PMID:26728573

  9. Posterior Pharyngeal Airway in Clockwise Rotation of Maxillomandibular Complex Using Surgery-first Orthognathic Approach

    PubMed Central

    Park, Young Jin; Lee, Chang-Yeol

    2015-01-01

    Background: Because obstructive sleep apnea is known to be an important preexisting factor causing chronic disease, many investigations have been done recently. There have been few reports regarding the posterior pharyngeal airway after clockwise rotation of maxillomandibular complex. Because the 2-jaw surgery in class III patients could cause obstructive sleep apnea or snoring, we investigated the posterior pharyngeal airway change of the clockwise maxillomandibular complex in the surgery-first orthognathic approach for the correction of class III dentofacial deformities. Methods: A cephalometric evaluation of 35 patients with skeletal class III deformity was performed preoperatively and postoperatively. Three measurements of the posterior pharyngeal airway space (nasopharynx, oropharynx, and hypopharynx) and hyoid bone positions (the distance from palatal plane to hyoid bone and the distance from mandibular plane to the hyoid bone) were evaluated and correlated with the skeletal movement of the jaws using imaging software (V-Ceph, Osstem, Seoul, Korea). Results: The preoperative airway space turned out to be enlarged in class III dentofacial deformities compared with those of normal persons. The preoperative P1, P2, and P3 in our cohort were increased and posterior nasal spine to hyoid bone and mandibular plane to hyoid bone were decreased compared with those of normal person’s data because the cohort consists of prognathic patients where the mandible is located in forward position. After 6 months, most values were nearly normal. Conclusion: Orthognathic surgery based on clockwise rotation of maxillomandibular complex did not cause severe posterior airway space changes at 6 months postoperation. PMID:26495198

  10. Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy

    PubMed Central

    Medina, Byron Cardoso; Riaño, Giovanni; Hoyos, Luis R.; Otalora, Camila

    2014-01-01

    Background and Objectives: Our aim was to evaluate whether the use of barbed suture for vaginal cuff closure is associated with a decrease in postoperative vaginal bleeding compared with cuff closure with polyglactin 910 in patients who have undergone laparoscopic hysterectomy. Methods: We performed a cohort study of patients who underwent laparoscopic hysterectomy between January 2008 and July 2012 by the minimally invasive gynecologic surgery division of the Gynecology, Obstetrics and Human Reproduction Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. Results: A total of 232 women were studied: 163 were in the polyglactin 910 group, and 69 were in the barbed suture group. The main outcome, postoperative vaginal bleeding, was documented in 53 cases (32.5%) in the polyglactin 910 group and in 13 cases (18.8%) in the barbed suture group (relative risk, 0.57; 95% confidence interval, 0.34–0.9; P = .03). No statistically significant differences were found in other postoperative outcomes, such as emergency department admission, vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. Conclusion: In this study an inverse association was observed between the use of barbed suture for vaginal cuff closure during laparoscopic hysterectomy and the presence of postoperative vaginal bleeding. PMID:24680149

  11. Rupture of the musculotendinous cuff of the shoulder.

    PubMed

    Wolfgang, G L

    1978-01-01

    Codman established the diagnostic criteria and treatment for musculotendinous cuff rupture over 40 years ago. Chronic shoulder pain after a history of trauma which is unresponsive to usual conservative treatment may indicate rotator cuff tear. Point tenderness, weakness of abduction and external rotation, atrophy, and palpable crepitus or a gap are confirming signs. X-rays may be negative in the acute injury but show definite changes with chronicity. An arthrogram confirms the presence of a tear. An electromyograph should be performed to rule out suprascapular nerve lesions. Surgical repair will result in good or excellent results in at least two-thirds of cases properly selected. Complications which can adversely influence the results include deltoid avulsion, residual impingement and ectopic bone formation. A successful repair is generally permanent. PMID:729251

  12. Shoulder Impingement/Rotator Cuff Tendinitis

    MedlinePLUS

    ... tennis are particularly vulnerable. Those who do repetitive li ing or overhead activities using the arm, such ... You may have pain and sti?ness when you li your arm. There may also be pain when ...

  13. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

  14. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique.

    PubMed

    De Cupis, Vincenzo; De Cupis, Mauro

    2012-04-01

    Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

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

    PubMed Central

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

    2010-01-01

    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

  16. Logic-controlled occlusive cuff system

    NASA Technical Reports Server (NTRS)

    Baker, J. T.; Hoffler, G. W. (inventors); Hursta, W. N.

    1981-01-01

    An occlusive cuff system comprises a pressure cuff and a source of regulated compressed gas feeding the cuff through an electrically operated fill valve. An electrically operated vent valve vents the cuff to the ambient pressure. The fill valve is normally closed and the vent valve is normally open. In response to an external start signal, a logic network opens the fill valve and closes the vent valve, thereby starting the pressurization cycle and a timer. A pressure transducer continuously monitors the pressure in the cuff. When the transducer's output equals a selected reference voltage, a comparator causes the logic network to close the fill valve. The timer, after a selected time delay, opens the vent valve to the ambient pressure, thereby ending the pressurization cycle.

  17. How to measure tracheostomy tube cuff pressure.

    PubMed

    Credland, Nicola

    2015-09-30

    Rationale and key points This article explores the process and principles of measuring tracheostomy tube cuff pressure and the associated evidence base. It discusses the indications for tracheostomy tube cuff pressure measurement and identifies potential complications associated with the procedure. ? Regular measurement of tracheostomy tube cuff pressure is essential to prevent complications associated with tracheostomy tube placement. ? Tracheostomy tube cuff pressure should be between 20mmHg and 25mmHg. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when checking tracheostomy tube cuff pressure. 2. Positive elements of care delivery and those that could be enhanced. Subscribers can upload their reflective accounts at: rcni.com/portfolio . PMID:26419168

  18. Rolling-cuff flexible bellows

    DOEpatents

    Lambert, D.R.

    1982-09-27

    A flexible connector apparatus used to join two stiff non-deformable members, such as piping, is described. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

  19. Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure

    PubMed Central

    Annoni, Raquel; de Almeida, Antonio Evanir

    2015-01-01

    Objective To test the agreement between two handcrafted devices and a cuff-specific manometer. Methods The agreement between two handcrafted devices adapted to measure tracheal tube cuff pressure and a cuff-specific manometer was tested on 79 subjects. The cuff pressure was measured with a commercial manometer and with two handcrafted devices (HD) assembled with aneroid sphygmomanometers (HD1 and HD2). The data were compared using Wilcoxon and Spearman tests, the intraclass correlation coefficient (ICC) and limit-of-agreement analysis. Results Cuff pressures assessed with handcrafted devices were significantly different from commercial device measurements (pressures were higher when measured with HD1 and lower with HD2). The ICCs between the commercial device and HD1 and HD2 were excellent (ICC = 0.8 p < 0.001) and good (ICC = 0.66, p < 0.001), respectively. However, the Bland- Altman plots showed wide limits of agreement between HD1 and HD2 and the commercial device. Conclusion The handcrafted manometers do not provide accurate cuff pressure measurements when compared to a cuff-specific device and should not be used to replace the commercial cuff manometers in mechanically ventilated patients. PMID:26376160

  20. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  1. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  2. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

  3. 21 CFR 870.1120 - Blood pressure cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Blood pressure cuff. 870.1120 Section 870.1120...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has an inflatable bladder in an...

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

    PubMed Central

    2014-01-01

    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

  5. Rotationally actuated prosthetic helping hand

    NASA Technical Reports Server (NTRS)

    Norton, William E. (inventor); Belcher, Jewell G., Jr. (inventor); Carden, James R. (inventor); West, Thomas W. (inventor)

    1991-01-01

    A prosthetic device has been developed for below-the-elbow amputees. The device consists of a cuff, a stem, a housing, two hook-like fingers, an elastic band for holding the fingers together, and a brace. The fingers are pivotally mounted on a housing that is secured to the amputee's upper arm with the brace. The stem, which also contains a cam, is rotationally mounted within the housing and is secured to the cuff, which fits over the amputee's stump. By rotating the cammed stem between the fingers with the lower arm, the amputee can open and close the fingers.

  6. Control device for prosthetic urinary sphincter cuff

    NASA Technical Reports Server (NTRS)

    Reinicke, Robert H. (Inventor)

    1983-01-01

    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.

  7. Arthroscopic "cuff-sparing" percutaneous (CUSP) technique for posterior instability repair in the beach-chair position.

    PubMed

    Bhatia, Deepak N

    2012-09-01

    Arthroscopic posterior labral repair and capsular shift procedures are technically difficult in the beach-chair position as compared with the lateral decubitus position. Optimal visualization in the beach-chair position, and anchor placement in the posterior glenoid rim, necessitate various lateral trans-cuff portals, and these may result in damage to the rotator cuff tendons. The author has devised a new technique for posterior labral repair in the beach-chair position; the technique involves visualization of the posterior capsulolabral complex through a 70-degree arthroscope placed in the posterior axillary pouch portal, and labral repair is performed through percutaneous medial portals. The cuff-sparing and percutaneous (CUSP) nature of the technique utilizes safe anatomic zones for visualization and percutaneous repair of the entire posterior labrum, and lateral portals that may potentially damage the rotator cuff tendons are avoided. Technical variants of the procedure include: (1) a "CUSP shift" technique (combined labral repair and capsular shift); (2) a "CUSP-stitch" technique (isolated labral repair without a capsular shift); and (3) a "posterior labroplasty" technique for reconstruction of deficient posterior labral tissue. Technical tips to avoid neurological injury, and a detailed rehabilitation protocol are presented. PMID:22914001

  8. A EWTD Compliant Rotation Schedule Which Protects Elective Training Opportunities Is Safe and Provides Sufficient Exposure to Emergency General Surgery: A Prospective Study

    PubMed Central

    Emmanuel, Andrew; Chohda, Ezzat; Sands, Carolyn; Ellul, Joseph; Khawaja, Hamid

    2015-01-01

    Introduction. Training opportunities have decreased dramatically since the introduction of the European Working Time Directive (EWTD). In order to maximise training we introduced a rotation schedule in which registrars do not work night shifts and elective training opportunities are protected. We aimed to determine the safety and effectiveness of this EWTD compliant rotation schedule in achieving exposure of trainees to acute general surgical admissions and operations. Methods. A prospective study of consecutive emergency surgical admissions over a 6-month period. Exposure to acute admissions and operative procedures and patient outcomes during day and night shifts was compared. Results. There were 1156 emergency admissions covering a broad range of acute conditions. Significantly more patients were admitted during the day shift and almost all emergency procedures were performed during the day shift (2.1 versus 0.3, p < 0.001). A registrar was the primary operating surgeon in 49% of cases and was directly involved in over 65%. There were no significant differences between patients admitted during the day and night shifts in mortality rate, length of stay, admission to ICU, requirement for surgery, or readmission rates. Conclusion. A EWTD compliant rotation schedule that protects elective training opportunities is safe for patients and provides adequate exposure to training opportunities in emergency surgery. PMID:26609544

  9. A EWTD Compliant Rotation Schedule Which Protects Elective Training Opportunities Is Safe and Provides Sufficient Exposure to Emergency General Surgery: A Prospective Study.

    PubMed

    Emmanuel, Andrew; Chohda, Ezzat; Sands, Carolyn; Ellul, Joseph; Khawaja, Hamid

    2015-01-01

    Introduction. Training opportunities have decreased dramatically since the introduction of the European Working Time Directive (EWTD). In order to maximise training we introduced a rotation schedule in which registrars do not work night shifts and elective training opportunities are protected. We aimed to determine the safety and effectiveness of this EWTD compliant rotation schedule in achieving exposure of trainees to acute general surgical admissions and operations. Methods. A prospective study of consecutive emergency surgical admissions over a 6-month period. Exposure to acute admissions and operative procedures and patient outcomes during day and night shifts was compared. Results. There were 1156 emergency admissions covering a broad range of acute conditions. Significantly more patients were admitted during the day shift and almost all emergency procedures were performed during the day shift (2.1 versus 0.3, p < 0.001). A registrar was the primary operating surgeon in 49% of cases and was directly involved in over 65%. There were no significant differences between patients admitted during the day and night shifts in mortality rate, length of stay, admission to ICU, requirement for surgery, or readmission rates. Conclusion. A EWTD compliant rotation schedule that protects elective training opportunities is safe for patients and provides adequate exposure to training opportunities in emergency surgery. PMID:26609544

  10. Rotator Cuff Tendinitis and Tear (Beyond the Basics)

    MedlinePLUS

    ... UpToDate, Inc. ("UpToDate"), in consideration of the subscription fee and acceptance of this Agreement, grants you a ... or your Institution have agreed to pay subscription fees. At the end of this period, your license ...

  11. Comprehensive Approach to Arthroscopic Rotator Cuff Repair: Options and Techniques

    MedlinePLUS Videos and Cool Tools

    ... tuberosity, I think there's ample evidence from basic science work and from also clinical work that double- ... least that it's multifactorial. We know from basic science for people like Christian Gerber and many others ...

  12. Effect of tear size, corticosteroids and subacromial decompression surgery on the hierarchical structural properties of torn supraspinatus tendons

    PubMed Central

    Tilley, J. M. R.; Murphy, R. J.; Chaudhury, S.; Czernuszka, J. T.; Carr, A. J.

    2014-01-01

    Objectives The effects of disease progression and common tendinopathy treatments on the tissue characteristics of human rotator cuff tendons have not previously been evaluated in detail owing to a lack of suitable sampling techniques. This study evaluated the structural characteristics of torn human supraspinatus tendons across the full disease spectrum, and the short-term effects of subacromial corticosteroid injections (SCIs) and subacromial decompression (SAD) surgery on these structural characteristics. Methods Samples were collected inter-operatively from supraspinatus tendons containing small, medium, large and massive full thickness tears (n = 33). Using a novel minimally invasive biopsy technique, paired samples were also collected from supraspinatus tendons containing partial thickness tears either before and seven weeks after subacromial SCI (n = 11), or before and seven weeks after SAD surgery (n = 14). Macroscopically normal subscapularis tendons of older patients (n = 5, mean age = 74.6 years) and supraspinatus tendons of younger patients (n = 16, mean age = 23.3) served as controls. Ultra- and micro-structural characteristics were assessed using atomic force microscopy and polarised light microscopy respectively. Results Significant structural differences existed between torn and control groups. Differences were identifiable early in the disease spectrum, and increased with increasing tear size. Neither SCI nor SAD surgery altered the structural properties of partially torn tendons seven weeks after treatment. Conclusions These findings may suggest the need for early clinical intervention strategies for torn rotator cuff tendons in order to prevent further degeneration of the tissue as tear size increases. Further work is required to establish the long-term abilities of SCI and SAD to prevent, and even reverse, such degeneration. Cite this article: Bone Joint Res 2014;3:252–61. PMID:25106417

  13. Clinical Paper Orthognathic Surgery

    E-print Network

    Frey, Pascal

    . Stoelinga4,5 1 Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, Netherlands; 5 DepartmentClinical Paper Orthognathic Surgery Do the changes in muscle mass, muscle direction, and rotations

  14. Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation

    SciTech Connect

    Ma, Daniel J.; Michaletz-Lorenz, Martha; Goddu, S. Murty; Grigsby, Perry W.

    2012-03-15

    Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose-volume histograms were also created by summing daily target positions. Results: The average ({+-} standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 {+-} 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 {+-} 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 {+-} 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53%, 26%, 4.2%, and 1.4% for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.

  15. Tracheomegaly Secondary to Tracheotomy Tube Cuff in Amyotrophic Lateral Sclerosis

    PubMed Central

    Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

    2015-01-01

    Abstract Tracheomegaly has not been reported in amyotrophic lateral sclerosis (ALS). Herein, the authors report a case of tracheomegaly secondary to tracheotomy tube cuff in a patient with ALS. To our knowledge, this is the first report of an ALS patient with tracheomegaly and of tracheomegaly being associated with tracheotomy tube cuff and home tracheotomy mechanical ventilator. The clinician should consider the possibility of tracheomegaly in the differential diagnosis, if a patient with ALS develops repeat air leakage around the tracheotomy tube or rupture of tracheotomy tube cuff. PMID:26496301

  16. Intrafraction Prostate Translations and Rotations During Hypofractionated Robotic Radiation Surgery: Dosimetric Impact of Correction Strategies and Margins

    SciTech Connect

    Water, Steven van de; Valli, Lorella; Aluwini, Shafak; Lanconelli, Nico; Heijmen, Ben; Hoogeman, Mischa

    2014-04-01

    Purpose: To investigate the dosimetric impact of intrafraction prostate motion and the effect of robot correction strategies for hypofractionated CyberKnife treatments with a simultaneously integrated boost. Methods and Materials: A total of 548 real-time prostate motion tracks from 17 patients were available for dosimetric simulations of CyberKnife treatments, in which various correction strategies were included. Fixed time intervals between imaging/correction (15, 60, 180, and 360 seconds) were simulated, as well as adaptive timing (ie, the time interval reduced from 60 to 15 seconds in case prostate motion exceeded 3 mm or 2° in consecutive images). The simulated extent of robot corrections was also varied: no corrections, translational corrections only, and translational corrections combined with rotational corrections up to 5°, 10°, and perfect rotational correction. The correction strategies were evaluated for treatment plans with a 0-mm or 3-mm margin around the clinical target volume (CTV). We recorded CTV coverage (V{sub 100%}) and dose-volume parameters of the peripheral zone (boost), rectum, bladder, and urethra. Results: Planned dose parameters were increasingly preserved with larger extents of robot corrections. A time interval between corrections of 60 to 180 seconds provided optimal preservation of CTV coverage. To achieve 98% CTV coverage in 98% of the treatments, translational and rotational corrections up to 10° were required for the 0-mm margin plans, whereas translational and rotational corrections up to 5° were required for the 3-mm margin plans. Rectum and bladder were spared considerably better in the 0-mm margin plans. Adaptive timing did not improve delivered dose. Conclusions: Intrafraction prostate motion substantially affected the delivered dose but was compensated for effectively by robot corrections using a time interval of 60 to 180 seconds. A 0-mm margin required larger extents of additional rotational corrections than a 3-mm margin but resulted in lower doses to rectum and bladder.

  17. Outpatient vaginal cuff brachytherapy for endometrial cancer.

    PubMed

    Petereit, D. G.; Tannehill, S. P.; Grosen, E. A.; Hartenbach, E. M.; Schink, J. C.

    1999-11-01

    Petereit DG, Tannehill SP, Grosen EA, Hartenbach EM, Schink JC. Outpatient vaginal cuff brachytherapy for endometrial cancer. The objective of this study was to determine the efficacy and complications of postoperative high-dose-rate (HDR) vaginal-cuff brachytherapy (VCB) in patients with endometrial carcinoma. Between August 1989 to September 1997, 191 patients were treated postoperatively after a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) with outpatient adjuvant HDR VCB for low-risk endometrial cancer (IB-84%, grade 1 or 2-96%). Patients were treated with 2 HDR fractions, delivered one week apart while under conscious sedation (16.2 Gy X 2 to the vaginal surface). All clinical endpoints were calculated using the Kaplan Meier method. The median time in the brachytherapy suite was 60 min in which no acute complications were observed. The 30-day morbidity and mortality rates were both 0%. With a median follow-up of 38 months (12-82 months), the 4-year survival, relapse-free survival, and vaginal-control rates were 95%, 98%, and 100%, respectively. One patient developed a colo-vaginal fistula at 5 years. Adjuvant HDR VCB in 2 outpatient insertions produced 100% vaginal control rates with minimal morbidity. The advantages of high dose-rate compared to low dose-rate vaginal brachytherapy include patient convenience, markedly shorter treatment times (1 h per insertion), and reduction in the cost and potential morbidity of hospitalization. HDR brachytherapy approach is a cost-effective alternative to either low-dose-rate brachytherapy or whole pelvic radiotherapy in carefully selected patients. PMID:11240811

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

    PubMed

    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

    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

  19. Early dexamethasone treatment after implantation of a sciatic-nerve cuff decreases the concentration of substance P in the lumbar spinal cord of rats with neuropathic pain

    PubMed Central

    Beaudry, Francis; Girard, Christiane; Vachon, Pascal

    2007-01-01

    The main purpose of this study was to evaluate the effects of early dexamethasone treatment on pain-related peptides at an early stage in the development of neuropathic pain induced by implantation of a sciatic nerve cuff in Sprague Dawley rats (body weight 250 to 350 g). The rats were tested for touch sensitivity with the use of von Frey filaments before and 3 d after cuff implantation (n = 12) or sham surgery (n = 6). Half of the cuff-implanted rats received dexamethasone, 1 mg/kg intraperitoneally, 1 h after surgery. Spinal cords were collected on the 3rd day after surgery, and the lumbar enlargement was processed for the detection of selected peptides (neurotensin, substance P, cholecystokinin [CCK], vasoactive intestinal peptide, and calcitonin gene-related peptide) by means of liquid chromatography and tandem mass spectrometry. The right sciatic nerve of each rat was collected, fixed, and stained for histopathological evaluation. Except for neurotensin, all the peptides showed an increased concentration with neuropathic pain; however, the differences were significant (P < 0.05) only for substance P and CCK. In the animals treated with dexamethasone, mechanical allodynia was less pronounced (P < 0.01), and only the concentration of substance P was decreased significantly (P < 0.05). Sciatic nerve sections showed a decrease in C (P < 0.01) and A? (P < 0.03) fibres with neuropathic pain and a nearly normal percentage of C fibres after dexamethasone treatment. The dexamethasone-treated animals also had less inflammation detectable microscopically at the nerve constriction site compared with cuff-implanted animals that were not treated with dexamethasone. Our results suggest that in the early stages of neuropathic pain induced by an inflammatory process, dexamethasone may be a useful treatment and that substance P plays an important role in pain perception. PMID:17479771

  20. Leakage of fluid around endotracheal tube cuffs: a cadaver study

    PubMed Central

    Lucius, Ralph; Ewald, Kristian

    2013-01-01

    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

  1. Robotic surgery

    MedlinePLUS

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  2. Latissimus dorsi tendon transfer for massive irreparable cuff tears: an anatomic study.

    PubMed

    Morelli, Moreno; Nagamori, Jun; Gilbart, Michael; Miniaci, Anthony

    2008-01-01

    The purpose of this study was to describe landmarks for latissimus dorsi tendon transfer in massive irreparable tears of the rotator cuff. Nine pairs of embalmed cadaveric shoulders were dissected. Crucial structures were identified, and their relationship with various bony and soft-tissue reference points was documented. Identification of the dense fibrous band, at the confluence of the teres major and latissimus dorsi musculotendinous unit, facilitates localization of the radial nerve, which crosses deep to this landmark. The axillary nerve can be seen to exit the quadrangular space 27 mm medial to the latissimus dorsi insertion into the proximal humerus, whereas the thoracodorsal neurovascular pedicle inserts into the latissimus dorsi 110 mm from the humeral tendon's humeral attachment. Harvest of the latissimus dorsi tendon can be safely accomplished by identifying the dense fibrous band and releasing the tendon within 2 cm of its humeral attachment. PMID:18069017

  3. [Contemporary views on perioperative complications and adhaesion formation after vaginal hysterectomy, in relation to peritoneal closure vs. non-closure in combination with open vs. closed vaginal cuff].

    PubMed

    Watrowski, Rafa?; Friebe, Zbigniew

    2006-12-01

    There exists few evidence about peritoneal closure vs. non-closure at vaginal hysterectomy as well as only scanty evidence for open vs. sutured vaginal cuff. It seems that non-closure of the peritoneum at vaginal hysterectomy holds no risks and probably some advantages, e.g. faster resumption of bowel function. In the light of the rare direct evidence from vaginal surgery and the strong evidence from cesarean section and abdominal hysterectomy, we recommend abandoning the routine closure of the peritoneum at vaginal hysterectomy. The vaginal cuff left open is probably also a safe procedure, if the hemostasis has been done carefully. The most promising modification of the vaginal incision-and-closure seems to be the "Benenden-Hospital technique" (V-shaped posterior incision and running longitudinal closure of the vaginal skin with partially non-sutured peritoneum). PMID:17373125

  4. Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval.

    PubMed

    Brendt, Peter; Schnekenburger, Marc; Paxton, Karen; Brown, Anthony; Mendis, Kumara

    2013-01-01

    Abstract Background. Increased endotracheal tube (ETT) cuff pressure is associated with compromised tracheal mucosal perfusion and injuries. No published data are available for Australia on pressures in the fixed-wing air medical retrieval setting. Objective. After introduction of a cuff pressure manometer (Mallinckrodt, Hennef, Germany) at the Royal Flying Doctor Service (RFDS) Base in Dubbo, New South Wales (NSW), Australia, we assessed the prevalence of increased cuff pressures before, during, and after air medical retrieval. Methods. This was a retrospective audit in 35 ventilated patients during fixed-wing retrievals by the RFDS in NSW, Australia. Explicit chart review of ventilated patients was performed for cuff pressures and changes during medical retrievals with pressurized aircrafts. Pearson correlation was calculated to determine the relation of ascent and ETT cuff pressure change from ground to flight level. Results. The mean (± standard deviation) of the first ETT cuff pressure measurement on the ground was 44 ± 20 cmH2O. Prior to retrieval in 11 patients, the ETT cuff pressure was >30 cmH2O and in 11 patients >50 cmH2O. After ascent to cruising altitude, the cuff pressure was >30 cmH2O in 22 patients and >50 cmH2O in eight patients. The cuff pressure was reduced 1) in 72% of cases prior to take off and 2) in 85% of cases during flight, and 3) after landing, the cuff pressure increased in 85% of cases. The correlation between ascent in cabin altitude and ETT cuff pressure was r = 0.3901, p = 0.0205. Conclusions. The high prevalence of excessive cuff pressures during air medical retrieval can be avoided by the use of cuff pressure manometers. Key words: cuff pressure; air medical retrieval; prehospital. PMID:23252881

  5. Cosmetic Surgery

    MedlinePLUS

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face ...

  6. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...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. This device is made of either stainless steel or plastic....

  7. Comparison of blood pressure measurements of anesthetized dogs obtained noninvasively with a cylindrical blood pressure cuff and an anatomically modified conical blood pressure cuff.

    PubMed

    Ramos, Sara J; da Cunha, Anderson F; Domingues, Michelle; Shelby, Amanda M; Stout, Rhett W; Acierno, Mark J

    2016-01-01

    OBJECTIVE To compare blood pressure measured noninvasively with an oscillometric device that involved use of a novel conical cuff and a traditional cylindrical blood pressure cuff. ANIMALS 17 adult hound-type dogs. PROCEDURES Dogs were anesthetized, and a 20-gauge, 1.5-inch catheter was inserted in the median sacral artery. The catheter was attached to a pressure transducer via fluid-filled noncompliant tubing, and direct blood pressure was recorded with a multifunction monitor. A specially fabricated conical cuff was placed on the antebrachium. Four sets of direct and indirect blood pressure measurements were simultaneously collected every 2 minutes. Four sets of measurements were then obtained by use of a cylindrical cuff. RESULTS The cylindrical cuff met American College of Veterinary Internal Medicine consensus guidelines for validation of indirect blood pressure measurements for mean arterial blood pressure (MAP), systolic arterial blood pressure (SAP), and diastolic arterial blood pressure (DAP). The conical cuff met the consensus guidelines for difference of paired measurements, SD, and percentages of measurements within 10 and 20 mm Hg of the value for the reference method, but it failed a correlation analysis. In addition, although bias for the conical cuff was less than that for the cylindrical cuff for SAP, MAP, and DAP measurements, the limits of agreement for the conical cuff were wider than those for the cylindrical cuff for SAP and MAP measurements. CONCLUSIONS AND CLINICAL RELEVANCE On the basis of results of this study, use of a conical cuff for oscillometric blood pressure measurement cannot be recommended. PMID:26709937

  8. Dose-Response Evaluation of Braslet-M Occlusion Cuffs

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

    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.

  9. Scapulothoracic and Glenohumeral Kinematics Following an External Rotation

    E-print Network

    Karduna, Andrew

    and shoulder pa- thology have been identified in impingement syndrome,35,38,72 ro- tator cuff tears,52-measures experimental design. Objective: To determine the effects of shoulder external rotator muscle fatigue on 3 of the shoulder are important for normal shoulder function. Impaired performance of these muscles has been

  10. PROSPECTIVE RANDOMIZED STUDY COMPARING A SINGLE-CUFF SELF-LOCATING CATHETER WITH A SINGLE-CUFF STRAIGHT TENCKHOFF CATHETER IN PERITONEAL DIALYSIS.

    PubMed

    Sanchez-Canel, Juan Jose; Garcia-Perez, Hector; Garcia-Calvo, Rafael; Pascual, Maria Jose; Casado, David

    2014-09-01

    ? Objectives: Peritoneal dialysis (PD) catheters are critical to the success of the technique. However, few studies provide evidence about which design helps to reduce complications. Self-locating catheters (SLCs) are used to avoid displacement of the catheter tip. The incidence of mechanical and infectious complications and catheter survival rate were assessed in Tenckhoff PD catheters. ? Design: The prospective randomized study compared drainage problems in 40 incident PD patients using a single-cuff SLCs and 38 patients using a single-cuff, straight Tenckhoff catheter (TC). ? Results: No significant differences were observed in the number of complications in the Pre period (from the insertion of the catheter to the start of the technique); however, the number of complications was lower in the SLC group during Post (p = 0.021) and Total period (p = 0.048). The number of problems related to catheter malfunction for each period: Pre, Post, and Total, was significantly lower with SLCs vs TCs (p = 0.018, p = 0.001 and p = 0.003, respectively). Problems were solved more easily with SLCs, using laxatives, with less need for fluoroscopic placement and no need for surgical replacement, as opposed to the TC group: Pre (not significant), Post (p = 0.007), and Total (p = 0.011). Median survival was 39.6 months (30.9 - 48.3) for SLCs and 30.1 months (22.6 - 37.5) for TCs, which is not a significant difference. However, SLCs have a higher malposition-free survival rate. Multivariate logistic regression models only included the variable "type of catheter" as a predictor of malfunction during the Pre period (odds ratio [OR] = 4.154). The Post period included the variables, "type of catheter" (OR = 7.701) and "age" (OR = 1.047), and the Total period only included the variable "type of catheter" (OR = 4.487), which indicates an increased probability of malfunction with the use of TCs vs SLCs. The variables (gender, previous intra-abdominal surgery, body mass index (BMI) and diabetes mellitus) did not add predictive value to the models (p > 0.05). ? Conclusion: The study confirms the hypothesis that TCs have more malfunctions and a lower malposition-free survival rate than SLCs, and TCs are considered as the highest risk factor for malfunction during all study periods. PMID:25185016

  11. Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

    PubMed Central

    ARRIGONI, PAOLO; ROSE, GIACOMO DELLE; D’AMBROSI, RICCARDO; ROTUNDO, GIORGIO; CAMPAGNA, VINCENZO; PIRANI, PIERGIORGIO; PANASCÌ, MANLIO; PETRICCIOLI, DARIO; BERTONE, CELESTE; GRASSO, ANDREA; LATTE, CARMINE; COSTA, ALBERTO; VIOLA, GINO; DE GIORGI, SILVANA; PANELLA, ANTONELLO; PADUA, ROBERTO; BECCARINI, ALESSANDRO; SALCHER, BARBARA; OLIVIERI, MATTEO; MUGNAINI, MARCO; PANNONE, ANTONELLO; CEOLDO, CHIARA; LONGO, UMILE GIUSEPPE; DENARO, VINCENZO; CERCIELLO, SIMONE; PANNI, ALFREDO SCHIAVONE; AVANZI, PAOLO; ZORZI, CLAUDIO; RAGONE, VINCENZA; CASTAGNA, ALESSANDRO; RANDELLI, PIETRO

    2015-01-01

    Purpose the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). Methods a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. Results the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. Conclusions painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. Level of evidence: level I, validating cohort study with good reference standards. PMID:26151035

  12. Post-operative pulmonary complications after non-cardiothoracic surgery

    PubMed Central

    Kelkar, Kalpana Vinod

    2015-01-01

    Post-operative pulmonary complications (PPCs) occur in 5–10% of patients undergoing non-thoracic surgery and in 22% of high risk patients. PPCs are broadly defined as conditions affecting the respiratory tract that can adversely influence clinical course of the patient after surgery. Prior risk stratification, risk reduction strategies, performing short duration and/or minimally invasive surgery and use of anaesthetic technique of combined regional with general anaesthesia can reduce the incidence of PPCs. Atelectasis is the main cause of PPCs. Atelectasis can be prevented or treated by adequate analgesia, incentive spirometry (IS), deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation. Pre-operative treatment of IS is more effective. The main reason for post-operative pneumonia is aspiration along the channels formed by longitudinal folds in the high volume, low pressure polyvinyl chloride cuffs of the endotracheal tubes. Use of tapered cuff, polyurethane cuffs and selective rather than the routine use of nasogastric tube can decrease chances of aspiration. Acute lung injury is the most serious PPC which may prove fatal. PMID:26556919

  13. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: a reliability study.

    PubMed

    Graven-Nielsen, Thomas; Vaegter, Henrik Bjarke; Finocchietti, Sara; Handberg, Gitte; Arendt-Nielsen, Lars

    2015-11-01

    Chronic musculoskeletal pain is linked with sensitization, and standardized methods for assessment are needed. This study investigated (1) the test-retest reliability of computer-controlled cuff-pressure algometry (pain thresholds and temporal pain summation) on the arm and leg and (2) conditioned pain modulation (CPM) assessed by cuff algometry. The influences of age and gender were evaluated. On 2 different days, cuff pain threshold (cPPT), cuff pain tolerance (cPTT), and temporal summation of pain (TSP) by visual analog scale scores to 10 repeated cuff stimulations at cPTT intensity, as well as pressure pain threshold with handheld pressure algometry, were assessed in 136 healthy subjects. In one session, cuff pain sensitivity was also assessed before and after cold pressor-induced CPM. Good-to-excellent intraclass correlations (0.60-0.90) were demonstrated for manual and cuff algometry, and no systematic bias between sessions was found for cPPT, cPTT, and TSP on the leg and for cPTT and TSP on the arm. Cuff pressure pain threshold and cPTT were higher in men compared with women (P < 0.05). Middle-aged subjects had higher pressure pain threshold, but lower cPPT and cPTT, compared with younger subjects (P < 0.05). Temporal summation of pain was increased in women compared with men (P < 0.05). Cuff algometry was sensitive to CPM demonstrated as increased cPPT and cPTT and reduced TSP (P < 0.05). Reliability and sensitivity of computer-controlled cuff algometry for pain assessment is comparable with manual pressure algometry and constitutes a user-independent method for assessment of pain. Difference in age-related pain sensitivity between manual and cuff algometry should be further investigated. PMID:26172551

  14. [Endotest--a simple method for the monitoring of internal pressure of the tube cuff].

    PubMed

    Fösel, T; Altemeyer, K H; Mehrkens, H H

    1985-07-01

    The Endotest is a simple device for monitoring the cuff pressure of an endotracheal tube. No complications could be observed during a 6 month period of usage in the daily routine. We found the handling very good and cuff pressure monitoring very useful. PMID:4037290

  15. Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.

    PubMed

    Efrati, Shai; Deutsch, Israel; Weksler, Nathan; Gurman, Gabriel M

    2015-02-01

    Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup. PMID:24870932

  16. Foot Surgery

    MedlinePLUS

    ... About Feet » Foot Health Information Surgery When is Foot Surgery Necessary? Many foot problems do not respond ... restore the function of your foot. Types of Foot Surgery Fusions: Fusions are usually performed to treat ...

  17. Cuff overinflation and endotracheal tube obstruction: case report and experimental study

    PubMed Central

    2010-01-01

    Background Initiated by a clinical case of critical endotracheal tube (ETT) obstruction, we aimed to determine factors that potentially contribute to the development of endotracheal tube obstruction by its inflated cuff. Prehospital climate and storage conditions were simulated. Methods Five different disposable ETTs (6.0, 7.0, and 8.0 mm inner diameter) were exposed to ambient outside temperature for 13 months. In addition, every second of these tubes was mechanically stressed by clamping its cuffed end between the covers of a metal emergency case for 10 min. Then, all tubes were heated up to normal body temperature, placed within the cock of a syringe, followed by stepwise inflation of their cuffs to pressures of 3 kPa and ?12 kPa, respectively. The inner lumen of the ETT was checked with the naked eye for any obstruction caused by the external cuff pressure. Results Neither in tubes that were exposed to ambient temperature (range: -12°C to +44°C) nor in those that were also clamped, visible obstruction by inflated cuffs was detected at any of the two cuff pressure levels. Conclusions We could not demonstrate a critical obstruction of an ETT by its inflated cuff, neither when the cuff was over-inflated to a pressure of 12 kPa or higher, nor in ETTs that had been exposed to unfavorable storage conditions and significant mechanical stress. PMID:20377858

  18. Cuff leakage, not paravalvular leakage, in the Carpentier Edwards PERIMOUNT Magna Ease aortic bioprosthesis.

    PubMed

    Tokunaga, Shigehiko; Cho, Tomoki; Izubuchi, Ryo; Masuda, Munetaka

    2015-12-01

    Though the Carpentier Edwards PERIMOUNT Magna Ease valve is a bioprosthesis with documented excellent haemodynamics and easy implantability, this valve has a gap between the cobalt-chromium-nickel alloy stent and silicone sewing ring. This gap, which is widest just below each of the three commissural struts, lacks silicone and leaves the two-layer polytetrafluoroethylene fabric unsupported and unprotected. If the needle of a valve suture is placed in this structurally weak area of the sewing ring, the resultant fabric tear may result in a true cuff leakage, not the usual paravalvular leakage. We describe this pitfall in the context of a recent operation to alert surgeons everywhere that suture placement too close to the stent (missing the silicone sewing ring) can result in postoperative cuff leakage. We need to be very careful to include the silicone ring in each stitch to prevent injury to the valve cuff of this prosthesis and to avoid cuff leakage. PMID:26337338

  19. Influences of thigh cuffs on the cardiovascular system during 7-day head-down bed rest.

    PubMed

    Arbeille, P; Herault, S; Fomina, G; Roumy, J; Alferova, I; Gharib, C

    1999-12-01

    Thigh cuffs, presently named "bracelets," consist of two straps fixed to the upper part of each thigh, applying a pressure of 30 mmHg. The objective was to evaluate the cardiac, arterial, and venous changes in a group of subjects in head-down tilt (HDT) for 7 days by using thigh cuffs during the daytime, and in a control group not using cuffs. The cardiovascular parameters were measured by echography and Doppler. Seven days in HDT reduced stroke volume in both groups (-10%; P < 0.05). Lower limb vascular resistance decreased more in the cuff group than in the control group (-29 vs. -4%; P < 0.05). Cerebral resistance increased in the control group only (+6%; P < 0.05). The jugular vein increased (+45%; P < 0.05) and femoral and popliteal veins decreased in cross-sectional area in both groups (-45 and -8%, respectively; P < 0.05). Carotid diameter tended to decrease (-5%; not significant) in both groups. Heart rate, blood pressure, cardiac output, and total resistance did not change significantly. After 8 h with thigh cuffs, the cardiac and arterial parameters had recovered their pre-HDT level except for blood pressure (+6%; P < 0.05). Jugular vein size decreased from the pre-HDT level (-21%; P < 0.05), and femoral and popliteal vein size increased (+110 and +136%, respectively; P < 0.05). The thigh cuffs had no effect on the development of orthostatic intolerance during the 7 days in HDT. PMID:10601164

  20. After Surgery

    MedlinePLUS

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  1. Turbinate surgery

    MedlinePLUS

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  2. Cuff inflations do not affect night-time blood pressure: comparison of 24?h ambulatory blood pressure measured by a cuff and a tonometric device in type 2 diabetes.

    PubMed

    Petersen, Emilie H; Theilade, Simone; Hansen, Tine W; Lindhardt, Morten K; Rossing, Peter

    2015-12-01

    Discomfort related to cuff inflation may bias 24?h ambulatory blood pressure (BP) measurements, especially during night-time. We accessed the impact of cuff inflations by comparing 24?h BP recorded with a cuff-less tonometric wrist device and an upper-arm oscillometric cuff device. Fifty-three participants with type 2 diabetes were assigned randomly to four 24-h BP recordings with a cuff (TM2430: visit 1 or 2, and 4) and a tonometric device (BPro: visit 1 or 2, 3, and 4). The mean 24?h systolic BP was significantly higher when measured with the cuff versus the tonometric device (141.6±14.6 vs. 128.3±14.6?mmHg, P?0.01), as was nocturnal BP (6.7±5.3 vs. 10.3±7.6%, P=0.002). In conclusion, nocturnal BP decline was higher when measured with the cuff device, suggesting that cuff inflations did not increase night-time BP. Further evaluation of the tonometric device using the updated European Society of Hypertension International Protocol revision 2010 is recommended before applying it in daily clinical practice. PMID:26154852

  3. Possibilities offered by implantable miniaturized cuff-electrodes for insect neurophysiology

    PubMed Central

    Hartbauer, Manfred; Krüger, Thilo B.; Stieglitz, Thomas

    2012-01-01

    Recent advances in microsystems technology led to a miniaturization of cuff-electrodes, which suggests these electrodes not just for long-term neuronal recordings in mammalians, but also in medium-sized insects. In this study we investigated the possibilities offered by cuff-electrodes for neuroethology using insects as a model organism. The implantation in the neck of a tropical bushcricket resulted in high quality extracellular nerve recordings of different units responding to various acoustic, vibratory, optical and mechanical stimuli. In addition, multi-unit nerve activity related to leg movements was recorded in insects walking on a trackball. A drawback of bi-polar nerve recordings obtained during tethered flight was overlay of nerve activity with large amplitude muscle potentials. Interestingly, cuff-electrode recordings were robust to withstand walking and flight activity so that good quality nerve recordings were possible even three days after electrode implantation. Recording multi-unit nerve activity in intact insects required an elaborate spike sorting algorithm in order to discriminate neuronal units responding to external stimuli from background activity. In future, a combination of miniaturized cuff-electrodes and light-weight amplifiers equipped with a wireless transmitter will allow the investigation of neuronal processes underlying natural behavior in freely moving insects. By this means cuff-electrodes may contribute to the development of realistic neuronal models simulating neuronal processes underlying natural insect behavior, such like mate choice and predator avoidance. PMID:23576843

  4. Case Report of Multiple Tracheostomy Revisions due to Persistent, Recurrent Cuff Leak

    PubMed Central

    Azimi-Bolourian, Jian P.; Hanna, Issa A.; Williams, George W.

    2015-01-01

    This case is a patient with amyotrophic lateral sclerosis who was unable to be separated from mechanical ventilator support and required a tracheostomy. The patient underwent an initial open tracheostomy utilizing flexible fiberoptic tracheoscopy (FFT) in the operating room (OR). Subsequently, he developed recurrent leaks in the tracheal tube cuff requiring multiple trips back to the operating room. The recurrent cuff leak occurred following each tube placement until the etiology of the leak was discovered during the fourth procedure. In the fourth procedure, the wound was explored more extensively, and it was found that there was a sharp, calcified, aberrant fragment of a tracheal cartilage ring protruding into the tracheal lumen, which was damaging the cuff of each tube. This fragment was not visible by multiple FFTs, nor was it visible in the wound by the surgeons until wider exploration of the wound occurred. The cartilage fragment was ultimately excised and the patient had no further cuff leaks. Aberrant tracheal cartilage should be on the differential diagnosis for cuff leaks subsequent to surgical tracheostomy (ST) or percutaneous dilatational tracheostomy (PDT). PMID:26240762

  5. Possibilities offered by implantable miniaturized cuff-electrodes for insect neurophysiology.

    PubMed

    Hartbauer, Manfred; Krüger, Thilo B; Stieglitz, Thomas

    2012-05-01

    Recent advances in microsystems technology led to a miniaturization of cuff-electrodes, which suggests these electrodes not just for long-term neuronal recordings in mammalians, but also in medium-sized insects. In this study we investigated the possibilities offered by cuff-electrodes for neuroethology using insects as a model organism. The implantation in the neck of a tropical bushcricket resulted in high quality extracellular nerve recordings of different units responding to various acoustic, vibratory, optical and mechanical stimuli. In addition, multi-unit nerve activity related to leg movements was recorded in insects walking on a trackball. A drawback of bi-polar nerve recordings obtained during tethered flight was overlay of nerve activity with large amplitude muscle potentials. Interestingly, cuff-electrode recordings were robust to withstand walking and flight activity so that good quality nerve recordings were possible even three days after electrode implantation. Recording multi-unit nerve activity in intact insects required an elaborate spike sorting algorithm in order to discriminate neuronal units responding to external stimuli from background activity. In future, a combination of miniaturized cuff-electrodes and light-weight amplifiers equipped with a wireless transmitter will allow the investigation of neuronal processes underlying natural behavior in freely moving insects. By this means cuff-electrodes may contribute to the development of realistic neuronal models simulating neuronal processes underlying natural insect behavior, such like mate choice and predator avoidance. PMID:23576843

  6. Effect of long-term implanted nerve cuff electrodes on the electrophysiological properties of human sensory nerves.

    PubMed

    Slot, P J; Selmar, P; Rasmussen, A; Sinkjaer, T

    1997-03-01

    During a long-term implantation (307 days) of a tripolar split cuff electrode around the palmar digital nerve to the radial side of the left index finger, branching off the median nerve in a medullary lesioned C6 patient, the physiological state of the nerve was intensively monitored. The resulting sensory nerve action potential (SNAP) amplitude was recorded, using both near-nerve electrodes and the implanted cuff electrode. The SNAP amplitude declined within 10 days to approximately 50% of the first SNAP cuff amplitude measured on Day 2 after implantation and recovered to the initial amplitude within 3 months. The SNAP amplitude measurements made with near-nerve electrodes were consistent with the cuff results; the SNAP conduction velocity (CV) recorded by the near-nerve electrodes and the cuff electrode was constant during the whole implantation period. This is in agreement with the results from two other patients: one with a cuff implanted around the sural nerve, and the other with a cuff implanted around a branch of the tibial nerve. These results and animals studies show that the cuff electrode is an electrically stable neural-electrical transducer. PMID:9148706

  7. Bipolar Posterior Deltoid Transfer for Massive Rotator Cuff Tears: A Report on 2 Patients

    PubMed Central

    2015-01-01

    Summary: A transfer of the posterior deltoid innervated by the posterior branch of the axillary nerve and vascularized by the posterior circumflex humeral artery is described for irreparable tears of the supra- and infraspinatus muscle tendons. Functionally useful abduction and flexion were restored in 2 patients. PMID:26090280

  8. Unnecessary surgery.

    PubMed Central

    Leape, L L

    1989-01-01

    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

  9. Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------

    E-print Network

    Miyashita, Yasushi

    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

  10. Bariatric Surgery Procedures

    MedlinePLUS

    ... Surgery Procedures Who is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery ... Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery ... and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, ...

  11. Brain surgery

    MedlinePLUS

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  12. Thyroid Surgery

    MedlinePLUS

    ... thyroid surgery, requiring treatment with thyroid hormone (see Hypothyroidism brochure ). This is especially true if you had ... Radioactive Iodine Low Iodine Diet Thyroid Function Tests Hypothyroidism Hyperthyroidism Thyroid Disease and Complementary and Alternative Medicine ...

  13. Sinus Surgery

    MedlinePLUS

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient?s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  14. Cataract Surgery

    MedlinePLUS

    ... Contact Lenses Colored Contact Lenses Eyeglasses IOLs Refractive Surgery & LASIK Sunglasses Living EyeSmart About Ophthalmologists Adults Under 40 Adults 40 to 60 Adults Over 60 Babies, Children & Teenagers Computer Usage Diabetes Diet & Nutrition Eye Injuries Eye ...

  15. Nose Surgery

    MedlinePLUS

    ... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal ... be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at ...

  16. Plastic Surgery

    MedlinePLUS

    ... appearance and self-image through both reconstructive and cosmetic procedures. Reconstructive procedures correct defects on the face ... a woman's breast after surgery for breast cancer. Cosmetic (also called aesthetic ) procedures alter a part of ...

  17. Lung surgery

    MedlinePLUS

    You will have several visits with your health care provider and undergo medical tests before your surgery. Your health care provider will: Do a complete physical exam Make sure other medical conditions you may have, such as ...

  18. The effect of mucosal cuff shrinkage around dental implants during healing abutment replacement.

    PubMed

    Nissan, J; Zenziper, E; Rosner, O; Kolerman, R; Chaushu, L; Chaushu, G

    2015-10-01

    Soft tissue shrinkage during the course of restoring dental implants may result in biological and prosthodontic difficulties. This study was conducted to measure the continuous shrinkage of the mucosal cuff around dental implants following the removal of the healing abutment up to 60 s. Individuals treated with implant-supported fixed partial dentures were included. Implant data - location, type, length, diameter and healing abutments' dimensions - were recorded. Mucosal cuff shrinkage, following removal of the healing abutments, was measured in bucco-lingual direction at four time points - immediately after 20, 40 and 60 s. anova was used to for statistical analysis. Eighty-seven patients (49 women and 38 men) with a total of 311 implants were evaluated (120 maxilla; 191 mandible; 291 posterior segments; 20 anterior segments). Two-hundred and five (66%) implants displayed thick and 106 (34%) thin gingival biotype. Time was the sole statistically significant parameter affecting mucosal cuff shrinkage around dental implants (P < 0·001). From time 0 to 20, 40 and 60 s, the mean diameter changed from 4·1 to 4·07, 3·4 and 2·81 mm, respectively. The shrinkage was 1%, 17% and 31%, respectively. The gingival biotype had no statistically significant influence on mucosal cuff shrinkage (P = 0·672). Time required replacing a healing abutment with a prosthetic element should be minimised (up to 20/40 s), to avoid pain, discomfort and misfit. PMID:26132112

  19. Biomechanical and functional variation in rat sciatic nerve following cuff electrode implantation

    PubMed Central

    2014-01-01

    Background Nerve cuff electrodes are commonly and successfully used for stimulating peripheral nerves. On the other hand, they occasionally induce functional and morphological changes following chronic implantation, for reasons not always clear. We hypothesize that restriction of nerve mobility due to cuff implantation may alter nerve conduction. Methods We quantified acute changes in nerve-muscle electrophysiology, using electromyography, and nerve kinematics in anesthetized Sprague Dawley rat sciatic nerves during controlled hindlimb joint movement. We compared electrophysiological and biomechanical response in uncuffed nerves and those secured within a cuff electrode using analysis of variance (ANOVA) and regression analysis. Results Tethering resulting from cuff implantation resulted in altered nerve strain and a complex biomechanical environment during joint movement. Coincident with biomechanical changes, electromyography revealed significantly increased variability in the response of conduction latency and amplitude in cuffed, but not free, nerves following joint movement. Conclusion Our findings emphasize the importance of the mechanical interface between peripheral nerves and their devices on neurophysiological performance. This work has implications for nerve device design, implantation, and prediction of long-term efficacy. PMID:24758405

  20. Microvascular anastomosis using fibrin glue and venous cuff in rat carotid artery.

    PubMed

    Sacak, Bulent; Tosun, Ugur; Egemen, Onur; Sakiz, Damlanur; Ugurlu, Kemal

    2015-04-01

    Conventional anastomosis with interrupted sutures can be time-consuming, can cause vessel narrowing, and can lead to thrombosis at the site of repair. The amount of suture material inside the lumen can impair the endothelium of the vessel, triggering thrombosis. In microsurgery, fibrin sealants have the potential beneficial effects of reducing anastomosis time and promoting accurate haemostasis at the anastomotic site. However, there has been a general reluctance to use fibrin glue for microvascular anastomoses because the fibrin polymer is highly thrombogenic and may not provide adequate strength. To overcome these problems, a novel technique was defined for microvascular anastomosis with fibrin glue and a venous cuff. Sixty-four rats in two groups are included in the study. In the experimental group (n = 32), end-to-end arterial anastomosis was performed with two stay sutures, fibrin glue, and a venous cuff. In the control group (n = 32), conventional end-to-end arterial anastomosis was performed. Fibrin glue assisted anastomosis with a venous cuff took less time, caused less bleeding at the anastomotic site, and achieved a patency rate comparable to that provided by the conventional technique. Fibrin sealant assisted microvascular anastomosis with venous cuff is a rapid, easy, and reliable technique compared to the end-to-end arterial anastomosis. PMID:25529101

  1. Measurement of brachial artery endothelial function using a standard blood pressure cuff.

    PubMed

    Maltz, Jonathan S; Tison, Geoffrey H; Alley, Hugh F; Budinger, Thomas F; Owens, Christopher D; Olgin, Jeffrey

    2015-11-01

    The integrity of endothelial function in major arteries (EFMA) is a powerful independent predictor of heart attack and stroke. Existing ultrasound-based non-invasive assessment methods are technically challenging and suitable only for laboratory settings. EFMA, like blood pressure (BP), is both acutely and chronically affected by factors such as lifestyle and medication. Consequently, laboratory-based measurements cannot fully gauge the effects of medical interventions on EFMA. EFMA and BP have, arguably, comparable (but complementary) value in the assessment of cardiovascular health. Widespread deployment of EFMA assessment is thus a desirable clinical goal. To this end, we propose a device based on modifying the measurement protocol of a standard electronic sphygmomanometer. The protocol involves inflating the cuff to sub-diastolic levels to enable recording of the pulse waveform before and after vasodilatory stimulus. The mechanical unloading of the arterial wall provided by the cuff amplifies the distension that occurs with each pulse, which is measured as a pressure variation in the cuff. We show that the height of the rising edge of each pulse is proportional to the change in lumen area between diastole and systole. This allows the effect of vasodilatory stimuli on the artery to be measured with high sensitivity. We compare the proposed cuff flow-mediated dilation (cFMD) method to ultrasound flow-mediated dilation (uFMD). We find significant correlation (r??=??0.55, p??=0.003, N??=??27) between cFMD- and uFMD-based metrics obtained when the release of a 5?min cuff occlusion is employed to induce endothelial stimulus via reactive hyperemia. cFMD is approximately proportional to the square of uFMD, representing a typical increase in sensitivity to vasodilation of 300-600%. This study illustrates the potential for an individual to conveniently measure his/her EFMA by using a low-cost reprogrammed home sphygmomanometer. PMID:26393958

  2. Department of Surgery Colorectal Surgery Section

    E-print Network

    Department of Surgery Colorectal Surgery Section 200 Hawkins Drive, 4621 JCP Iowa City, IA 52242.uihealthcare.org Colorectal Surgery and General Gastrointestinal Surgery Education Topics Neoplastic Disease 1. Controversies. Management of the patient with Stage IV colorectal cancer: Role of surgery 5. Options in patients

  3. Carotid artery surgery

    MedlinePLUS

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  4. Wound surgery.

    PubMed

    Caldwell, Michael D

    2010-12-01

    The purpose of this article is to review the concepts behind, and practice of, wound surgery. The techniques of wound surgery, born of necessity in the art of military surgeons, have found their renaissance in the modern age of wound care driven by the economic and functional considerations inherent to the outcome-based management of chronic disease. Over 300 years of literature on wound healing has shown an innate ability of the wound (in the absence of infection and repeated trauma) to control its progress, largely through the local inflammatory cells. This article discusses several historical works on wound surgery and healing, topical wound therapy, minimal intervention, and emphasizes the closure of chronic wounds. PMID:21074031

  5. [Foreskin surgery].

    PubMed

    Kolehmainen, Maija; Taskinen, Seppo; Ossi, Lindell

    2010-01-01

    Balanitis, phimosis and foreskin adhesions are common indications for foreskin surgery during childhood. In phimosis, the foreskin cannot be drawn behind the glans penis because of the narrow external opening of the former. It is important to be able to distinguish between physiologic and pathologic phimosis, since their treatment is different. In adulthood, the need for surgery can be caused by phimosis, a difficult sequel of paraphimosis, recurrent inflammations of the glans penis and foreskin, diseases and cancers of the skin as well as difficulties at intercourse due to the shortness of the frenulum of the prepuce of the penis. PMID:20405611

  6. Atrial Fibrillation Surgery - Maze Procedure

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Atrial Fibrillation Surgery - Maze Procedure ...

  7. Rodding Surgery

    MedlinePLUS

    Rodding Surgery 804 W. Diamond Ave., Ste. 210 Gaithersburg, MD 20878 (800) 981-2663 (301) 947-0083 Fax: (301) 947-0456 Internet: www.oif.org ... osteogenesis imperfecta contact: Osteogenesis Imperfecta Foundation 804 W. Diamond Avenue, Suite 210, Gaithersburg, MD 20878 Tel: 800- ...

  8. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    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

  9. Cosmetic surgery.

    PubMed Central

    Harris, D. L.

    1989-01-01

    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

  10. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    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.…

  11. Gallbladder Cancer: Surgery

    MedlinePLUS

    ... treated? Next Topic Radiation therapy for gallbladder cancer Surgery for gallbladder cancer There are 2 general types ... gallbladder: Potentially curative surgery Palliative surgery Potentially curative surgery is done when imaging tests or the results ...

  12. Tennis elbow surgery - discharge

    MedlinePLUS

    Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Gosens T. Lateral and medical epicondylitis. In: Stanley D, Trail IA, eds. Operative Elbow Surgery . Philadelphia, PA: Elsevier; 2012:chap 35. ...

  13. Lung Carcinoid Tumor: Surgery

    MedlinePLUS

    ... for lung carcinoid tumor symptoms Surgery to treat lung carcinoid tumors Surgery is the main treatment for ... often be cured by surgery alone. Types of lung surgery Different operations can be used to treat ( ...

  14. Facial Cosmetic Surgery

    MedlinePLUS

    ... find out more. asc"} Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  15. Dental Implant Surgery

    MedlinePLUS

    ... find out more. asc"} Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  16. Corrective Jaw Surgery

    MedlinePLUS Videos and Cool Tools

    ... find out more. asc"} Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  17. Repeated Tracheostomy Tube Cuff Rupture Due to Tracheobronchopathia Osteochondroplastica: A Case Report

    PubMed Central

    Nikandish, Reza; Fallahi, Mahammad Javad; Ziaian, Beezhan; Iranpour, Pooya

    2015-01-01

    Introduction: Tracheobronchopathia osteochondroplastica (TPO) is a rare benign disorder of the lower part of the trachea and the upper part of the main bronchi. Case Report: A case of tracheobronchopathia osteochondroplastica (TPO) diagnosed at the time of intubation in an intensive care unit due to difficulty when advancing the endotracheal tube beyond the vocal cords, is reported. A problem was encountered which had not been reported previously in TPO: repeated cuff rupture at the time of surgical tracheostomy occurred possibly because of bony and cartilaginous tissue located in the tracheal wall. Conclusion: In addition to difficulty of intubation, TPO may cause tracheostomy tube cuff rupture, which could be explained due to bonny calcification in the tracheal wall. PMID:26568943

  18. Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures

    PubMed Central

    Sudhoff, Tobias H.; Seidl, Rainer O.; Estel, Barbara

    2015-01-01

    Objectives Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. Methods Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. Results In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. Conclusion This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used. PMID:26622963

  19. Selectivity for specific cardiovascular effects of vagal nerve stimulation with a multi-contact electrode cuff.

    PubMed

    Ordelman, Simone C M A; Kornet, Lilian; Cornelussen, Richard; Buschman, Hendrik P J; Veltink, Peter H

    2013-01-01

    The cardiovascular system can be influenced by electrically stimulating the vagal nerve. Selectivity for specific cardiac fibers may be limited when stimulating at the cervical level. Our objective was to increase effectiveness and selectivity for cardiovascular effects of vagal nerve stimulation by using local bipolar stimulation in one nerve cross section using a multi-contact cuff instead of less localized stimulation using a tripolar ring electrode. Both types of cuff electrodes were compared with respect to their relative effects on R-R interval (RRI), P-Q interval (PQI), left ventricular contractility (LVC), and left ventricular pressure (P(LV)) in seven pigs. Stimulation using the optimal bipolar configuration on the multi-contact cuff significantly affected RRI, PQI, LVC, and P(LV), whereas stimulation with the ring electrode only significantly affected RRI and PQI. The cardiovascular parameters that could be significantly influenced varied between the bipolar configurations. These novel findings may be relevant for optimizing electrode configurations for clinical cardiac applications of vagal nerve stimulation. PMID:22987542

  20. Department of Surgery Acute Care Surgery Service

    E-print Network

    Department of Surgery Acute Care Surgery Service 200 Hawkins Drive Iowa City, Iowa 52242-1086 319-356-2902 Clinic Scheduling 319-356-7892 Administrative Support 319-356-3392 Fax www.uihealthcare.org/surgery Acute Care Surgery Education Topics Burns: 1. Acute Burn Resuscitation 2. Necrotizing Acute Soft Tissue

  1. Department of Surgery Colorectal Surgery Section

    E-print Network

    Department of Surgery Colorectal Surgery Section 200 Hawkins Drive, 4621 JCP Iowa City, IA 52242.uihealthcare.org Minimally Invasive Surgery Education Topics Foregut 1. Controversies in Rx of achalasia: Botox versus time to consider surgery? 3. GERD and Nissen fundoplication. Are we under diagnosing this disorder? 4

  2. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    MedlinePLUS

    ... Most people rotate through and they do fine. Robotic surgery requires a little bit of expertise and ... physician assistant is [Aaron Murstoka]. Head nurse of robotics is [Sara Harrick]. And the rest of these ...

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

    NASA Technical Reports Server (NTRS)

    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

    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'.

  4. DEHN SURGERY SIDDHARTHA GADGIL

    E-print Network

    Gadgil, Siddhartha

    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

  5. Laser surgery - skin

    MedlinePLUS

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  6. Coronary Artery Bypass Surgery

    MedlinePLUS

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  7. Joint Replacement Surgery

    MedlinePLUS

    ... a Clinical Trial Journal Articles Arthritis July 2014 Joint Replacement Surgery: Health Information Basics for You and Your Family What Is Joint Replacement Surgery? Joint replacement surgery is removing a ...

  8. Types of Heart Surgery

    MedlinePLUS

    ... heart surgery that is becoming more common is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms. The tools are inserted through small incisions ...

  9. Human Cadaver Material in Preclinical Oral Surgery.

    ERIC Educational Resources Information Center

    Barber, H. Dexter; And Others

    1993-01-01

    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)

  10. Robotic Surgery

    NASA Technical Reports Server (NTRS)

    2000-01-01

    The Automated Endoscopic System for Optimal Positioning, or AESOP, was developed by Computer Motion, Inc. under a SBIR contract from the Jet Propulsion Lab. AESOP is a robotic endoscopic positioning system used to control the motion of a camera during endoscopic surgery. The camera, which is mounted at the end of a robotic arm, previously had to be held in place by the surgical staff. With AESOP the robotic arm can make more precise and consistent movements. AESOP is also voice controlled by the surgeon. It is hoped that this technology can be used in space repair missions which require precision beyond human dexterity. A new generation of the same technology entitled the ZEUS Robotic Surgical System can make endoscopic procedures even more successful. ZEUS allows the surgeon control various instruments in its robotic arms, allowing for the precision the procedure requires.

  11. Cosmetic Plastic Surgery Statistics

    MedlinePLUS

    2014 Cosmetic Plastic Surgery Statistics Cosmetic Procedure Trends 2014 Plastic Surgery Statistics Report Please credit the AMERICAN SOCIETY OF PLASTIC SURGEONS when citing statistical data or using ...

  12. Endotracheal Tube Cuff Pressure Assessment: Education May Improve but not Guarantee the Safety of Palpation Technique

    PubMed Central

    Seyed Siamdoust, Seyed Alireza; Mohseni, Masood; Memarian, Arash

    2015-01-01

    Background: Endotracheal Tube Cuff Pressure (ETCP) should be kept in the range of 20 - 30 cm H2O. Earlier studies suggested that ETCP assessment by palpation of pilot balloon results in overinflation or underinflation and subsequent complications such as tracheal wall damage and aspiration. Objectives: The current study aimed to evaluate the effect of an in vitro educational program on the ability of anesthesia personnel to inflate Endotracheal Tube Cuffs (ETT) within safe pressure limits. Patients and Methods: The survey included two series of blinded ETCP measurements in intubated patients before and two weeks after an in vitro educational intervention. The in vitro educational program included two separate trials. The anesthesia personnel were asked to inflate an ETT cuff inserted in a tracheal model using their usual inflation technique. In the same session, six ETTs at different pressure levels were examined by the participants and their estimation of ETCP was recorded. After the in vitro assessment, the participants were informed about the actual pressure of the in vitro ETCPs and were allowed to train their fingers by in vitro pilot balloon palpation with validated manometer measurements. Results: The mean ETCP after the in vitro survey was significantly lower than the mean ETCP before the intervention (45 ± 13 vs. 51 ± 15 cm H2O, P = 0.002). The rate of measurements within the safe pressure limits significantly improved after the in vitro education (24.2% vs. 39.7%, P = 0.002). Conclusions: Implementing educational programs with the introduction of estimation techniques besides the use of manometer as a standard intraoperative monitoring will improve the safety of the practice. PMID:26161313

  13. Drinking citrus fruit juice inhibits vascular remodeling in cuff-induced vascular injury mouse model.

    PubMed

    Ohnishi, Arika; Asayama, Rie; Mogi, Masaki; Nakaoka, Hirotomo; Kan-No, Harumi; Tsukuda, Kana; Chisaka, Toshiyuki; Wang, Xiao-Li; Bai, Hui-Yu; Shan, Bao-Shuai; Kukida, Masayoshi; Iwanami, Jun; Horiuchi, Masatsugu

    2015-01-01

    Citrus fruits are thought to have inhibitory effects on oxidative stress, thereby attenuating the onset and progression of cancer and cardiovascular disease; however, there are few reports assessing their effect on vascular remodeling. Here, we investigated the effect of drinking the juice of two different citrus fruits on vascular neointima formation using a cuff-induced vascular injury mouse model. Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% Citrus unshiu (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% Citrus iyo (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Neointima formation was significantly attenuated in CU40, CI10 and CI40 compared with C; however, no remarkable preventive effect was observed in CU10. The increases in levels of various inflammatory markers including cytokines such as monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-1?, and tumor necrosis factor-? in response to vascular injury did not differ significantly between C, CU10 and CI10. The increases in cell proliferation and superoxide anion production were markedly attenuated in CI10, but not in CU10 compared with C. The increase in phosphorylated ERK expression was markedly attenuated both in CU10 and CI10 without significant difference between CU10 and CI10. Accumulation of immune cells did not differ between CU10 and CI10. These results indicate that drinking citrus fruit juice attenuates vascular remodeling partly via a reduction of oxidative stress. Interestingly, the preventive efficacy on neointima formation was stronger in CI than in CU at least in part due to more prominent inhibitory effects on oxidative stress by CI. PMID:25692290

  14. Drinking Citrus Fruit Juice Inhibits Vascular Remodeling in Cuff-Induced Vascular Injury Mouse Model

    PubMed Central

    Ohnishi, Arika; Asayama, Rie; Mogi, Masaki; Nakaoka, Hirotomo; Kan-no, Harumi; Tsukuda, Kana; Chisaka, Toshiyuki; Wang, Xiao-Li; Bai, Hui-Yu; Shan, Bao-Shuai; Kukida, Masayoshi; Iwanami, Jun; Horiuchi, Masatsugu

    2015-01-01

    Citrus fruits are thought to have inhibitory effects on oxidative stress, thereby attenuating the onset and progression of cancer and cardiovascular disease; however, there are few reports assessing their effect on vascular remodeling. Here, we investigated the effect of drinking the juice of two different citrus fruits on vascular neointima formation using a cuff-induced vascular injury mouse model. Male C57BL6 mice were divided into five groups as follows: 1) Control (water) (C), 2) 10% Citrus unshiu (CU) juice (CU10), 3) 40% CU juice (CU40), 4) 10% Citrus iyo (CI) juice (CI10), and 5) 40% CI juice (CI40). After drinking them for 2 weeks from 8 weeks of age, cuff injury was induced by polyethylene cuff placement around the femoral artery. Neointima formation was significantly attenuated in CU40, CI10 and CI40 compared with C; however, no remarkable preventive effect was observed in CU10. The increases in levels of various inflammatory markers including cytokines such as monocyte chemotactic protein-1, interleukin-6 (IL-6), IL-1?, and tumor necrosis factor-? in response to vascular injury did not differ significantly between C, CU10 and CI10. The increases in cell proliferation and superoxide anion production were markedly attenuated in CI10, but not in CU10 compared with C. The increase in phosphorylated ERK expression was markedly attenuated both in CU10 and CI10 without significant difference between CU10 and CI10. Accumulation of immune cells did not differ between CU10 and CI10. These results indicate that drinking citrus fruit juice attenuates vascular remodeling partly via a reduction of oxidative stress. Interestingly, the preventive efficacy on neointima formation was stronger in CI than in CU at least in part due to more prominent inhibitory effects on oxidative stress by CI. PMID:25692290

  15. Soft tissue perineurioma with peripheral lymphoid cuff of the tongue: a case report and literature review

    PubMed Central

    Gu, Hai-Yan; Wei, Zhi-Min; Lin, Dong-Liang; Zhao, Han; Hao, Feng-Yun

    2014-01-01

    Perineurioma are rare tumors, derived from nerve sheath perineurial cells. Soft tissue perineurioma are extraordinarily rare in the tongue, with only one previous report in a child to our knowledge. Herein, we describe the first case of an adult patient who had a soft tissue perineurioma localized to the tongue, with emphasis on the clinic pathologic and immunohistochemical features of this tumor, and review the previously reported soft tissue cases. Besides, we first describe the histologic feature of peripheral lymphoid cuff in perineurioma. PMID:24482726

  16. Cuff inflation to aid nasotracheal intubation using the C-MAC videolaryngoscope.

    PubMed

    Baddoo, H K; Phillips, B J

    2011-06-01

    A preliminary report is presented of a technique for using the C-MAC videolaryngoscope to carry out nasopharyngeal intubations. The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have been difficult to intubate using conventional laryngoscopy. The full technique is described together with pictures at the various stages of intubation. PMID:21857727

  17. Rotating Wavepackets

    ERIC Educational Resources Information Center

    Lekner, John

    2008-01-01

    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…

  18. Thanks to the American College of Surgeons For more information on general surgery residency programs,

    E-print Network

    MacMillan, Andrew

    programs, contact your local Department of Surgery Residency Program or check the Royal College of Physicians and Surgeons website for a list of programs across Canada. http://rcpsc.medical.org/residency/accreditation/arps/gen surgery_e.php Im still not sure if surgery is right for me. I loved my surgical rotations, but I dont

  19. Bariatric Surgery

    PubMed Central

    2005-01-01

    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

  20. Rotator interval.

    PubMed

    Woertler, Klaus

    2015-07-01

    The rotator interval is an anatomically complex region of the shoulder joint that is difficult to evaluate on clinical examination and by imaging. Abnormalities of its components may contribute to instability, shoulder stiffness, and pain and are challenging to diagnose and treat. This article gives an overview of the anatomy, MR anatomy, and normal variants of the rotator interval, together with basic technical aspects of MR imaging of this area. Pathologic conditions of the rotator interval capsule, the long head of biceps tendon, and the pulley system are reviewed and illustrated with several clinical examples. PMID:26021585

  1. Measurements of endotracheal tube cuff contact pressure using fibre Bragg gratings

    NASA Astrophysics Data System (ADS)

    Hernandez, F. U.; Correia, R.; Korposh, S.; Morgan, S. P.; Hayes-Gill, B. R.; James, S. W.; Evans, D.; Norris, A.

    2015-09-01

    An optical fibre Bragg grating (FBG) was used to measure local strain (due to contact pressure) at the interface of a cuffed endotracheal tube (ETT) tested in a tracheal model. The tracheal model consisted of a corrugated tube. Two FBG sensors written in a single optical fibre were attached to the outside wall of the cuff of the ETT. Intracuff endotracheal pressure was measured using a digital manometer, while the contact pressure between the model trachea and the ETT was measured using Flexiforce sensors. Changes in the Bragg wavelengths in response to the inflation of the cuff of the ETT, and concomitant pressure increase, were observed to be dependent on the location of the FBGs at the corrugations, i.e., the annular peaks and troughs of the corrugated tube. The performance of both contact pressure sensors FBG and Flexiforce suggests that FBG technology is better suited to this application as it allows the measurement of contact pressures on non-uniform surfaces such as in the tracheal model.

  2. Selection of muscle and nerve-cuff electrodes for neuroprostheses using customizable musculoskeletal model.

    PubMed

    Blana, Dimitra; Hincapie, Juan G; Chadwick, Edward K; Kirsch, Robert F

    2013-01-01

    Neuroprosthetic systems based on functional electrical stimulation aim to restore motor function to individuals with paralysis following spinal cord injury. Identifying the optimal electrode set for the neuroprosthesis is complicated because it depends on the characteristics of the individual (such as injury level), the force capacities of the muscles, the movements the system aims to restore, and the hardware limitations (number and type of electrodes available). An electrode-selection method has been developed that uses a customized musculoskeletal model. Candidate electrode sets are created based on desired functional outcomes and the hard ware limitations of the proposed system. Inverse-dynamic simulations are performed to determine the proportion of target movements that can be accomplished with each set; the set that allows the most movements to be performed is chosen as the optimal set. The technique is demonstrated here for a system recently developed by our research group to restore whole-arm movement to individuals with high-level tetraplegia. The optimal set included selective nerve-cuff electrodes for the radial and musculocutaneous nerves; single-channel cuffs for the axillary, suprascapular, upper subscapular, and long-thoracic nerves; and muscle-based electrodes for the remaining channels. The importance of functional goals, hardware limitations, muscle and nerve anatomy, and surgical feasibility are highlighted. PMID:23881765

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

    NASA Astrophysics Data System (ADS)

    Kent, Alexander R.; Grill, Warren M.

    2013-06-01

    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 ten 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.

  4. Continuous and Noninvasive Recording of Cardiovascular Parameters with the Finapres Finger Cuff Enhances Undergraduate Student Understanding of Physiology

    ERIC Educational Resources Information Center

    Hodgson, Yvonne; Choate, Julia

    2012-01-01

    The Finapres finger cuff recording system provides continuous calculations of beat-to-beat variations in cardiac output (CO), total peripheral resistance, heart rate (HR), and blood pressure (BP). This system is unique in that it allows experimental subjects to immediately, continuously, and noninvasively visualize changes in CO at rest and during…

  5. Chronic stability and selectivity of four-contact spiral nerve-cuff electrodes in stimulating the human femoral nerve

    NASA Astrophysics Data System (ADS)

    Fisher, L. E.; Tyler, D. J.; Anderson, J. S.; Triolo, R. J.

    2009-08-01

    This study describes the stability and selectivity of four-contact spiral nerve-cuff electrodes implanted bilaterally on distal branches of the femoral nerves of a human volunteer with spinal cord injury as part of a neuroprosthesis for standing and transfers. Stimulation charge threshold, the minimum charge required to elicit a visible muscle contraction, was consistent and low (mean threshold charge at 63 weeks post-implantation: 23.3 ± 8.5 nC) for all nerve-cuff electrode contacts over 63 weeks after implantation, indicating a stable interface with the peripheral nervous system. The ability of individual nerve-cuff electrode contacts to selectively stimulate separate components of the femoral nerve to activate individual heads of the quadriceps was assessed with fine-wire intramuscular electromyography while measuring isometric twitch knee extension moment. Six of eight electrode contacts could selectively activate one head of the quadriceps while selectively excluding others to produce maximum twitch responses of between 3.8 and 8.1 N m. The relationship between isometric twitch and tetanic knee extension moment was quantified, and selective twitch muscle responses scaled to between 15 and 35 N m in tetanic response to pulse trains with similar stimulation parameters. These results suggest that this nerve-cuff electrode can be an effective and chronically stable tool for selectively stimulating distal nerve branches in the lower extremities for neuroprosthetic applications.

  6. Comparative analysis of transverse intrafascicular multichannel, longitudinal intrafascicular and multipolar cuff electrodes for the selective stimulation of nerve fascicles

    NASA Astrophysics Data System (ADS)

    Badia, Jordi; Boretius, Tim; Andreu, David; Azevedo-Coste, Christine; Stieglitz, Thomas; Navarro, Xavier

    2011-06-01

    The selection of a suitable nerve electrode for neuroprosthetic applications implies a trade-off between invasiveness and selectivity, wherein the ultimate goal is achieving the highest selectivity for a high number of nerve fascicles by the least invasiveness and potential damage to the nerve. The transverse intrafascicular multichannel electrode (TIME) is intended to be transversally inserted into the peripheral nerve and to be useful to selectively activate subsets of axons in different fascicles within the same nerve. We present a comparative study of TIME, LIFE and multipolar cuff electrodes for the selective stimulation of small nerves. The electrodes were implanted on the rat sciatic nerve, and the activation of gastrocnemius, plantar and tibialis anterior muscles was recorded by EMG signals. Thus, the study allowed us to ascertain the selectivity of stimulation at the interfascicular and also at the intrafascicular level. The results of this study indicate that (1) intrafascicular electrodes (LIFE and TIME) provide excitation circumscribed to the implanted fascicle, whereas extraneural electrodes (cuffs) predominantly excite nerve fascicles located superficially; (2) the minimum threshold for muscle activation with TIME and LIFE was significantly lower than with cuff electrodes; (3) TIME allowed us to selectively activate the three tested muscles when stimulating through different active sites of one device, both at inter- and intrafascicular levels, whereas selective activation using multipolar cuff (with a longitudinal tripolar stimulation configuration) was only possible for two muscles, at the interfascicular level, and LIFE did not activate selectively more than one muscle in the implanted nerve fascicle.

  7. Solar rotation.

    NASA Astrophysics Data System (ADS)

    Dziembowski, W.

    Sunspot observations made by Johannes Hevelius in 1642 - 1644 are the first ones providing significant information about the solar differential rotation. In modern astronomy the determination of the rotation rate is done in a routine way by measuring positions of various structures on the solar surface as well as by studying the Doppler shifts of spectral lines. In recent years a progress in helioseismology enabled determination of the rotation rate in the layers inaccessible for direct observations. There are still uncertainties concerning, especially, the temporal variations of the rotation rate and its behaviour in the radiative interior. We are far from understanding the observations. Theoretical works have not yet resulted in a satisfactory model for the angular momentum transport in the convective zone.

  8. Rotational Energy.

    ERIC Educational Resources Information Center

    Lockett, Keith

    1988-01-01

    Demonstrates several objects rolling down a slope to explain the energy transition among potential energy, translational kinetic energy, and rotational kinetic energy. Contains a problem from Galileo's rolling ball experiment. (YP)

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

    PubMed

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

    2000-03-01

    The objectives of this investigation were to study the effects of thigh cuffs (bracelets) on cardiovascular adaptation and deconditioning in 0 g. The cardiovascular parameters of six cosmonauts were measured by echocardiography, Doppler, and plethysmography, during three 6-month MIR spaceflights. Measurements were made at rest during preflight (-30 days), inflight (1, 3-4, and 5-5.5 months) without cuffs (morning) and after 5 h with cuffs, and during postflight (+3 and +7 days). Lower-body negative pressure (LBNP) measurements were performed 1 day after each resting session. Inflight values of left ventricle end-diastolic volume and stroke volume measured without the thigh cuffs (-8 to -24% and -10 to -16%, respectively, both P < 0.05) were lower than corresponding preflight values. The jugular and femoral vein cross-sectional areas (Ajv and Afv, respectively) were enlarged (Ajv: by 23-30%, P < 0.001; Afv: by 33-70% P < 0.01). The renal and femoral vascular resistances (Rra and Rfa, respectively) decreased (Rra: by -15 to -16%, P < 0.01; Rfa: by -5 to -11%, P < 0.01). Inflight, the thigh cuffs reduced the Ajv (by -12 to -20%, P < 0.02), but enlarged the Afv (Afv: by 9-20%, P < 0.02) and increased the vascular resistance (Rra: by 8-13%, P < 0.05; Rfa: by 10-16%, P < 0.01) compared to corresponding inflight, without-cuffs values. During LBNP (-45 mmHg, where 1 mmHg = 133.3 N/ m2), Rfa and the ratio between cerebral and femoral blood flow (Qca/Qfa) increased less inflight and postflight (+25% for Rfa and +30% for Qca/Qfa) than during preflight (60% for Rfa and 75% for Qca/Qfa, P < 0.01). This reduced vasoconstrictive response and less efficient flow redistribution toward the brain was associated with orthostatic intolerance during postflight stand tests in all of the cosmonauts. The calf circumference increased less inflight and postflight (6% P < 0.05) than preflight (9% P < 0.05). The vascular response to LBNP remained similarly altered throughout the flight. The thigh cuffs compensated partially for the cardiovascular changes induced by exposure to 0 g, but did not interfere with 0 g deconditioning. PMID:10751099

  10. Electromyography of 3 Scapular Muscles: A Comparative Analysis of The Cuff Link Device and a Standard Push-Up

    PubMed Central

    Tucker, W Steven; Campbell, Brian M; Swartz, Erik E; Armstrong, Charles W

    2008-01-01

    Context: The Cuff Link is a closed kinetic chain rehabilitation apparatus for the upper extremity. Limited research has established its effectiveness to elicit muscle activation of the scapular muscles. Objective: To determine if scapular muscle activation differs in response to 2 upper extremity closed kinetic chain exercises: Cuff Link and standard push-up. Design: A single-group, repeated-measures design. Setting: Controlled laboratory. Patients or Other Participants: Twenty-eight healthy individuals (13 women: age ?=? 19.69 ± 1.55 years, height ?=? 167.44 ± 9.52 cm, mass ?=? 61.00 ± 8.79 kg; 15 men: age ?=? 22.00 ± 3.91 years, height ?=? 181.44 ± 6.60 cm, mass ?=? 82.36 ± 13.23 kg) with no history of shoulder or low back injury volunteered to participate in this study. Intervention(s): Participants performed 10 trials of complete revolutions on the Cuff Link and 10 full–weight-bearing push-ups. We controlled trial velocity and randomized order. Trunk and shoulder positions were normalized to the participant's height. Using surface electromyography, we recorded muscle activity of the serratus anterior, middle trapezius, and lower trapezius. Rectified and smoothed electromyography data for the serratus anterior, middle trapezius, and lower trapezius were normalized as a percentage of the maximal voluntary isometric contractions (%MVIC). Main Outcome Measure(s): Mean muscle activity of the serratus anterior, middle trapezius, and lower trapezius. We used paired-samples t tests to analyze the mean data for each condition. The ? level was adjusted to .016 to avoid a type I error. Results: Middle trapezius %MVIC was greater during push-ups (27.01 ± 20.40%) than during use of the Cuff Link (11.49 ± 9.46%) (P ?=? .001). Lower trapezius %MVIC was greater during push-ups (36.07 ± 18.99%) than during use of the Cuff Link (16.29 ± 8.64%) (P ?=? .001). There was no difference in %MVIC for the serratus anterior between conditions. Conclusions: The push-up demonstrated greater middle trapezius and lower trapezius activation levels compared with the Cuff Link. However, the push-up had a high participant failure rate. Because serratus anterior activation levels were similar, the Cuff Link may be an appropriate alternative for individuals lacking the upper body strength to perform a push-up. PMID:18833308

  11. Arteries Stiffen With Age, but Can Retain an Ability to Become More Elastic With Applied External Cuff Pressure

    PubMed Central

    Liu, Chengyu; Zheng, Dingchang; Murray, Alan

    2015-01-01

    Abstract It is accepted that arterial compliance decreases with age, with changes in the arterial pulse shape measured at the periphery. The aim of this study was to determine the relationship between arterial transmural pressure changes and changes in peripheral finger pulse shape characteristics for both older and younger subjects. Finger photoplethysmographic pulses were recorded noninvasively from the right index fingers of 100 healthy normotensive subjects. Their median age was 43 years (range 20–71 years) allowing two distinct age groups to be compared (older group ?45 and younger group?cuff inflated to 10, 20, 30, and 40?mmHg. Pulse maximum amplitude and rise time were calculated for each age group, and for each cuff pressure level. Gradual and significant decreases in both pulse maximum amplitude and rise time were found with increasing cuff pressure for both age groups. With an external cuff pressure of 40?mmHg, there was an average maximum amplitude and rise time decrease of 27.1% (P?cuff pressure. PMID:26469929

  12. Advanced Nail Surgery

    PubMed Central

    Haneke, Eckart

    2011-01-01

    Six techniques not yet widely known or used in the dermatologic surgery of the nails are briefly described. Small-to-medium-sized tumours of the proximal nail fold (PNF) can be excised and the defect repaired with advancement or rotation flaps. A superficial biopsy technique of the matrix for the diagnosis of longitudinal brown streaks in the nail, which allows rapid histological diagnosis of the melanocyte focus to be performed, is described here. Because the excision is very shallow and leaves the morphogenetic connective tissue of the matrix intact, the defect heals without scarring. Laterally positioned nail tumours can be excised in the manner of a wide lateral longitudinal nail biopsy. The defect repair is performed with a bipedicled flap from the lateral aspect of the distal phalanx. Malignant tumours of the nail organ often require its complete ablation. These defects can be covered by a full-thickness skin graft, reversed dermal graft, or cross-finger flap. The surgical correction of a split nail is often difficult. The cicatricial tissue of the matrix and PNF have to be excised and the re-attachment of these wounds prevented. The matrix defect has to be excised and sutured or covered with a free matrix graft taken either from the neighbouring area or from the big toe nail. PMID:22279381

  13. Earth Rotation

    NASA Technical Reports Server (NTRS)

    Dickey, Jean O.

    1995-01-01

    The study of the Earth's rotation in space (encompassing Universal Time (UT1), length of day, polar motion, and the phenomena of precession and nutation) addresses the complex nature of Earth orientation changes, the mechanisms of excitation of these changes and their geophysical implications in a broad variety of areas. In the absence of internal sources of energy or interactions with astronomical objects, the Earth would move as a rigid body with its various parts (the crust, mantle, inner and outer cores, atmosphere and oceans) rotating together at a constant fixed rate. In reality, the world is considerably more complicated, as is schematically illustrated. The rotation rate of the Earth's crust is not constant, but exhibits complicated fluctuations in speed amounting to several parts in 10(exp 8) [corresponding to a variation of several milliseconds (ms) in the Length Of the Day (LOD) and about one part in 10(exp 6) in the orientation of the rotation axis relative to the solid Earth's axis of figure (polar motion). These changes occur over a broad spectrum of time scales, ranging from hours to centuries and longer, reflecting the fact that they are produced by a wide variety of geophysical and astronomical processes. Geodetic observations of Earth rotation changes thus provide insights into the geophysical processes illustrated, which are often difficult to obtain by other means. In addition, these measurements are required for engineering purposes. Theoretical studies of Earth rotation variations are based on the application of Euler's dynamical equations to the problem of finding the response of slightly deformable solid Earth to variety of surface and internal stresses.

  14. Imaging in gynecologic surgery.

    PubMed

    Mettler, Liselotte; Sammur, Wael; Alkatout, Ibrahim; Schollmeyer, Thoralf

    2011-03-01

    The technical development of instruments for endoscopic surgery started in the field of gynecology. In the early 1970s, with the improvement of optics and instruments for laparoscopic surgery, gyne-endoscopic surgery developed and set milestones for all other surgical fields. However, the general surgeons propagated the advantages of 2D or 3D imaging surgery much better than the conservative gynecologists. Surgery on a 2D screen without direct vision is regarded as more advantageous than open surgery and has achieved wide acceptance. Several schools of gynecologic endoscopy in Europe (in Kiel, Giessen, Clermont Ferrand and Strasbourg) have set guidelines for gyne-endoscopic surgery. Our catalog of indications in the areas of gyne-endoscopic surgery, published in 2002, reveals the broad application of these techniques today. 3D vision, robotic instruments and systems, such as the da Vinci(®) Surgical System from Intuitive Surgical, Inc. (CA, USA), round up the picture of endoscopic surgery. The advantages of endoscopic surgery over open surgery (more precision, less trauma, less postoperative pain, shorter hospital stays and a faster recovery period) are becoming more accepted. The present healthcare systems and hospital administrations understand the challenges of imaging in surgery, particularly in endoscopic surgery. PMID:21410349

  15. Model-based ankle joint angle tracing by cuff electrode recordings of peroneal and tibial nerves.

    PubMed

    Lin, Chou-Ching K; Ju, Ming-Shaung; Cheng, Hang-Shing

    2007-04-01

    The main goal of the present study was to estimate the ankle joint angle from the peroneal and tibial electroneurography (ENG) recordings. Two single-channel cuff electrodes for recording ENG were placed on the proximal part of rabbit peroneal and tibial nerves respectively and static positioning and ramp-and-hold stretches were performed to characterize the static and dynamic ENG responses. An ENG model, consisting of static and dynamic parts, was constructed to relate ENG to ankle angle trajectory and an inverse ENG model was derived to predict ankle angle. The results showed that the new model could accurately estimate large-range ankle angles during and after ramp-and-hold movements. Our study provides a basis for implementing joint angle tracing without using artificial angle sensors. PMID:17273879

  16. Weight Loss Surgery

    MedlinePLUS

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

  17. Cataract surgery - series (image)

    MedlinePLUS

    Cataract surgery usually works very well. The operation has few risks, the pain and recovery period are short, ... improved. Ninety-five percent or more of all cataract surgeries result in improved vision.

  18. Gastric bypass surgery

    MedlinePLUS

    ... your belly. The surgery is called laparoscopy . The scope allows the surgeon to see inside your belly. ... to 6 small cuts in your belly. The scope and instruments needed to perform the surgery are ...

  19. Ear Plastic Surgery

    MedlinePLUS

    ... Meeting Calendar Find an ENT Doctor Near You Ear Plastic Surgery Ear Plastic Surgery Patient Health Information ... they may improve appearance and self-confidence. Can Ear Deformities Be Corrected? Formation of the ear during ...

  20. Complications of Sinus Surgery

    MedlinePLUS

    ... further intracranial surgeries. Impaired sense of taste or smell : The sense of smell usually improves after the procedure because airflow is ... in their voice after sinus surgery. Impairment of smell or taste: (see above) Infection: The most common ...

  1. Blood donation before surgery

    MedlinePLUS

    ... you, if you need blood transfusion after surgery. Blood from these donors must be collected at least a few days ... blood bank before your surgery to have directed donor blood. It is important to note that there is ...

  2. Gum Graft Surgery

    MedlinePLUS

    ... Augmentation Ridge Modification Periodontal Pocket Reduction Procedures Periodontal Plastic Surgery Procedures Love the Gums You're With Member ... Augmentation Ridge Modification Periodontal Pocket Reduction Procedures Periodontal Plastic Surgery Procedures Love the Gums You're With Find ...

  3. Cosmetic breast surgery - discharge

    MedlinePLUS

    ... Higdon KK. Reduction mammoplasty. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 8. ... Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 2.

  4. Electrochemical and Electrophysiological Performance of Platinum Electrodes Within the Ninety-Nine-Electrode Stimulating Nerve Cuff.

    PubMed

    Pe?lin, Polona; Mehle, Andraž; Karpe, Blaž; Rozman, Janez

    2015-10-01

    The trend in neural prostheses using selective nerve stimulation for electrical stimulation therapies is headed toward single-part systems having a large number of working electrodes (WEs), each of which selectively stimulate neural tissue or record neural response (NR). The present article reviews the electrochemical and electrophysiological performance of platinum WE within a ninety-nine-electrode spiral cuff for selective nerve stimulation and recording of peripheral nerves, with a focus on the vagus nerve (VN). The electrochemical properties of the WE were studied in vitro using the electrochemical impedance spectroscopy (EIS) technique. The equivalent circuit model (ECM) of the interface between the WE and neural tissue was extracted from the EIS data and simulated in the time domain using a preset current stimulus. Electrophysiological performance of in-space and fiber-type highly selective vagus nerve stimulation (VNS) was tested using an isolated segment of a porcine VN and carotid artery as a reference. A quasitrapezoidal current-controlled pulse (stimulus) was applied to the VN or arterial segment using an appointed group of three electrodes (triplet). The triplet and stimulus were configured to predominantly stimulate B-fibers and minimize the stimulation of A-fibers. The EIS results revealed capacitive charge transfer predominance, which is a highly desirable property. Electrophysiological performance testing indicated the potential existence of certain parameters and waveforms of the stimulus for which the contribution of the A-fibers to the NR decreased slightly and that of the B-fibers increased slightly. Findings show that the design of the stimulating electrodes, based on the EIS and ECM results, could act as a useful tool for nerve cuff development. PMID:26471140

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

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

    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.

  6. Robotic liver surgery

    PubMed Central

    Leung, Universe

    2014-01-01

    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

  7. Brain surgery - discharge

    MedlinePLUS

    Craniotomy - discharge; Surgery - brain - discharge; Neurosurgery - discharge; Craniectomy - discharge; Stereotactic craniotomy - discharge; Stereotactic brain biopsy - discharge; Endoscopic craniotomy - discharge

  8. [Ambulatory emergency surgery].

    PubMed

    Triboulet, Jean-Pierre

    2014-03-01

    Development of outpatient cases in emergency is still a controversy. Ambulatory surgery is possible in ambulatory surgical unit (ASU), or in emergency surgical units (ESU). Quality of care and safety need to be associated to patients' ambulatory management without impairment of ASU and ESU organization. Patient eligibility concerns not only traumatic hand surgery but also general or visceral surgery. PMID:24530140

  9. Pediatric Surgery Gallengangatresie

    E-print Network

    Manstein, Dietmar J.

    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

  10. Pediatric heart surgery

    MedlinePLUS

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  11. Successful incorporation of robotic surgery into gynecologic oncology fellowship training

    PubMed Central

    Soliman, Pamela T.; Iglesias, David; Munsell, Mark F.; Frumovitz, Michael; Westin, Shannon N.; Nick, Alpa M.; Schmeler, Kathleen M.; Ramirez, Pedro T.

    2013-01-01

    Background The increasing role of robotic surgery in gynecologic oncology may impact fellowship training. The purpose of this study was to review the proportion of robotic procedures performed by fellows at the console, and compare operative times and lymph node yields to faculty surgeons. Methods A prospective database of women undergoing robotic gynecologic surgery has been maintained since 2008. Intra-operative datasheets completed include surgical times and primary surgeon at the console. Operative times were compared between faculty and fellows for simple hysterectomy (SH), bilateral salpingo-oophorectomy (BSO), pelvic (PLND) and paraaortic lymph node dissection (PALND) and vaginal cuff closure (VCC). Lymph nodes counts were also compared. Results Times were recorded for 239 SH, 43 BSOs, 105 right PLNDs, 104 left PLNDs, 34 PALND and 269 VCC. Comparing 2008 to 2011, procedures performed by the fellow significantly increased; SH 16% to 83% (p<0.001), BSO 7% to 75% (p=0.005), right PLND 4% to 44% (p<0.001), left PLND 0% to 56% (p<0.001), and VCC 59% to 82% (p=0.024). Console times (min) were similar for SH (60vs. 63, p= 0.73), BSO (48 vs. 43, p=0.55), and VCC (20 vs. 22, p=0.26). Faculty times (min) were shorter for PLND (right 26 vs. 30, p=0.04, left 23 vs. 27, p=0.02). Nodal counts were not significantly different (right 7 vs. 8, p=0.17 or left 7 vs. 7, p=0.87). Conclusions Robotic surgery can be successfully incorporated into gynecologic oncology fellowship training. With increased exposure to robotic surgery, fellows had similar operative times and lymph node yields as faculty surgeons. PMID:24055616

  12. [Intraoperative monitoring of pressure within saline-filled, endotracheal tube cuff in adult patients undergoing CO2 laser laryngomicrosurgery].

    PubMed

    Matsuo, Kazumasa; Akata, Takasi; Yamaura, Ken; Morikawa, Keiko; Kandabashi, Tadashi; Ueda, Naoyuki; Tohyama, Kohei; Takahashi, Shosuke

    2002-05-01

    In laser laryngomicrosurgery, saline is injected into the endotracheal tube cuff to prevent airway fire. Utilizing regression analyses, we investigated the relation between the saline volume required to obtain optimal intracuff pressure and tracheal diameters in patients undergoing laser laryngomicrosurgery as well as in model tracheas. Although excellent linear correlations were found between the saline volume and the diameter of model tracheas, no significant linear or non-linear correlation was found between the saline volume and the patient's tracheal diameter. In the model tracheas, a rate of rise in the intracuff pressure caused by increments in the injected volume was far steeper when saline was injected into the cuff than when air was injected into the cuff. Addition of only 0.2 ml saline could result in large (> 50 mmHg) increases in the intracuff pressure. Also in patients, addition of 1 ml could result in notable (> 50 mmHg) increases in the intracuff pressure. These results suggest that the saline volume necessary to obtain optimal intracuff pressure is difficult to be predicted from the patient's tracheal diameter, and that slight increases in the saline volume may cause excessive increases in the intracuff pressure. The intracuff pressure should be tightly monitored in patients undergoing laser laryngomicrosurgery. PMID:12058429

  13. SURGERY CLERKSHIP EVALUATIONS DRIVE IMPROVED PROFESSIONALISM

    PubMed Central

    Biagioli, Frances E.; Rdesinski, Rebecca E.; Elliot, Diane L.; Chappelle, Kathryn G.; Kwong, Karen L.; Toffler, William L.

    2012-01-01

    PURPOSE To determine whether a brief student survey can differentiate amongst third-year clerkship student’s professionalism experiences and whether sharing specific feedback with surgery faculty and residents can lead to improvements. METHODS Medical students completed a survey on professionalism at the conclusion of each third-year clerkship specialty rotation during academic years 2007-2010. RESULTS 2007-2008 comparisons of survey items revealed significantly lower ratings for the surgery clerkship on both Excellence (F = 10.75, p < 0.001) and Altruism/Respect (F = 15.59, p < 0.001) subscales. This data was shared with clerkship directors, prompting the surgery department to discuss student perceptions of professionalism with faculty and residents. Post-meeting ratings of surgery professionalism significantly improved on both Excellence and Altruism/Respect dimensions (p < 0.005 for each). CONCLUSIONS A brief survey can be used to measure student perceptions of professionalism and an intervention as simple as a surgery department openly sharing results and communicating expectations appears to drive positive change in student experiences. COMPETENCIES Professionalism, Interpersonal and Communication Skills PMID:23337685

  14. Hyperoxaluria and Bariatric Surgery

    NASA Astrophysics Data System (ADS)

    Asplin, John R.

    2007-04-01

    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.

  15. Pediatric heart surgery - discharge

    MedlinePLUS

    Congenital heart surgery - discharge; Patent ductus arteriosus ligation - discharge; Hypoplastic left heart repair - discharge; Tetralogy of Fallot repair - discharge; Coarctation of the aorta repair - discharge; ...

  16. Lung surgery - discharge

    MedlinePLUS

    Thoracotomy - discharge; Lung tissue removal - discharge; Pneumonectomy - discharge; Lobectomy - discharge; Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - ...

  17. Treatment of a type IIIb endoleak in a Talent endograft using telescoping cuffs and two parallel upside-down excluder contralateral legs.

    PubMed

    Reijnen, Michel M P J; Minion, David J; Lardenoye, Jan Willem H P

    2012-08-01

    We describe a case of a type IIIb endoleak arising from the main body of a Talent endograft that was treated using two telescoping cuffs and two parallel upside-down inserted Excluder contralateral legs, thereby creating a new bifurcating endograft. First, a 23-mm cuff was deployed onto the flow divider of the Talent endograft, followed by a second 28-mm cuff below the renal arteries creating a tapering lumen. Two 20-mm Excluder contralateral limbs were then positioned upside-down in the 23-mm cuff and deployed simultaneously, creating a new bifurcated prosthesis. Control computed tomography (CT) scan at 6 weeks showed a good position of the endografts without signs of an endoleak. In conclusion, a type IIIb endoleak at the level of the flow divider may successfully be excluded using two telescoping cuffs and two parallel upside-down contralateral Excluder limbs. Due to the rarity of this complication, the treatment will always have to be tailor-made. PMID:22703976

  18. 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

    Leistikow, Bruce N.

    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

  19. 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

    Leistikow, Bruce N.

    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

  20. 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

    Leistikow, Bruce N.

    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

  1. Improved Measurement of Blood Pressure by Extraction of Characteristic Features from the Cuff Oscillometric Waveform

    PubMed Central

    Lim, Pooi Khoon; Ng, Siew-Cheok; Jassim, Wissam A.; Redmond, Stephen J.; Zilany, Mohammad; Avolio, Alberto; Lim, Einly; Tan, Maw Pin; Lovell, Nigel H.

    2015-01-01

    We present a novel approach to improve the estimation of systolic (SBP) and diastolic blood pressure (DBP) from oscillometric waveform data using variable characteristic ratios between SBP and DBP with mean arterial pressure (MAP). This was verified in 25 healthy subjects, aged 28 ± 5 years. The multiple linear regression (MLR) and support vector regression (SVR) models were used to examine the relationship between the SBP and the DBP ratio with ten features extracted from the oscillometric waveform envelope (OWE). An automatic algorithm based on relative changes in the cuff pressure and neighbouring oscillometric pulses was proposed to remove outlier points caused by movement artifacts. Substantial reduction in the mean and standard deviation of the blood pressure estimation errors were obtained upon artifact removal. Using the sequential forward floating selection (SFFS) approach, we were able to achieve a significant reduction in the mean and standard deviation of differences between the estimated SBP values and the reference scoring (MLR: mean ± SD = ?0.3 ± 5.8 mmHg; SVR and ?0.6 ± 5.4 mmHg) with only two features, i.e., Ratio2 and Area3, as compared to the conventional maximum amplitude algorithm (MAA) method (mean ± SD = ?1.6 ± 8.6 mmHg). Comparing the performance of both MLR and SVR models, our results showed that the MLR model was able to achieve comparable performance to that of the SVR model despite its simplicity. PMID:26087370

  2. Rotating Bioreactor

    NASA Technical Reports Server (NTRS)

    1988-01-01

    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.

  3. Penile enlargement surgery.

    PubMed

    Alter, G J

    1998-06-01

    Aesthetic surgery to improve the appearance of the penis, scrotum, and pubic region has successfully evolved. Penile lengthening is performed by releasing the suspensory ligament of the penis followed by use of penile weights. Girth is increased by wrapping a dermal-fat graft around the penile circumference. The choice of surgery is determined by the patient's anatomy and desires. PMID:9623619

  4. 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

  5. Laparoscopic Surgery - What Is It?

    MedlinePLUS

    ... because the instruments are placed so closely together. “Robotic surgery” or “robotic-assisted surgery” is a newer variation on minimally ... remainder of the operation is usually performed laparoscopically. Robotic surgery is gaining popularity primarily for rectal operations ...

  6. Surgery for Stress Urinary Incontinence

    MedlinePLUS

    ... Events Advocacy For Patients About ACOG Surgery for Stress Urinary Incontinence Home For Patients Search FAQs Surgery ... Incontinence FAQ166, July 2014 PDF Format Surgery for Stress Urinary Incontinence Special Procedures What is stress urinary ...

  7. Limited-Access Heart Surgery

    MedlinePLUS

    ... not have to be split open. What is robotic-assisted heart surgery? In yet another kind of ... perform videoscopic surgery with even greater precision. In robotic-assisted surgery, surgeons make several small incisions in ...

  8. Recording of short-term finger blood pressure changes induced by an arterial occlusive thigh cuff: comparison between the modified oscillometric and Finapres techniques.

    PubMed

    Raamat, R; Jagomägi, K; Talts, J; Toska, K; Walløe, L

    2001-05-01

    Blood pressure recordings obtained by the volume clamp method (Finapres monitor, Ohmeda, USA) were compared with measurements by using a novel modification of the oscillometric method (UT9201 beat-to-beat monitor, University of Tartu, Estonia). Step changes in total peripheral resistance were introduced in 11 healthy volunteers by rapid inflation to the suprasystolic pressure of bilateral thigh cuffs during a rhythmical exercise with the quadriceps muscles and simultaneously performed handgrip compression. The provoked short-term changes in mean arterial pressure (MAP) were similarly tracked by both devices. The agreement between the methods was better for MAP rise than drop. The group-averaged difference UT9201 minus Finapres did not exceed 1.2 mmHg (NS, p = 0.46) after cuff successive inflation but yielded 3.8 mmHg (significant, p < 0.05) after cuff successive deflation. PMID:11411252

  9. Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness--a study of non-athletic healthy subjects.

    PubMed

    Lemming, Dag; Börsbo, Björn; Sjörs, Anna; Lind, Eva-Britt; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas; Gerdle, Björn

    2015-01-01

    Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation. Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). Besides the well-known gender difference in pressure pain sensitivity this study demonstrates that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people. PMID:25933412

  10. Single-Point but Not Tonic Cuff Pressure Pain Sensitivity Is Associated with Level of Physical Fitness – A Study of Non-Athletic Healthy Subjects

    PubMed Central

    Lemming, Dag; Börsbo, Björn; Sjörs, Anna; Lind, Eva-Britt; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas; Gerdle, Björn

    2015-01-01

    Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation. Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). Besides the well-known gender difference in pressure pain sensitivity this study demonstrates that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people. PMID:25933412

  11. Intraoperative Neurophysiologic Monitoring (INM) in scoliosis surgery.

    PubMed

    Pankowski, Rafal; Dziegiel, Krzysztof; Roclawski, Marek; Smoczynski, Andrzej; Ceynowa, Marcin; Kloc, Wojciech; Wasilewski, Wojciech; Jende, Piotr; Liczbik, Wieslaw; Beldzinski, Piotr; Libionka, Witold; Pierzak, Olaf; Adamski, Stanislaw; Niedbala, Miroslaw

    2012-01-01

    Even among skilled spinal deformity surgeons, neurologic deficits are inherent potential complications of spine surgery. The aim was to assess the meaning of changes and to evaluate the critical rates of Somatosensory Evoked Potentials (SEP) and Motor Evoked Potentials (MEP) for Neurologic Deficit (ND) occurrence associated with scoliosis surgery. A Group of 30 patients with idiopathic scoliosis treated surgically by posterior correction and stabilisation were included. Patients were matched by age, sex, aetiology, Cobb angle, and surgical criteria. Data on three planar scoliosis correction and concomitant (INM) alarms were compared. Radiographic assessment was performed from radiographs taken before surgery and just after it. The (INM) was performed with the use of ISSIS (Inomed) in every patients the same fashion. The average thoracic curve correction was 69.7% and lumbar 69.8%. The average preoperative Apical Vertebral Rotation was 23.5° for thoracic and 27.9° for lumbar curves and postoperatively 10.9° and 14.3° respectively. There was a significant variability of SEP during surgery with only 7 (23%) patients with stable SEP. 15(50%) patients had a decrease of SEP below 50% and 8(27%) had severe decrease of SEP below 50% what caused us to stop surgery or to decrease correction of curves. There was a MEP decrease in 11(37%) patients and in 6 (20%) directly after correction up to 50% of normal value. In 5 of 30 (17%) patients there was a significant decrease of MEP below 50% and we immediately released the implant. The SEP decrease up to 50% without any MEP change did not influenced the outcome. There was no correlation between flexibility and correction of the curve and SEP and MEP decrease. The safe level for MEP was not determined but its meaning for the outcome was more important than SEP value. The need of (INM) during scoliosis surgery to avoid (ND) was confirmed. PMID:22744519

  12. Rotation of Red Giants

    NASA Astrophysics Data System (ADS)

    Kissin, Y.; Thompson, C.

    2015-12-01

    A new rotation model for post-main sequence stars is proposed. This model quantitatively reproduces core and surface rotation rates of subgiant stars, as well as the core rotation of helium-burning clump stars.

  13. Tracheal Rupture due to Diffusion of Nitrous Oxide to Cuff of High-Volume, Low-Pressure Intubation Tube.

    PubMed

    Atalay, Canan; Aykan, ?eyda; Can, Abdullah; Do?an, Naz?m

    2009-08-01

    Tracheal rupture is a rare complication of endotracheal intubation. Risk factors include short neck, repeated attempts due to failed intubation, inappropriate stylus, over-inflation of the cuff, poor positioning of the tube, inappropriate tube size, weakened membrane structure due to steroid use, chronic obstructive pulmonary disease, tracheomalacia, kyphosis, and use of nitric oxide during the operation. In this article, we suggest that high-volume, low-pressure tubes may not always provide a low-pressure effect and could rupture due to reduced tracheal perfusion pressure and ischemic damage upon over-inflation. PMID:25610086

  14. Glenohumeral Rotational Motion and Strength and Baseball Pitching Biomechanics

    PubMed Central

    Hurd, Wendy J.; Kaufman, Kenton R.

    2012-01-01

    Context: Addressing loss of shoulder range of motion and rotator cuff weakness in injury-prevention programs might be an effective strategy for preventing throwing arm injuries in baseball pitchers. However, the influence of these clinical measures on pitching biomechanics is unclear. Objective: To evaluate the relationships among clinical measures of shoulder rotational motion and strength and 3-dimensional pitching biomechanics and to evaluate the presence of coupling between the shoulder and the elbow during pitching to provide insight into the influence of clinical shoulder characteristics on elbow biomechanics. Design: Cross-sectional study. Setting: Biomechanics laboratory. Patients or Other Participants: A total of 27 uninjured male high school baseball pitchers (age ?=? 16 ± 1.1 years, height ?=? 183 ± 7 cm, mass ?=? 83 ± 12 kg). Main Outcome Measure(s): Clinical measures included shoulder internal- and external-rotation range of motion and peak isometric internal- and external-rotator strength. Three-dimensional upper extremity biomechanics were assessed as participants threw from an indoor pitching mound to a target at regulation distance. Linear regressions were used to assess the influence of clinical measures on the peak shoulder internal and external rotation moments and the peak elbow-adduction moment. Results: We found a positive relationship between clinically measured internal-rotator strength and shoulder external-rotation moment (R2 ?=? 0.181, P ?=? .04) during pitching. We also noted an inverse relationship between clinically measured external-rotation motion and the elbow-adduction moment (R2 ?=? 0.160, P ?=? .04) and shoulder internal-rotation moment (R2 ?=? 0.250, P ?=? .008) during pitching. We found a positive relationship between peak shoulder internal-rotation moment and the peak elbow-adduction moment (R2 ?=? 0.815, P < .001) during pitching. Conclusions: This study provides insight into the effects of shoulder strength and motion on pitching biomechanics and how these clinical measures might contribute to throwing arm injuries in the baseball pitcher. A relationship also was identified between peak shoulder and elbow moments in the throwing arm during pitching, providing biomechanical support for addressing clinical shoulder characteristics as a potential strategy for preventing elbow injury. PMID:22892405

  15. Post-operative urothelial recurrence in patients with upper urinary tract urothelial carcinoma managed by radical nephroureterectomy with an ipsilateral bladder cuff: Minimal prognostic impact in comparison with non-urothelial recurrence and other clinical indicators.

    PubMed

    Takahara, Kiyoshi; Inamoto, Teruo; Komura, Kazumasa; Watsuji, Toshikazu; Azuma, Haruhito

    2013-10-01

    Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, and novel prognostic factors for patients who have undergone a radical nephroureterectomy (RNU) for UTUC have been studied intensely. To the best of our knowledge, the prognostic value of urothelial recurrence in patients with UTUC has not been previously described in studies. The present study compared the prognostic value of urothelial and non-urothelial recurrence in patients with UTUC of the kidney and ureter managed by surgery. The inclusion criteria consisted of a diagnosis of non-metastatic UTUC (any T stage, N0-1 and M0) and receipt of an RNU with an ipsilateral bladder cuff as the primary treatment. Of the 153 patients that were screened for the study, comprehensive clinical and pathological data was available for 103 patients, who were consequently included in the analysis. Overall survival (OS) and cancer-specific survival (CSS) times were estimated. A multivariate analysis was performed using the Cox regression model. The median follow-up period was 29 months (interquartile range, 14-63 months). The patient population was comprised of 71 males (68.9%) and 32 females (31.1%). A total of 32 patients (31.1%) showed non-urothelial recurrence, while 38 patients (36.9%) exhibited urothelial recurrence and 33 patients (32.0%) exhibited no recurrence. When comparing the risk parameters between the non-urothelial recurrence categories, the factors of pathological grade, microvascular invasion, lymphatic invasion and pT classification showed significant differences. However, there were no significant differences between the urothelial recurrence categories. No significant difference was observed between the OS and CSS times within the urothelial recurrence categories (P=0.3955 and P=0.05891, respectively), but significant differences were identified in the non-urothelial recurrence categories (P<0.0001 and P<0.0001, respectively). Among the other relevant descriptive pre-operative characteristics in the multivariate analysis, only non-urothelial recurrence remained associated with a worse CSS [P=0.002; hazard ratio (HR) 9.512]. The results show that urothelial recurrence has a minimal prognostic value in patients with UTUC managed by RNU with an ipsilateral bladder cuff. PMID:24137456

  16. Transoral robotic thyroid surgery

    PubMed Central

    Clark, James H.; Kim, Hoon Yub

    2015-01-01

    There is currently significant demand for minimally invasive thyroid surgery; however the majority of proposed surgical approaches necessitate a compromise between minimal tissue dissection with a visible cervical scar or extensive tissue dissection with a remote, hidden scar. The development of transoral endoscopic thyroid surgery however provides an approach which is truly minimally invasive, as it conceals the incision within the oral cavity without significantly increasing the amount of required dissection. The transoral endoscopic approach however presents multiple technical challenges, which could be overcome with the incorporation of a robotic operating system. This manuscript summarizes the literature on the feasibility and current clinical experience with transoral robotic thyroid surgery. PMID:26425456

  17. Principles of Pituitary Surgery.

    PubMed

    Farrell, Christopher J; Nyquist, Gurston G; Farag, Alexander A; Rosen, Marc R; Evans, James J

    2016-02-01

    Since the description of a transnasal approach for treatment of pituitary tumors, transsphenoidal surgery has undergone continuous development. Hirsch developed a lateral endonasal approach before simplifying it to a transseptal approach. Cushing approached pituitary tumors using a transsphenoidal approach but transitioned to the transcranial route. Transsphenoidal surgery was not "rediscovered" until Hardy introduced the surgical microscope. An endoscopic transsphenoidal approach for pituitary tumors has been reported and further advanced. We describe the principles of pituitary surgery including the key elements of surgical decision making and discuss the technical nuances distinguishing the endoscopic from the microscopic approach. PMID:26614830

  18. Transoral robotic thyroid surgery.

    PubMed

    Clark, James H; Kim, Hoon Yub; Richmon, Jeremy D

    2015-10-01

    There is currently significant demand for minimally invasive thyroid surgery; however the majority of proposed surgical approaches necessitate a compromise between minimal tissue dissection with a visible cervical scar or extensive tissue dissection with a remote, hidden scar. The development of transoral endoscopic thyroid surgery however provides an approach which is truly minimally invasive, as it conceals the incision within the oral cavity without significantly increasing the amount of required dissection. The transoral endoscopic approach however presents multiple technical challenges, which could be overcome with the incorporation of a robotic operating system. This manuscript summarizes the literature on the feasibility and current clinical experience with transoral robotic thyroid surgery. PMID:26425456

  19. A portable Halbach magnet that can be opened and closed without force: The NMR-CUFF

    NASA Astrophysics Data System (ADS)

    Windt, Carel W.; Soltner, Helmut; Dusschoten, Dagmar van; Blümler, Peter

    2011-01-01

    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.

  20. The role of noninvasive penile cuff test in patients with bladder outlet obstruction

    PubMed Central

    Kazemeyni, Seyed Mohamad; Mehraban, Darab; Naderi, Gholam Hossein; Ghadiri, Afsoon; Jafari, Mahdi

    2015-01-01

    Purpose The aim of this study was to compare the penile cuff test (PCT) and standard pressure-flow study (PFS) in patients with bladder outlet obstruction. Materials and Methods A total of 58 male patients with moderate to severe lower urinary tract symptoms (LUTS) were selected. Seven patients were excluded; thus, 51 patients were finally enrolled. Each of the patients underwent a PCT and a subsequent PFS. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio were calculated. Chi-square and Fisher exact test were used to evaluate relationships between PCT results and maximal urine flow (Qmax); a p<0.05 was considered statistically significant. Results The mean (±standard deviation) age of the study group was 65.5±10.4 years. Overall, by use of the PCT, 24 patients were diagnosed as being obstructed and 27 patients as unobstructed. At the subsequent PFS, 16 of the 24 patients diagnosed as obstructed by the PCT were confirmed to be obstructed, 4 were diagnosed as unobstructed, and the remaining 4 patients appeared equivocal. Of the 27 patients shown to be unobstructed by the PCT, 25 were confirmed to not be obstructed by PFS, with 13 equivocal and 12 unobstructed. Two patients were diagnosed as being obstructed. For detecting obstruction, the PCT showed an SE of 88.9% and an SP of 75.7%. The PPV was 66.7% and the NPV was 93%. Conclusions The PCT is a beneficial test for evaluating patients with LUTS. In particular, this instrument has an acceptable ability to reject obstruction caused by benign prostatic hyperplasia. PMID:26495074

  1. What to Expect during Heart Surgery

    MedlinePLUS

    ... the NHLBI on Twitter. What To Expect During Heart Surgery Heart surgery is done in a hospital, ... surgery, takes about 3–6 hours. Traditional Open-Heart Surgery For this type of surgery, you'll ...

  2. A new dimension in endo surgery: Micro endo surgery

    PubMed Central

    Pecora, Gabriele Edoardo; Pecora, Camilla Nicole

    2015-01-01

    There is an immense difference between tradizional Endodontic Surgery and Micro-Endo Surgery. Microsurgical techniques made possible and accessible results,that were unimaginable before. Under microscopic control,the operative techniques reached continous changes,allowing a better precision and quality standards. The dramatic evolution from Endo Surgery to Micro-Endo Surgery has enlarged the horizon of therapeutic options. Illumination and magnification through the Microscope has fundamentally and radically changed the way endo surgery can be performed. PMID:25657519

  3. Knee microfracture surgery

    MedlinePLUS

    Physical therapy may begin in the recovery room right after your surgery . A machine gently exercises your leg ... cartilage grow. You will need to go to physical therapy and do exercises at home for 3 to ...

  4. Surgery for Breast Cancer

    MedlinePLUS

    ... cancer care team right away. Reconstructive or breast implant surgery After having a mastectomy (or certain breast- ... Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® Lodging Rides To ...

  5. Orthognathic Surgery: General Considerations

    PubMed Central

    Khechoyan, David Y.

    2013-01-01

    Orthognathic surgery is a unique endeavor in facial surgery: a patient's appearance and occlusal function can be improved significantly, impacting the patient's sense of self and well-being. Successful outcomes in modern orthognathic surgery rely on close collaboration between the surgeon and the orthodontist across all stages of treatment, from preoperative planning to finalization of occlusion. Virtual computer planning promotes a more accurate analysis of dentofacial deformity and preoperative planning. It is also an invaluable aid in providing comprehensive patient education. In this article, the author describes the general surgical principles that underlie orthognathic surgery, highlighting the sequence of treatment, preoperative analysis of dentofacial deformity, surgical execution of the treatment plan, and possible complications. PMID:24872758

  6. American Board of Surgery

    MedlinePLUS

    ... Training & Certification Toggle navigation arrow About Certification Dates & Fees Taking a Computer Exam International Training For Residency & ... CME Repository About MOC Exams Exam Information Dates & Fees Taking a Computer Exam General Surgery About the ...

  7. Expectations of Sinus Surgery

    MedlinePLUS

    ... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... reduce the pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also ...

  8. Heart valve surgery - discharge

    MedlinePLUS

    ... as using a rowing machine, twisting, or lifting weights.) DO NOT drive for at least 4 to 6 weeks after your surgery. The twisting movements needed to turn the steering wheel may pull on your incision. Expect to take ...

  9. Breast augmentation surgery

    MedlinePLUS

    ... a change in the shape of your breast, hardening of breast tissue, or some pain. Emotional risks ... starting 5 days after surgery. Massaging helps reduce hardening of the capsule that surrounds the implant. Ask ...

  10. Brain Tumor Surgery

    MedlinePLUS

    ... The surgical removal of a portion of the skull. Doing so allows the neurosurgeon to find the ... much of it as possible. The piece of skull that was removed is replaced following surgery. Craniectomy: ...

  11. Aortic valve surgery - open

    MedlinePLUS

    ... have this type of valve. Biological, made of human or animal tissue. These valves may last 10 ... surgery Infection of the new valve Kidney failure Memory loss and loss of mental clarity, or "fuzzy ...

  12. Laparoscopic Spine Surgery

    MedlinePLUS

    ... Opportunities Login Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Version Find a SAGES Surgeon Laparoscopic ... 2015 CME Credits Healthy Sooner: Patient Information Contact SAGES Society of American Gastrointestinal and Endoscopic Surgeons 11300 ...

  13. Carpal Tunnel Surgery

    MedlinePLUS Videos and Cool Tools

    ... carried out for the condition of carpal tunnel syndrome. Carpal Tunnel Syndrome is a neuropathy where the median nerve gets ... of the hand. The surgery for carpal tunnel syndrome consists of a release of the transverse carpal ...

  14. Sculptures honour wartime surgery.

    PubMed

    2014-11-18

    The Florence Nightingale Museum has marked the centenary of the first world war with a display of life-size sculptures of soldiers from different wars who had reconstructive surgery after experiencing appalling facial injuries. PMID:25388690

  15. What Is Refractive Surgery?

    MedlinePLUS

    ... Contact Lenses Colored Contact Lenses Eyeglasses IOLs Refractive Surgery & LASIK Sunglasses Living EyeSmart About Ophthalmologists Adults Under 40 Adults 40 to 60 Adults Over 60 Babies, Children & Teenagers Computer Usage Diabetes Diet & Nutrition Eye Injuries Eye ...

  16. Spine surgery - discharge

    MedlinePLUS

    ... in your back where nerve roots leave your spinal column Laminectomy -- surgery to remove the lamina, two small ... to take pressure off your spinal nerves or spinal column Spinal fusion -- the fusing of two bones together ...

  17. Robotic Surgery in Arthroplasty

    MedlinePLUS

    ... Home AAOS Now 2013 December research AAOS Now Robotic Surgery in Arthroplasty Share By: Karthikeyan E. Ponnusamy, ... E. Ponnusamy, MD, and S. Raymond Golish, MD, PhD Robotic assistance is a relatively new technology for unicompartmental ( ...

  18. Endoscopic Sinus Surgery

    MedlinePLUS

    ... The nasal endoscope is a small, lighted metal telescope placed into the nostril. The endoscope allows the ... sinus surgery involves the use of a small telescope (nasal endoscope) that is inserted through the nostril ...

  19. Department of Surgery Reunion Gala

    E-print Network

    Thompson, Michael

    Department of Surgery Reunion Gala Report A celebration of over 40 years of the Department of Surgery October25th&26th2013 #12;October25th2013:Wine&Cheese Surgery Reunion Gala Weekend: Wine & Cheese On Friday October 25, 2013 the Surgery Reunion Gala weekend kicked off with a wine and cheese event

  20. Photobiomodulation in laser surgery

    NASA Astrophysics Data System (ADS)

    Liu, Timon Cheng-Yi; Rong, Dong-Liang; Huang, Jin; Deng, Xiao-Yuan; Liu, Song-Hao

    2006-01-01

    Laser surgery provides good exposure with clear operating fields and satisfactory preliminary functional results. In contrast to conventional excision, it was found that matrix metalloproteinases and the tissue inhibitors of metalloproteinases -1 mRNA expression is higher, myofibroblasts appeared and disappeared slower in laser excision wounds. It has been suggested that the better anatomical and functional results achieved following laser cordectomy may be explained by the fact that such procedures result in better, more rapid healing processes to recover vocal cord for early glottic tumors and better. In this paper, the role of photobiomodulation in laser surgery will be discussed by the cultured monolayer normal human skin fibroblast model of the photobiomodulation of marginal irradiation of high intensity laser beam, the photobiomodulation related to the irradiated tissue, the biological information model of photobiomodulation and the animal models of laser surgery. Although high intensity laser beam is so intense that it destroys the irradiated cells or tissue, its marginal irradiation intensity is so low that there is photobiomodulation on non-damage cells to modulate the regeneration of partly damaged tissue so that the surgery of laser of different parameters results in different post-surgical recovery. It was concluded that photobiomodulation might play an important role in the long-term effects of laser surgery, which might be used to design laser surgery.

  1. Cardioprotection during cardiac surgery

    PubMed Central

    Hausenloy, Derek J.; Boston-Griffiths, Edney; Yellon, Derek M.

    2012-01-01

    Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. For a large number of patients with CHD, coronary artery bypass graft (CABG) surgery remains the preferred strategy for coronary revascularization. Over the last 10 years, the number of high-risk patients undergoing CABG surgery has increased significantly, resulting in worse clinical outcomes in this patient group. This appears to be related to the ageing population, increased co-morbidities (such as diabetes, obesity, hypertension, stroke), concomitant valve disease, and advances in percutaneous coronary intervention which have resulted in patients with more complex coronary artery disease undergoing surgery. These high-risk patients are more susceptible to peri-operative myocardial injury and infarction (PMI), a major cause of which is acute global ischaemia/reperfusion injury arising from inadequate myocardial protection during CABG surgery. Therefore, novel therapeutic strategies are required to protect the heart in this high-risk patient group. In this article, we review the aetiology of PMI during CABG surgery, its diagnosis and clinical significance, and the endogenous and pharmacological therapeutic strategies available for preventing it. By improving cardioprotection during CABG surgery, we may be able to reduce PMI, preserve left ventricular systolic function, and reduce morbidity and mortality in these high-risk patients with CHD. PMID:22440888

  2. Robotic surgery in gynecology

    PubMed Central

    Sinha, Rooma; Sanjay, Madhumati; Rupa, B.; Kumari, Samita

    2015-01-01

    FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over. PMID:25598600

  3. Cardiac surgery 2014 reviewed.

    PubMed

    Doenst, Torsten; Strüning, Constanze; Moschovas, Alexandros; Gonzalez-Lopez, David; Valchanov, Ilija; Kirov, Hristo; Diab, Mahmoud; Faerber, Gloria

    2015-12-01

    For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery. PMID:26404007

  4. Robotic surgery in gynecology.

    PubMed

    Sinha, Rooma; Sanjay, Madhumati; Rupa, B; Kumari, Samita

    2015-01-01

    FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over. PMID:25598600

  5. Stability and selectivity of a chronic, multi-contact cuff electrode for sensory stimulation in human amputees

    NASA Astrophysics Data System (ADS)

    Tan, Daniel W.; Schiefer, Matthew A.; Keith, Michael W.; Anderson, J. Robert; Tyler, Dustin J.

    2015-04-01

    Objective. Stability and selectivity are important when restoring long-term, functional sensory feedback in individuals with limb-loss. Our objective is to demonstrate a chronic, clinical neural stimulation system for providing selective sensory response in two upper-limb amputees. Approach. Multi-contact cuff electrodes were implanted in the median, ulnar, and radial nerves of the upper-limb. Main results. Nerve stimulation produced a selective sensory response on 19 of 20 contacts and 16 of 16 contacts in subjects 1 and 2, respectively. Stimulation elicited multiple, distinct percept areas on the phantom and residual limb. Consistent threshold, impedance, and percept areas have demonstrated that the neural interface is stable for the duration of this on-going, chronic study. Significance. We have achieved selective nerve response from multi-contact cuff electrodes by demonstrating characteristic percept areas and thresholds for each contact. Selective sensory response remains consistent in two upper-limb amputees for 1 and 2 years, the longest multi-contact sensory feedback system to date. Our approach demonstrates selectivity and stability can be achieved through an extraneural interface, which can provide sensory feedback to amputees.

  6. Innovation in Surgery

    PubMed Central

    Riskin, Daniel J.; Longaker, Michael T.; Gertner, Michael; Krummel, Thomas M.

    2006-01-01

    Objective: To describe the field of surgical innovation from a historical perspective, applying new findings from research in technology innovation. Background: While surgical innovation has a rich tradition, as a field of study it is embryonic. Only a handful of academic centers of surgical innovation exist, all of which have arisen within the last 5 years. To this point, the field has not been well defined, nor have future options to promote surgical innovation been thoroughly explored. It is clear that surgical innovation is fundamental to surgical progress and has significant health policy implications. A process of systematically evaluating and promoting innovation in surgery may be critical in the evolving practice of medicine. Methods: A review of the academic literature in technology innovation was undertaken. Articles and books were identified through technical, medical, and business sources. Luminaries in surgical innovation were interviewed to develop further relevance to surgical history. The concepts in technology innovation were then applied to innovation in surgery, using the historical example of surgical endoscopy as a representative area, which encompasses millennia of learning and spans multiple specialties of care. Results: The history of surgery is comprised largely of individual, widely respected surgeon innovators. While respecting individual accomplishments, surgeons as a group have at times hindered critical innovation to the detriment of our profession and patients. As a clinical discipline, surgery relies on a tradition of research and attracting the brightest young minds. Innovation in surgery to date has been impressive, but inconsistently supported. Conclusion: A body of knowledge on technology innovation has been developed over the last decade but has largely not been applied to surgery. New surgical innovation centers are working to define the field and identify critical aspects of surgical innovation promotion. It is our responsibility as a profession to work to understand innovation in surgery, discover, translate, and commercialize advances to address major clinical problems, and to support the future of our profession consistently and rationally. PMID:17060760

  7. Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using "Braslet-M" Occlusion Cuffs

    NASA Technical Reports Server (NTRS)

    Hamilton, D. R.; Sargsyan, A. E.; Garcia, K. M.; Ebert, D.; Feiveson, A. H.; Alferova, I. V.; Dulchavsky, S. A.; Matveev, V. P.; Bogomolov, V. V.; Duncan, J. M.

    2011-01-01

    BACKGROUND: 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, nasal congestion, and headache. This experiment examined the responses to modified Valsalva and Mueller maneuvers as measured by cardiac and vascular ultrasound in a baseline microgravity steady state, and under the influence of thigh occlusion cuffs (Braslet cuffs). 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). 27 cardiac and vascular parameters were obtained under three respiratory conditions (baseline, Valsalva, and Mueller) before and after tightening of the Braslet cuffs for a total of 162 data points per session. The quality of cardiac and vascular ultrasound examinations was assured through remote monitoring and guidance by Investigators from the NASA Telescience Center in Houston, TX, USA. RESULTS: Fourteen of the 81 measured conditions were significantly different with Braslet application and were apparently related to cardiac preload reduction or increase in the venous volume sequestered in the lower extremity. These changes represented 10 of the 27 parameters measured. In secondary analysis, 7 of the 27 parameters were found to respond differently to respiratory maneuvers depending on the presence or absence of thigh compression, with a total of 11 differences. CONCLUSIONS: Acute application of Braslet occlusion cuffs causes lower extremity fluid sequestration and exerts proportionate measurable effects on cardiac performance in microgravity. Ultrasound techniques measuring the hemodynamic effects of thigh cuffs in combination with respiratory maneuvers may serve as an effective tool in determining the volume status of a cardiac or hemodynamically compromised patient in microgravity.

  8. Surgery without interventions?

    PubMed

    Guiraudon, G M

    1998-11-01

    Cardiac surgeons took to the heart and claimed an exclusive privilege to intervene. The task of cardiologists was to identify "candidates" and feed the Great Surgical Machine. Recently catheter surgery has developed and fell into the hands of cardiologists, who became interventionists. Cardiac surgeons are concerned about losing interventions and their identify. The analysis of the current situation implies a revisitation of old concepts: surgery, intervention, therapy, patients, invasiveness etc ... etc ... and a review of our therapeutic philosophy. Therapeutic plans comprise three interrelated components: the target, the bullet (therapeutic agent), and the gun (the way of delivering the bullet on target). This description characterizes surgery as a way of delivering. If side effects are effects that do not affect the target, surgical procedures are mostly side effects, with significant morbidity. Future surgical rationales should reconcile target-specific therapy and minimal collateral damages: Minimal Surgery! or to use a new buzz, less invasiveness. Cardiac surgery has focused too much on surgical practice and neglected the rest of cardiology, missing opportunities for new researches, new rationales, and new techniques. Surgeons must become again Renaissance Men, involved in the entire field of cardiology, with a special skill in surgical techniques. Cardiac surgeons should no longer confine their practice to the delivering end. This end does not, any more, justify the means. PMID:9825311

  9. Robotic facelift thyroid surgery

    PubMed Central

    Bomeli, Steven R.; Duke, William S.

    2015-01-01

    Techniques for thyroid surgery have advanced dramatically over the past two decades, driven by a better understanding of thyroid physiology, anatomy, and perioperative management strategies. Improvements in surgical technology have permitted surgeons to perform minimally invasive surgery associated with less dissection, decreased pain, smaller anterior cervical incisions, and most importantly a faster recovery. The advent of robotic surgical technology has allowed the development of remote access thyroidectomy for select patients who wish to avoid a visible cervical incision completely. The robotic facelift thyroidectomy (RFT) approach also offers the advantage of outpatient surgery without the need for postoperative drainage. A growing body of evidence supports the safety and efficacy of the approach, and as a result the technique is now being performed at several centers around the world. PMID:26425453

  10. Robotic transaxillary thyroid surgery.

    PubMed

    Rabinovics, Naomi; Aidan, Patrick

    2015-10-01

    Recent technological advances have led to a rapid progress in endocrine surgery. With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has emerged as one of the most promising approaches. Its main advantages are improved cosmetic outcome, avoiding cervical incisions, increased patient satisfaction, improved visualization, arms articulations, eliminating surgeon's natural tremor, thereby increasing precision. The main disadvantages are longer operative time, and increased cost compared to conventional thyroidectomy, as well as potential injuries to the brachial plexus, skin flap, esophagus, and trachea. Large-scale studies, mainly from South-Korea, have proved that in skilled hands, RATS is a safe alternative to conservative thyroidectomy and should be presented to patients with aesthetic concerns. As with any new emerging technique, careful patient selection is crucial, and further evidence must be sought to confirm its indications. PMID:26425452

  11. Cosmetic Facial Surgery

    PubMed Central

    Adamson, Peter A.

    1987-01-01

    Canadians have committed themselves to a healthier lifestyle, and many are seeking to look as well as they feel. For patients with realistic expectations, modern techniques of cosmetic facial surgery can enhance appearance and be of psychological benefit. Today most procedures can be done under local anesthesia on an out-patient basis. Facial contour defects can be improved by means of procedures such as rhinoplasty, mentoplasty, otoplasty and malarplasty. Facial rejuvenation surgery to decrease the signs of aging includes the forehead lift, eyebrow and eyelid lift, rhytidectomy, liposuction and chemical peeling. Newer controversial trends in cosmetic facial surgery include collagen implantation and fat transfer for contour defects, and eyelid tattooing. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:21263984

  12. Robotic aortic surgery.

    PubMed

    Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F; Bismuth, Jean

    2011-01-01

    Surgical robotics was first utilized to facilitate neurosurgical biopsies in 1985, and it has since found application in orthopedics, urology, gynecology, and cardiothoracic, general, and vascular surgery. Surgical assistance systems provide intelligent, versatile tools that augment the physician's ability to treat patients by eliminating hand tremor and enabling dexterous operation inside the patient's body. Surgical robotics systems have enabled surgeons to treat otherwise untreatable conditions while also reducing morbidity and error rates, shortening operative times, reducing radiation exposure, and improving overall workflow. These capabilities have begun to be realized in two important realms of aortic vascular surgery, namely, flexible robotics for exclusion of complex aortic aneurysms using branched endografts, and robot-assisted laparoscopic aortic surgery for occlusive and aneurysmal disease. PMID:21979124

  13. Psychopharmacology and Bariatric Surgery.

    PubMed

    Roerig, James L; Steffen, Kristine

    2015-11-01

    Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. PMID:26338011

  14. Robotic transaxillary thyroid surgery

    PubMed Central

    Rabinovics, Naomi

    2015-01-01

    Recent technological advances have led to a rapid progress in endocrine surgery. With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has emerged as one of the most promising approaches. Its main advantages are improved cosmetic outcome, avoiding cervical incisions, increased patient satisfaction, improved visualization, arms articulations, eliminating surgeon’s natural tremor, thereby increasing precision. The main disadvantages are longer operative time, and increased cost compared to conventional thyroidectomy, as well as potential injuries to the brachial plexus, skin flap, esophagus, and trachea. Large-scale studies, mainly from South-Korea, have proved that in skilled hands, RATS is a safe alternative to conservative thyroidectomy and should be presented to patients with aesthetic concerns. As with any new emerging technique, careful patient selection is crucial, and further evidence must be sought to confirm its indications. PMID:26425452

  15. Robotic facelift thyroid surgery.

    PubMed

    Bomeli, Steven R; Duke, William S; Terris, David J

    2015-10-01

    Techniques for thyroid surgery have advanced dramatically over the past two decades, driven by a better understanding of thyroid physiology, anatomy, and perioperative management strategies. Improvements in surgical technology have permitted surgeons to perform minimally invasive surgery associated with less dissection, decreased pain, smaller anterior cervical incisions, and most importantly a faster recovery. The advent of robotic surgical technology has allowed the development of remote access thyroidectomy for select patients who wish to avoid a visible cervical incision completely. The robotic facelift thyroidectomy (RFT) approach also offers the advantage of outpatient surgery without the need for postoperative drainage. A growing body of evidence supports the safety and efficacy of the approach, and as a result the technique is now being performed at several centers around the world. PMID:26425453

  16. [Ambulatory surgery: safety, quality].

    PubMed

    Jouffroy, L

    2001-01-01

    Demands related to regulation of Ambulatory surgery in France and to expectations of the patients implies that we can be able to proof that ambulatory organization guarantees total patient care with optimal safety conditions; and that detection of unexpected events is the first step in a larger approach to continue quality improvement and minimize risks for patients. To achieve these goals, we suggest a list of means based on international ambulatory surgery definitions, including clinical indicators, frequent asked questions and measurement of patient satisfaction. PMID:11717824

  17. [Ambulatory surgery: safety, quality].

    PubMed

    Jouffroy, L

    2001-09-01

    Demands related to regulation of ambulatory surgery in France and to expectations of the patients imply that we can be able to proof that ambulatory organization guarantees total patient care with optimal safety conditions and that detection of unexpected events is the first step in a larger approach to continue quality improvement and minimize risks for patients. To achieve these goals, we suggest a list of means based on international ambulatory surgery definitions, including clinical indicators, frequent asked questions and measurement of patient satisfaction. PMID:11676245

  18. Avian Soft Tissue Surgery.

    PubMed

    Guzman, David Sanchez-Migallon

    2016-01-01

    Basic surgical instrumentation for avian soft tissue surgery includes soft tissue retractors, microsurgical instrumentation, surgical loupes, and head-mounted lights. Hemostasis is fundamental during the surgical procedures. The indications, approach, and complications associated with soft tissue surgeries of the integumentary (digit constriction repair, feather cyst excision, cranial wound repair, sternal wound repair, uropygial gland excision), gastrointestinal (ingluviotomy, crop biopsy, crop burn repair, celiotomy, coelomic hernia and pseudohernia repair, proventriculotomy, ventriculotomy, enterotomy, intestinal resection and anastomosis, cloacoplasty, cloacopexy), respiratory (rhinolith removal, sinusotomy, tracheotomy, tracheal resection and anastomosis, tracheostomy, pneumonectomy) and reproductive (ovocentesis, ovariectomy, salpingohysterectomy, cesarean section, orchidectomy, vasectomy, phallectomy) systems are reviewed. PMID:26611927

  19. Surgery in Amphibians.

    PubMed

    Chai, Norin

    2016-01-01

    Amphibian surgery has been especially described in research. Since the last decade, interest for captive amphibians has increased, so have the indications for surgical intervention. Clinicians should not hesitate to advocate such manipulations. Amphibian surgeries have no overwhelming obstacles. These patients heal well and tolerate blood loss more than higher vertebrates. Most procedures described in reptiles (mostly lizards) can be undertaken in most amphibians if equipment can be matched to the patients' size. In general, the most difficult aspect would be the provision of adequate anesthesia. PMID:26611925

  20. Recent advances in laparoscopic surgery.

    PubMed

    Lee, Wei-Jei; Chan, Chien-Pin; Wang, Bing-Yen

    2013-02-01

    Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. PMID:23126424

  1. [Robotic surgery in gynecology].

    PubMed

    Hibner, Micha?; Marianowski, Piotr; Szymusik, Iwona; Wielgós, Miros?aw

    2012-12-01

    Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional "straight stick" laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This results in much less fatigue and therefore increases precision and potentially may decrease the number of medical errors. The eyes of the surgeon are directed at where the hands should be, which is more natural, allows for a more natural body position and mimics open surgery Robot also enables better teaching, especially when two consoles are used. The surgeon and the student may be either sharing the instruments with two consoles or switching between one another. In a situation where the student operates, the surgeon can use the telestation to teach. Robotic simulator attached to one of the consoles allows students to practice after hours. In summary surgical robot is a great tool, especially in gynecology but also in urology cardiac surgery general surgery and laryngology The device will evolve and most likely with time will eliminate laparoscopy PMID:23488297

  2. Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery.

    E-print Network

    1/ 17 Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery. Simon;2/ 17 Spines, backbones and orthopedic surgery. Motivation #12;2/ 17 Spines, backbones and orthopedic motion with a near critical drift towards an absorbing barrier at the origin. #12;3/ 17 Spines, backbones

  3. [Contribution of ambulatory digestive surgery].

    PubMed

    Sales, J P

    2000-10-01

    In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept. PMID:11033485

  4. Heart bypass surgery - minimally invasive

    MedlinePLUS

    ... MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... To perform this surgery: The heart surgeon will make a 3- to 5-inch-long surgical cut in the left part of your chest between your ribs ...

  5. Getting yourself healthy before surgery

    MedlinePLUS

    ... at risk of bleeding during surgery. Medicines includes aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs. Ask your doctor which medicines you should still take on the day of your surgery.

  6. Infant open heart surgery (image)

    MedlinePLUS

    During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia. ... During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia.

  7. Bariatric Surgery for Severe Obesity

    MedlinePLUS

    ... 2. Wilson ST, Thomas HI, Randall SB. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome . Archives of Pediatrics & Adolescent Medicine . ... prepared they are for the surgery and the lifestyle changes they will need to ...

  8. Liver Surgery Codes

    Cancer.gov

    Liver and Intrahepatic Bile Ducts C220–C221 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic

  9. Surgery on Nullhomologous Tori

    E-print Network

    Fintushel, Ronald

    2011-01-01

    By studying the example of smooth structures on CP^2#3(-CP^2) we illustrate how surgery on a single embedded nullhomologous torus can be utilized to change the symplectic structure, the Seiberg-Witten invariant, and hence the smooth structure on a 4-manifold.

  10. Pharynx Surgery Codes

    Cancer.gov

    Pharynx Tonsil C090–C099, Oropharynx C100–C109, Nasopharynx C110–C119 Pyriform Sinus C129, Hypopharynx C130–C139, Pharynx C140 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery

  11. Lung Surgery Codes

    Cancer.gov

    Lung C340–C349 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 19 Local tumor destruction or excision, NOS Unknown whether a specimen was

  12. Kidney Surgery Codes

    Cancer.gov

    Kidney, Renal Pelvis, and Ureter Kidney C649, Renal Pelvis C659, Ureter C669 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor

  13. Bladder Surgery Codes

    Cancer.gov

    Bladder C670–C679 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic therapy (PDT) 12

  14. Stomach Surgery Codes

    Cancer.gov

    Stomach C160–C169 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic therapy (PDT) 12 Electrocautery;

  15. Chair of surgery.

    PubMed

    Scott-Conner, Carol; Hooks, Mary

    2010-10-01

    There are several essential qualities required for success as a chair of surgery. These include determination and resilience, thoughtful planning, superb organization skills, a balance of hard (accounting, management and finance) and soft skills (interpersonal including faculty development), and careful execution is absolutely essential as is a commitment to maintaining momentum. PMID:20887845

  16. Remote access thyroid surgery

    PubMed Central

    Bhatia, Parisha; Mohamed, Hossam Eldin; Kadi, Abida; Walvekar, Rohan R.

    2015-01-01

    Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains. PMID:26425450

  17. Parotid Surgery Codes

    Cancer.gov

    Parotid and Other Unspecified Glands Parotid Gland C079, Major Salivary Glands C080–C089 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY

  18. Esophagus Surgery Codes

    Cancer.gov

    Esophagus C150–C159 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic therapy (PDT) 12

  19. Consecutive exotropia following surgery.

    PubMed Central

    Folk, E R; Miller, M T; Chapman, L

    1983-01-01

    We studied 250 patients with consecutive exotropia. The interval between the surgical procedure and the onset of the consecutive exotropia may take many years. Consecutive exotropia occurred with all types of corrective esotropia surgery that we studied. Amblyopia and medial rectus limitation postoperatively seemed to be common factors associated with consecutive exotropia. PMID:6871147

  20. Shoulder surgery - discharge

    MedlinePLUS

    ... DO NOT place it directly on the dressing. Ice helps keep swelling down. Your sutures (stitches) will be removed about 1 week after surgery. Keep your bandage and your wound clean and dry . Ask your doctor if it is ok to ...

  1. Anus Surgery Codes

    Cancer.gov

    Anus C210–C218 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) [SEER Note: Do not code infrared coagulation as treatment.] Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor

  2. Breast Surgery Codes

    Cancer.gov

    Breast C500–C509 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 19 Local tumor destruction, NOS No specimen was sent to pathology for

  3. Dutch surgery in Japan.

    PubMed

    van Gulik, Thomas M; Nimura, Yuji

    2005-01-01

    An isolation policy was adopted in feudal Japan from 1639 to 1853 owing to the fear of foreign influence. During those 200 years of isolation, all foreigners were withheld from the country with the exception of the Dutch, who were permitted to establish a trading post on a small island in the Bay of Nagasaki, called Decima. Western culture and science reached the Japanese exclusively through the Dutch on Decima. Health care on Decima was provided by Dutch barber-surgeons, who introduced Western surgical practice in Japan. Official interpreters were the only Japanese allowed on Decima. It was from among these interpreters that the first Japanese surgeons arose who, having mastered the Dutch language, translated several Dutch anatomic and surgical texts. Genpaku Sugita translated a Dutch anatomy textbook into Japanese, which was completed in 1774. This book, entitled Kaitai Shinsho [New Book on Anatomy], was the first Western scientific monograph to be translated entirely into Japanese. Several Dutch surgical schools were founded through which Dutch surgery, known in Japan as "surgery of the red-haired" was propagated. According to the custom of the surgical guilds in Holland, certificates were granted to Japanese apprentices who had completed their training in Dutch surgery. About 60 Dutch surgeons had served on Decima up to 1850, providing the basis for surgery to develop in Japan. Among them, Philipp Franz von Siebold was an exceptional scholar who also had a great impact in making Japanese culture known to the Western world. PMID:15599736

  4. Antibiotics before surgery.

    PubMed

    Kaatz, B

    1996-01-01

    The antimicrobial era (along with greater surgical skill and precision) has brought us relative safety for procedures that previously were fraught with danger. Civil War amputation surgeries, for example, had an extraordinarily high incidence of infections and mortality. Staying aware of and avoiding the small, but real, risks associated with surgical antibiotic prophylaxis will help sustain the advances we enjoy today. PMID:8650524

  5. Periodontal Plastic Surgery Procedures

    MedlinePLUS

    ... smile just the right look. Long Teeth/Exposed Roots Sometimes gum recession causes the tooth root to become exposed, which makes your teeth look ... including periodontal diseases. Gum graft surgery and other root coverage procedures are designed to cover exposed roots, ...

  6. Never Events in Surgery.

    PubMed

    Makar, Adel; Kodera, Ahmed; Bhayani, Sam B

    2015-12-01

    Never events such as wrong-site surgery are still somewhat prevalent in urology and may have serious adverse consequences for the patient, surgeon, and institution. By embracing a safety culture and improving mindfulness, urologists can minimize these events via system improvement. PMID:26162234

  7. Larynx Surgery Codes

    Cancer.gov

    Larynx C320–C329 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic therapy (PDT) 12 Electrocautery;

  8. Remote access thyroid surgery.

    PubMed

    Bhatia, Parisha; Mohamed, Hossam Eldin; Kadi, Abida; Kandil, Emad; Walvekar, Rohan R

    2015-10-01

    Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains. PMID:26425450

  9. Evolving endoscopic surgery.

    PubMed

    Sakai, Paulo; Faintuch, Joel

    2014-06-01

    Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques. PMID:24628672

  10. Cataract Surgery in Uveitis

    PubMed Central

    Agrawal, Rupesh; Murthy, Somashiela; Ganesh, Sudha K.; Phaik, Chee Soon; Sangwan, Virender; Biswas, Jyotimai

    2012-01-01

    Cataract surgery in uveitic eyes is often challenging and can result in intraoperative and postoperative complications. Most uveitic patients enjoy good vision despite potentially sight-threatening complications, including cataract development. In those patients who develop cataracts, successful surgery stems from educated patient selection, careful surgical technique, and aggressive preoperative and postoperative control of inflammation. With improved understanding of the disease processes, pre- and perioperative control of inflammation, modern surgical techniques, availability of biocompatible intraocular lens material and design, surgical experience in performing complicated cataract surgeries, and efficient management of postoperative complications have led to much better outcome. Preoperative factors include proper patient selection and counseling and preoperative control of inflammation. Meticulous and careful cataract surgery in uveitic cataract is essential in optimizing the postoperative outcome. Management of postoperative complications, especially inflammation and glaucoma, earlier rather than later, has also contributed to improved outcomes. This manuscript is review of the existing literature and highlights the management pearls in tackling complicated cataract based on medline search of literature and experience of the authors. PMID:22518338

  11. Ovary Surgery Codes

    Cancer.gov

    Ovary C569 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 17 Local tumor destruction, NOS No specimen sent to pathology from surgical event

  12. Power Harvesting from Rotation?

    ERIC Educational Resources Information Center

    Chicone, Carmen; Feng, Z. C.

    2008-01-01

    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.)

  13. Comparison of heart rate variability between resting state and external-cuff-inflation-and-deflation state: a pilot study.

    PubMed

    Ji, Lizhen; Liu, Chengyu; Li, Peng; Wang, Xinpei; Yan, Chang; Liu, Changchun

    2015-10-01

    Heart rate variability (HRV) has been widely used in clinical research to provide an insight into the autonomic control of the cardiovascular system. Measurement of HRV is generally performed under a relaxed resting state. The effects of other conditions on HRV measurement, such as running, mountaineering, head-up tilt, etc, have also been investigated. This study aimed to explore whether an inflation-and-deflation process applied to a unilateral upper arm cuff would influence the HRV measurement. Fifty healthy young volunteers aged between 21 and 30 were enrolled in this study. Electrocardiogram (ECG) signals were recorded for each subject over a five minute resting state followed by a five minute external-cuff-inflation-and-deflation state (ECID state). A one minute gap was scheduled between the two measurements. Consecutive RR intervals in the ECG were extracted automatically to form the HRV data for each of the two states. Time domain (SDNN, RMSSD and PNN50), frequency domain (LFn, HFn and LF/HF) and nonlinear (VLI, VAI and SampEn) HRV indices were analyzed and compared between the two states. In addition, the effects of mean artery pressure (MAP) and heart rate (HR) on the aforementioned HRV indices were assessed for the two states, respectively, by Pearson correlation analysis. The results showed no significant difference in all aforementioned HRV indices between the resting and the ECID states (all p??>??0.05). The corresponding HRV indices had significant positive correlation (all p????0.05) for either state. Besides, none of the indices showed HR-related change (all p??>??0.05) for either state except the index of VLI in the resting state. To conclude, this pilot study suggested that the applied ECID process hardly influenced those commonly used HRV indices. It would thus be applicable to simultaneously measure both blood pressure and HRV indices in clinical practice. PMID:26333766

  14. Prospective Clinical Trial of Bladder Filling and Three-Dimensional Dosimetry in High-Dose-Rate Vaginal Cuff Brachytherapy

    SciTech Connect

    Stewart, Alexandra J.; Cormack, Robert A.; Lee, Hang; Xiong Li; Hansen, Jorgen L.; O'Farrell, Desmond A.; Viswanathan, Akila N.

    2008-11-01

    Purpose: To investigate the effect of bladder filling on dosimetry and to determine the best bladder dosimetric parameter for vaginal cuff brachytherapy. Methods and Materials: In this prospective clinical trial, a total of 20 women underwent vaginal cylinder high-dose-rate brachytherapy. The bladder was full for Fraction 2 and empty for Fraction 3. Dose-volume histogram and dose-surface histogram values were generated for the bladder, rectum, and urethra. The midline maximal bladder point (MBP) and the midline maximal rectal point were recorded. Paired t tests, Pearson correlations, and regression analyses were performed. Results: The volume and surface area of the irradiated bladder were significantly smaller when the bladder was empty than when full. Of the several dose-volume histogram and dose-surface histogram parameters evaluated, the bladder maximal dose received by 2 cm{sup 3} of tissue, volume of bladder receiving {>=}50% of the dose, volume of bladder receiving {>=}70% of the dose, and surface area of bladder receiving {>=}50% of the dose significantly predicted for the difference between the empty vs. full filling state. The volume of bladder receiving {>=}70% of the dose and the maximal dose received by 2 cm{sup 3} of tissue correlated significantly with the MBP. Bladder filling did not alter the volume or surface area of the rectum irradiated. However, an empty bladder did result in the nearest point of bowel being significantly closer to the vaginal cylinder than when the bladder was full. Conclusions: Patients undergoing vaginal cuff brachytherapy treated with an empty bladder have a lower bladder dose than those treated with a full bladder. The MBP correlated well with the volumetric assessments of bladder dose and provided a noninvasive method for reporting the MBP dose using three-dimensional imaging. The MBP can therefore be used as a surrogate for complex dosimetry in the clinic.

  15. Early Cocking Phase Mechanics and Upper Extremity Surgery Risk in Starting Professional Baseball Pitchers

    PubMed Central

    Douoguih, Wiemi A.; Dolce, Donald L.; Lincoln, Andrew E.

    2015-01-01

    Background: Early cocking phase pitching mechanics may affect risk of upper extremity injury requiring surgery in professional baseball players. Purpose: To assess the occurrence of inverted-W arm positioning and early trunk rotation in Major League Baseball (MLB) pitchers and to determine whether this throwing position is associated with upper extremity injury requiring surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: For 250 MLB pitchers in the 2010 season, 15 to 20 pitches from the start and end of an outing were reviewed using slow-motion game video for presence of an inverted-W position and early trunk rotation. Previous or current incidence of upper extremity injury requiring surgery for each player was determined using the MLB injury database, minor league injury records, available collegiate data, and publicly available online injury databases. Upper extremity surgery associated with an injury was considered to result from pitching. Results: Consensus between investigators was achieved for 99% of players for inverted-W positioning (248 players) and in 97% of players for early trunk rotation (243 players) for videos reviewed independently. Rate of surgery with and without inverted-W position was 28 of 93 (30%) and 42 of 155 (27%), respectively. Rate of surgery with and without early trunk rotation was 37 of 111 (33%) and 30 of 132 (23%), respectively. Using a Cox proportional hazards model for risk analysis using the measured number of innings pitched at time of surgery as an approximate index of exposure and adjusting for age and fastball speed at time of surgery, early trunk rotation was associated with significantly increased risk of shoulder and/or elbow surgery with hazard ratio estimate of 1.69 (95% CI, 1.02-2.80). Presence of the inverted-W position was not associated with significantly increased risk (hazard ratio, 1.30; 95% CI, 0.79-2.14). Conclusion: The inverted-W throwing position was not associated with significantly greater risk of upper extremity injury requiring surgery in MLB pitchers. Early trunk rotation was associated with significantly elevated risk of injury requiring surgery.

  16. 2015 PLASTIC SURGERY VISITING PROFESSOR

    E-print Network

    Shoubridge, Eric

    2015 PLASTIC SURGERY VISITING PROFESSOR Dr. MichaelW. Neumeister June 25th 2015 McGill University Division of Plastic Surgery #12;PROGRAM THURSDAY, JUNE 25th 2015 7:30 am OSLER AMPHITHEATRE ­ MONTREAL-102 Research Presentations ­ Residents & Graduate Students in Plastic Surgery 10:15 am Coffee Break 10:30 am

  17. Thurston norm and cosmetic surgeries

    E-print Network

    Ni, Yi

    2010-01-01

    Two Dehn surgeries on a knot are called cosmetic if they yield homeomorphic manifolds. For a null-homologous knot with certain conditions on the Thurston norm of the ambient manifold, if the knot admits cosmetic surgeries, then the surgery coefficients are equal up to sign.

  18. ROTATION-VIBRATION TETRAHEDRAL

    E-print Network

    Sadovskií, Dmitrií

    ANALYSIS OF ROTATION-VIBRATION RELATIVE EQUILIBRIA ON THE EXAMPLE OF A TETRAHEDRAL FOUR ATOM (RE) of a nonrigid molecule which vibrates about a well de#12;ned equilibrium con#12;guration and rotates as a whole. Our analysis uni#12;es the theory of rotational and vibrational RE. We rely

  19. Rotations with Rodrigues' Vector

    ERIC Educational Resources Information Center

    Pina, E.

    2011-01-01

    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…

  20. Visualizing molecular unidirectional rotation

    NASA Astrophysics Data System (ADS)

    Lin, Kang; Song, Qiying; Gong, Xiaochun; Ji, Qinying; Pan, Haifeng; Ding, Jingxin; Zeng, Heping; Wu, Jian

    2015-07-01

    We directly visualize the spatiotemporal evolution of a unidirectional rotating molecular rotational wave packet. Excited by two time-delayed polarization-skewed ultrashort laser pulses, the cigar- or disk-shaped rotational wave packet is impulsively kicked to unidirectionally rotate as a quantum rotor which afterwards disperses and exhibits field-free revivals. The rich dynamics can be coherently controlled by varying the timing or polarization of the excitation laser pulses. The numerical simulations very well reproduce the experimental observations and intuitively revivify the thoroughgoing evolution of the molecular rotational wave packet of unidirectional spin.

  1. Robot-assisted cardiac surgery.

    PubMed

    Ishikawa, Norihiko; Watanabe, Go

    2015-01-01

    Recognition of the significant advantages of minimizing surgical trauma has resulted in the development of minimally invasive surgical procedures. Endoscopic surgery offers patients the benefits of minimally invasive surgery, and surgical robots have enhanced the ability and precision of surgeons. Consequently, technological advances have facilitated totally endoscopic robotic cardiac surgery, which has allowed surgeons to operate endoscopically rather than through a median sternotomy during cardiac surgery. Thus, repairs for structural heart conditions, including mitral valve plasty, atrial septal defect closure, multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB), and totally endoscopic coronary artery bypass graft surgery (CABG), can be totally endoscopic. Robot-assisted cardiac surgery as minimally invasive cardiac surgery is reviewed. PMID:26134073

  2. Corneoplastique™: Art of vision surgery

    PubMed Central

    Gulani, Arun C

    2014-01-01

    Corneoplastique incorporates the entire spectrum of Vision corrective surgery including Lasik, premium cataract surgery, corneal surgery, ocular surface surgery and the full range of anterior segment surgery itself in manipulating the optics of every eye towards unaided emmetropia to define each and every eye surgeon as a “Vision Corrective Surgeon”. This concept of approaching each case individually and designing vision therewith enables surgeons to correct not only virgin eyes but also approach complex cases and complications with the goal of 20/20 vision. Armed with this holistic approach, eye surgeons can use minimally invasive, aesthetically pleasing and visually focused surgery in single or staged process aiming for each patient's Best Vision Potential (BVP) raising eye surgery itself then to an Art! PMID:24492495

  3. Cataract Surgery Tool

    NASA Technical Reports Server (NTRS)

    1977-01-01

    The NASA-McGannon cataract surgery tool is a tiny cutter-pump which liquefies and pumps the cataract lens material from the eye. Inserted through a small incision in the cornea, the tool can be used on the hardest cataract lens. The cutter is driven by a turbine which operates at about 200,000 revolutions per minute. Incorporated in the mechanism are two passages for saline solutions, one to maintain constant pressure within the eye, the other for removal of the fragmented lens material and fluids. Three years of effort have produced a design, now being clinically evaluated, with excellent potential for improved cataract surgery. The use of this tool is expected to reduce the patient's hospital stay and recovery period significantly.

  4. Controversies in amputation surgery.

    PubMed

    Pinzur, Michael S; Pinto, Marco A Guedes de Souza; Schon, Lew C; Smith, Douglas G

    2003-01-01

    Amputation surgery should be the first step in the rehabilitation of a patient with a nonfunctional limb, rather than the final step in treatment. When faced with a difficult decision regarding lower extremity amputation compared with attempted limb reconstruction, expectations for a reasonable outcome must be determined. After reasonable goals have been set, the surgery should be directed toward interfacing with a prosthetic limb. Current surgical techniques of lower extremity amputation, paying special attention to transosseous versus disarticulation amputation, help to optimize prosthetic limb fitting and functional rehabilitation. With the evolution of end-bearing amputation levels, there is resurgent interest in the bone bridging technique of Johann Ertl and interest in a new pneumatic immediate postoperative prosthetic limb fitting system. PMID:12690870

  5. Minor surgery in microgravity

    NASA Technical Reports Server (NTRS)

    Billica, Roger; Krupa, Debra T.; Stonestreet, Robert; Kizzee, Victor D.

    1991-01-01

    The purpose is to investigate and demonstrate equipment and techniques proposed for minor surgery on Space Station Freedom (SSF). The objectives are: (1) to test and evaluate methods of surgical instrument packaging and deployment; (2) to test and evaluate methods of surgical site preparation and draping; (3) to evaluate techniques of sterile procedure and maintaining sterile field; (4) to evaluate methods of trash management during medical/surgical procedures; and (4) to gain experience in techniques for performing surgery in microgravity. A KC-135 parabolic flight test was performed on March 30, 1990 with the goal of investigating and demonstrating surgical equipment and techniques under consideration for use on SSF. The flight followed the standard 40 parabola profile with 20 to 25 seconds of near-zero gravity in each parabola.

  6. Laparoscopy in General Surgery

    PubMed Central

    O'Regan, Patrick J.; Anderson, Dawn L.

    1992-01-01

    After a period of rather slow initial acceptance by general surgeons, laparoscopy and video endoscopic surgery have suddenly burst on to the surgical scene. Almost overnight many of the surgical procedures once requiring a large incision are now being performed through small punctures. This article describes some of the more common procedures and discusses the merits and difficulties associated with these innovations. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:21221367

  7. Surgery of the Trachea

    PubMed Central

    Allen, Mark S.

    2015-01-01

    Surgical procedures on the trachea have only been undertaken within the past 50 years. Knowing the unique blood supply of the trachea and how to reduce tension on any anastomosis are key to a successful outcome. Tracheal conditions requiring surgery usually present with shortness of breath on exertion, and preoperative evaluation involves computed tomography and rigid bronchoscopy. Tracheal resection and reconstruction can be safely performed with excellent outcomes by following a well-described technique. PMID:26290833

  8. Pediatric Sleep Surgery

    PubMed Central

    Sulman, Cecille G.

    2014-01-01

    Adenotonsillectomy is the most common surgery performed for sleep disordered breathing with good outcomes. Children with obesity, craniofacial disorders, and neurologic impairment are at risk for persistent sleep apnea after adenotonsillectomy. Techniques exist to address obstructive lesions of the palate, tongue base, or craniofacial skeleton in children with persistent sleep apnea. Children with obstructive sleep apnea have a higher rate of peri-operative complications. PMID:24926473

  9. Common surgery, uncommon complication

    PubMed Central

    Akdeniz, Hande; Ozer, Kadri; Dikmen, Adile; Kocer, Uger

    2015-01-01

    Ingrown nail surgery is the one of the most common surgeries in outpatient clinics that are generally perfomed in response to patient complaints. Still, making simple observations, taking patient histories and conducting further tests are often neglected by outpatient clinics. Consequently, it is important to be aware if ingrown nail is associated with any underlying diseases that can lead to major complications. In this article, we report on two cases ending in amputation that were performed with Winograd’s partial matrix excision procedure for ingrown nails. Such a complication is rare, unexpected, and most unwanted in forefoot surgery. After a detailed analysis of the situation, we discovered that both patients were smokers, and one of them had Buerger’s disease. These conditions led to the ingrown nails in addition to poor wound healing. This case report emphasizes the fact that even when performing minor procedures, obtaining a detailed history and conducting an examination are of paramount importance. Patient selection is also a considerable factor, especially for patients who are smokers, who may experience a worst case surgical scenario. PMID:26693080

  10. Common surgery, uncommon complication.

    PubMed

    Akdeniz, Hande; Ozer, Kadri; Dikmen, Adile; Kocer, Uger

    2015-10-01

    Ingrown nail surgery is the one of the most common surgeries in outpatient clinics that are generally perfomed in response to patient complaints. Still, making simple observations, taking patient histories and conducting further tests are often neglected by outpatient clinics. Consequently, it is important to be aware if ingrown nail is associated with any underlying diseases that can lead to major complications. In this article, we report on two cases ending in amputation that were performed with Winograd's partial matrix excision procedure for ingrown nails. Such a complication is rare, unexpected, and most unwanted in forefoot surgery. After a detailed analysis of the situation, we discovered that both patients were smokers, and one of them had Buerger's disease. These conditions led to the ingrown nails in addition to poor wound healing. This case report emphasizes the fact that even when performing minor procedures, obtaining a detailed history and conducting an examination are of paramount importance. Patient selection is also a considerable factor, especially for patients who are smokers, who may experience a worst case surgical scenario. PMID:26693080

  11. Cardiac surgery for arrhythmias.

    PubMed

    Cox, James L

    2004-02-01

    Cardiac arrhythmia surgery was initiated in 1968 with the first successful division of an accessory AV connection for the Wolff-Parkinson-White Syndrome. Subsequent surgical procedures included the left atrial isolation procedure and the right atrial isolation procedure for automatic atrial tachycardias, discrete cryosurgery of the AV node for AV nodal reentry tachycardia, the atrial transection procedure, corridor procedure and Maze procedure for atrial fibrillation, the right ventricular disconnection procedure for arrhythmogenic right ventricular tachycardia, the encircling endocardial ventriculotomy, subendocardial resection procedure, endocardial cryoablation, the Jatene procedure, and the Dor procedure for ischemic ventricular tachycardia. Because of monumental strides in the treatment of most refractory arrhythmias by endocardial catheter techniques during the past decade, the only remaining viable surgical procedures for cardiac arrhythmias are the Maze procedure for atrial fibrillation and the Dor procedure for ischemic ventricular tachycardia. Nevertheless, the 25-30 years of intense activity in the field of cardiac arrhythmia surgery provided the essential foundation for the development of these catheter techniques and represent one of the most exciting and productive eras in the history of medicine. In one short professional career, we have witnessed the birth of arrhythmia surgery, its adolescence as an "esoteric" specialty, its prime as an enlightening yet exhausting period, and finally its waning years as a source of knowledge and wisdom on which better methods of treatment have been founded. One could hardly ask for a more rewarding experience. PMID:14764186

  12. Cardiac surgery for arrhythmias.

    PubMed

    Cox, James L

    2004-02-01

    Cardiac arrhythmia surgery was initiated in 1968 with the first successful division of an accessory AV connection for the Wolff-Parkinson-White syndrome. Subsequent surgical procedures included the left atrial isolation procedure and right atrial isolation procedure for automatic atrial tachycardias, discrete cryosurgery of the AV node for AV nodal reentrant tachycardia, the atrial transection procedure, the corridor procedure, and the maze procedure for atrial fibrillation, the right ventricular disconnection procedure for arrhythmogenic right ventricular tachycardia, and the encircling endocardial ventriculotomy, subendocardial resection procedure, endocardial cryoablation, the Jatene procedure, and the Dor procedure for ischemic ventricular tachycardia. Because of monumental strides in the treatment of most refractory arrhythmias by endocardial catheter techniques during the past decade, the only remaining viable surgical procedures for cardiac arrhythmias are the maze procedure for atrial fibrillation and the Dor procedure for ischemic ventricular tachycardia. Nevertheless, the 25 to 30 years of intense activity in the field of cardiac arrhythmia surgery provided the essential foundation for the development of these catheter techniques and represent one of the most exciting and productive eras in the history of medicine. In one short professional career, we have witnessed the birth of arrhythmia surgery, its adolescence as an "esoteric" specialty, its prime as an enlightening yet exhausting period, and finally its waning years as a source of knowledge and wisdom upon which better methods of treatment have been founded. One could hardly ask for a more rewarding experience. PMID:15028063

  13. Cardiac surgery for arrhythmias.

    PubMed

    Cox, James L

    2004-11-01

    Cardiac arrhythmia surgery was initiated in 1968 with the first successful division of an accessory AV connection for the Wolff-Parkinson-White Syndrome. Subsequent surgical procedures included the left atrial isolation procedure and the right atrial isolation procedure for automatic atrial tachycardias, discrete cryosurgery of the AV node for AV nodal reentry tachycardia, the atrial transection procedure, corridor procedure and Maze procedure for atrial fibrillation, the right ventricular disconnection procedure for arrhythmogenic right ventricular tachycardia, the encircling endocardial ventriculotomy, subendocardial resection procedure, endocardial cryoablation, the Jatene procedure, and the Dor procedure for ischemic ventricular tachycardia. Because of monumental strides in the treatment of most refractory arrhythmias by endocardial catheter techniques during the past decade, the only remaining viable surgical procedures for cardiac arrhythmias are the Maze procedure for atrial fibrillation and the Dor procedure for ischemic ventricular tachycardia. Nevertheless, the 25-30 years of intense activity in the field of cardiac arrhythmia surgery provided the essential foundation for the development of these catheter techniques and represent one of the most exciting and productive eras in the history of medicine. In one short professional career, we have witnessed the birth of arrhythmia surgery, its adolescence as an "esoteric" specialty, its prime as an enlightening yet exhausting period, and finally its waning years as a source of knowledge and wisdom on which better methods of treatment have been founded. One could hardly ask for a more rewarding experience. PMID:23570110

  14. Percutaneous Nephroscopic Surgery

    PubMed Central

    2010-01-01

    With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases. PMID:20495691

  15. Spare-Part Surgery

    PubMed Central

    Peng, Yeong Pin; Lahiri, Amitabha

    2013-01-01

    The authors discuss the use of scavenged tissue for reconstruction of an injured limb, also referred to as “spare-part surgery.” It forms an important part of overall reconstructive strategy. Though some principles can be laid down, there is no “textbook” method for the surgeon to follow. Successful application of this strategy requires understanding of the concept, accurate judgment, and the ability to plan “on-the-spot,” as well as knowledge and skill to improvise composite flaps from nonsalvageable parts. Requirements for limb reconstruction vary from simple solutions such as tissue coverage, which include skin grafts or flaps to more complex planning as in functional reconstruction of the hand, where the functional importance of individual digits as well as the overall prehensile function of the hand needs to be addressed right from the time of primary surgery. The incorporation of the concept of spare-part surgery allows the surgeon to carry out primary reconstruction of the limb without resorting to harvest tissue from other regions of the body. PMID:24872768

  16. Radioguided Adrenal Surgery

    PubMed Central

    Deus, Javier; Millera, Alfonso; Andrés, Alejandro; Prats, Enrique; Gil, Ismael; Suarez, Manuel; Salcini, José L.; Lahoz, Manuel

    2015-01-01

    Abstract The laparoscopic adrenalectomy is considered as the procedure of choice for the treatment of adrenal hyperplasia and tumor lesions. However, some special situations may limit the use of this method due to the difficulty to locate the gland and perform the lesion excision. We analyze 2 patients of a left adrenal tumor, explaining how they have overcome the difficulties in both situations. The first case was a patient with a history of intra-abdominal surgery and the other patient suffered from severe obesity. We performed with the use of the gamma probe, and the 2 cases, was of great help to access and glandular localization. The help of gamma probe test was achieved in the surgical bed, that removal was complete. The use of the portable gamma probe facilitated the access to the left adrenal gland as well as conducting the glandular excision without delay, despite the difficulties due to the intra abdominal surgery caused by the previous surgery, and in the case of severe obesity. PMID:26426608

  17. [Precise thoracic surgery: new era of minimally invasive surgery].

    PubMed

    Li, Hui

    2015-10-01

    Precise surgery is based on the integrated application of modern science and technology and integrated innovation of surgical technology revolution features. It is built in high-end digital medical bases. The purpose of precise surgery is to achieve accurate lesion resection, minimize injury, improve the quality of life and reduce the risk of surgery. In this paper we forward new concept of precise thoracic surgery. An overview was made on the development of precise surgery with great support of virtual reality technology, augmented reality technology and image acquisition technology. Finally the paper illustrated the prospect of precise of thoracic surgery from the following aspects: preoperative planning, the choice of surgical approach, precise tumor localization, postoperative immediate 3-dimension multi modality imaging evaluation. PMID:26654300

  18. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    PubMed Central

    Hartel, Bas Pieter; Alta, Tjarco D.; Sewnath, Miguel E.; Willems, Willem J.

    2015-01-01

    Introduction: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision indication and differences between total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) in hemiarthroplasty (HA) revision surgery. Materials and Methods: All patients with an indication for revision of HA were retrospectively included. Clinical evaluation consisted of pre- and post-operative constant scores, disability of arm-shoulder-hand-score (DASH), Dutch translation of the simple shoulder test ((D)SST), Oxford shoulder score test (OSS), short form (SF-36) and the complication rate. Results: From July 1994 to July 2008, 39 patients (40 shoulders) underwent revision arthroplasty. Of 19 patients (19 shoulders) we obtained a complete follow-up. The mean age at revision surgery 69 ± 10 years (range: 46-83) and the mean follow-up 41 ± 31 months (range: 10-113). In 7 cases TSA was used for revision when the cuff was intact, 12 times RSA was performed. The indications for the revision were glenoid erosion (n = 4), humeral component malposition (n = 2), cuff-pathology (n = 12) and infection (n = 1). Postoperative constant score 51.7 ± 11.4 for TSA and 31.1 ± 18.7 for RSA (P = 0.008). The DASH was 48.3 ± 25.1 and 68.7 ± 17.5, respectively (P = 0.09). DSST showed 6 ± 4 and 4 ± 4 (P = 0.414). OSS 41.3 ± 10.1 and 28.1 ± 10.3 (P = 0.017). SF-36 43.3 ± 22.1 and 24.5 ± 12.8 (P = 0.072). Four shoulders (21%) presented four complications. Conclusions: In this study, revision surgery showed poor to reasonable postoperative results and better clinical outcome for TSA. When a revision after HA was needed, and the soft-tissue component of the shoulder was intact, a TSA proved to be a preferable solution. PMID:26288535

  19. Global cancer surgery: delivering safe, affordable, and timely cancer surgery.

    PubMed

    Sullivan, Richard; Alatise, Olusegun Isaac; Anderson, Benjamin O; Audisio, Riccardo; Autier, Philippe; Aggarwal, Ajay; Balch, Charles; Brennan, Murray F; Dare, Anna; D'Cruz, Anil; Eggermont, Alexander M M; Fleming, Kenneth; Gueye, Serigne Magueye; Hagander, Lars; Herrera, Cristian A; Holmer, Hampus; Ilbawi, André M; Jarnheimer, Anton; Ji, Jia-Fu; Kingham, T Peter; Liberman, Jonathan; Leather, Andrew J M; Meara, John G; Mukhopadhyay, Swagoto; Murthy, Shilpa S; Omar, Sherif; Parham, Groesbeck P; Pramesh, C S; Riviello, Robert; Rodin, Danielle; Santini, Luiz; Shrikhande, Shailesh V; Shrime, Mark; Thomas, Robert; Tsunoda, Audrey T; van de Velde, Cornelis; Veronesi, Umberto; Vijaykumar, Dehannathparambil Kottarathil; Watters, David; Wang, Shan; Wu, Yi-Long; Zeiton, Moez; Purushotham, Arnie

    2015-09-01

    Surgery is essential for global cancer care in all resource settings. Of the 15·2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US$6·2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery-eg, pathology and imaging-are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning. PMID:26427363

  20. Research and education in thoracic surgery: the European trainees’ perspective

    PubMed Central

    Ilonen, Ilkka K.

    2015-01-01

    Thoracic surgery training within Europe is diverse and a consensus may help to harmonise the training. Currently, training for thoracic surgery compromises thoracic, cardiothoracic and aspects of general surgical training. The recognition of specialist degrees should be universal and equal. Between different nations significant differences in training exist, especially in general surgery rotations and in the role of oesophageal surgery. The European board examination for thoracic surgery is one of the key ways to achieve harmonisation within the European Union (EU) and internationally. Further support and encouragement may be beneficial to promote diverse and engaging fellowships and clinical exchange programmes between nations. International fellowships may even benefit young residents, in both clinical and academic settings. Many studies currently would benefit from multi-centre and multi-national design, enhancing the results and giving better understanding of clinical scenarios. Educational content provided by independent organisations should be more recognised as an integral part in both resident training and continuing development throughout surgeons’ careers. During annual society meetings, trainees should have some sessions that are aimed at enhancing their training and establishing networks of international peers. PMID:25984356

  1. Resident away rotations allow adaptive neurosurgical training.

    PubMed

    Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

    2015-04-01

    Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations. PMID:25635889

  2. Robotic surgery of the pancreas

    PubMed Central

    Joyce, Daniel; Morris-Stiff, Gareth; Falk, Gavin A; El-Hayek, Kevin; Chalikonda, Sricharan; Walsh, R Matthew

    2014-01-01

    Pancreatic surgery is one of the most challenging and complex fields in general surgery. While minimally invasive surgery has become the standard of care for many intra-abdominal pathologies the overwhelming majority of pancreatic surgery is performed in an open fashion. This is attributed to the retroperitoneal location of the pancreas, its intimate relationship to major vasculature and the complexity of reconstruction in the case of pancreatoduodenectomy. Herein, we describe the application of robotic technology to minimally invasive pancreatic surgery. The unique capabilities of the robotic platform have made the minimally invasive approach feasible and safe with equivalent if not better outcomes (e.g., decreased length of stay, less surgical site infections) to conventional open surgery. However, it is unclear whether the robotic approach is truly superior to traditional laparoscopy; this is a key point given the substantial costs associated with procuring and maintaining robotic capabilities. PMID:25356035

  3. Robotic surgery of the pancreas.

    PubMed

    Joyce, Daniel; Morris-Stiff, Gareth; Falk, Gavin A; El-Hayek, Kevin; Chalikonda, Sricharan; Walsh, R Matthew

    2014-10-28

    Pancreatic surgery is one of the most challenging and complex fields in general surgery. While minimally invasive surgery has become the standard of care for many intra-abdominal pathologies the overwhelming majority of pancreatic surgery is performed in an open fashion. This is attributed to the retroperitoneal location of the pancreas, its intimate relationship to major vasculature and the complexity of reconstruction in the case of pancreatoduodenectomy. Herein, we describe the application of robotic technology to minimally invasive pancreatic surgery. The unique capabilities of the robotic platform have made the minimally invasive approach feasible and safe with equivalent if not better outcomes (e.g., decreased length of stay, less surgical site infections) to conventional open surgery. However, it is unclear whether the robotic approach is truly superior to traditional laparoscopy; this is a key point given the substantial costs associated with procuring and maintaining robotic capabilities. PMID:25356035

  4. Pediatric robotic urologic surgery-2014.

    PubMed

    Kearns, James T; Gundeti, Mohan S

    2014-07-01

    We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide. PMID:25197187

  5. Pediatric robotic urologic surgery-2014

    PubMed Central

    Kearns, James T.; Gundeti, Mohan S.

    2014-01-01

    We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide. PMID:25197187

  6. Telemetric Blood Pressure Assessment in Angiotensin II-Infused ApoE-/- Mice: 28 Day Natural History and Comparison to Tail-Cuff Measurements

    PubMed Central

    Haggerty, Christopher M.; Mattingly, Andrea C.; Gong, Ming C.; Su, Wen; Daugherty, Alan; Fornwalt, Brandon K.

    2015-01-01

    Abdominal aortic aneurysm (AAA) is a disease of the aortic wall, which can progress to catastrophic rupture. Assessment of mechanical characteristics of AAA, such as aortic distensibility, may provide important insights to help identify at-risk patients and understand disease progression. While the majority of studies on this topic have focused on retrospective patient data, recent studies have used mouse models of AAA to prospectively evaluate the evolution of aortic mechanics. Quantification of aortic distensibility requires accurate measurement of arterial blood pressure, particularly pulse pressure, which is challenging to perform accurately in murine models. We hypothesized that volume/pressure tail-cuff measurements of arterial pulse pressure in anesthetized mice would have sufficient accuracy to enable calculations of aortic distensibility with minimal error. Telemetry devices and osmotic mini-pumps filled with saline or angiotensin-II were surgically implanted in male apolipoprotein-E deficient (ApoE-/-) mice. Blood pressure in the aortic arch was measured continuously via telemetry. In addition, simultaneous blood pressure measurements with a volume/pressure tail-cuff system were performed under anesthesia at specific intervals to assess agreement between techniques. Compared to controls, mice infused with angiotensin-II had an overall statistically significant increase in systolic pressure, with no overall difference in pulse pressure; however, pulse pressure did increase significantly with time. Systolic measurements agreed well between telemetry and tail-cuff (coefficient of variation = 10%), but agreement of pulse pressure was weak (20%). In fact, group-averaged pulse pressure from telemetry was a better predictor of a subject’s pulse pressure on a given day than a simultaneous tail-cuff measurement. Furthermore, these approximations introduced acceptable errors (15.1 ± 12.8%) into the calculation of aortic distensibility. Contrary to our hypothesis, we conclude that tail-cuff measures of arterial pulse pressure have limited accuracy. Future studies of aneurysm mechanics using the ApoE-/-/angiotensin-II model would be better in assuming pulse pressure profiles consistent with our telemetry findings instead of attempting to measure pulse pressure in individual mice. PMID:26086817

  7. Nonintubated anesthesia for thoracic surgery

    PubMed Central

    Wang, Bei

    2014-01-01

    Nonintubated thoracic surgery has been used in procedures including pleura, lungs and mediastinum. Appropriate anesthesia techniques with or without sedation allow thoracic surgery patients to avoid the potential risks of intubated general anesthesia, particularly for the high-risk patients. However, nonintubated anesthesia for thoracic surgery has some benefits as well as problems. In this review, the background, indication, perioperative anesthetic consideration and management, and advantages and disadvantages are discussed and summarized. PMID:25589994

  8. Surgery for gastrinoma.

    PubMed

    Cisco, Robin M; Norton, Jeffrey A

    2007-01-01

    Surgery has been demonstrated to offer potential for cure in patients who have sporadic ZES and improved tumor-related survival in all patients who have ZES with gastrinomas larger than 2.5 cm. Techniques such as preoperative localization with SRS and intraoperative localization with duodenotomy have improved the effectiveness of surgical intervention for ZES. Future directions for investigation should include better defining the role of preoperative EUS and developing new, more sensitive techniques for preoperative localization. More research also is needed to define the appropriate indications for pancreaticoduodenectomy in ZES and to determine whether proximal vagotomy should be performed at the time of surgical exploration. PMID:17972563

  9. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery. PMID:15747974

  10. Revision of failed flatfoot surgery.

    PubMed

    Lee, Michael S; Maker, Jared M

    2009-01-01

    Revision of failed flatfoot surgery presents a unique and challenging dilemma for the foot and ankle surgeon. Revision surgery is focused on establishing a plantigrade foot with correction of the hindfoot valgus, midfoot abduction, and forefoot varus. Successful reconstruction of failed flatfoot surgery begins with a proper evaluation. No treatment algorithm exists for the management of the malaligned flatfoot. Patient complaints, an understanding of the initial deformity and biomechanical problems, and surgeon experience play a role in correction of failed flatfoot surgery. PMID:19121753

  11. Differential-Rotation Law of Slowly Rotating Star Jianyong Shen

    E-print Network

    Xu, Ren-Xin

    they will became uniformly rotating by some mechanisms in the process of cooling down. A differentially rotating star can support more mass in equilibrium than by uniform rotation, because the core of star may rotate valid and little effects will happen when we change eqn.(8). It's necessary to find a rotation law

  12. Anesthesia for microlaryngeal surgery: the case for subglottic jet ventilation.

    PubMed

    Hunsaker, D H

    1994-08-01

    Although the techniques for surgery on the endolarynx using suspension and the operating microscope have been fully developed, the safest, and least obtrusive anesthetic technique has yet to be manifested, as evidenced by more than 200 references to anesthesia for microlaryngoscopy in the world literature. This study reviews the physiology, physics, and problems of each anesthetic technique. In light of this review, animal and human studies are reported demonstrating the utility and safety of subglottic ventilation when provided with proper monitoring using an automatic ventilator. A modified Ben-Jet tube is reported, which has a 1-mm ID channel to monitor PCO2 and tracheal pressure. This self-centering 3.0-mm tube, which extends 6 to 8 cm below the glottis, is unobtrusive for the surgeon. The subglottic tube, which is much less likely to be malaligned, is much more acceptable to the anesthesiologist. Anesthesia, by intravenous sedation, utilizes neuromuscular blockade while ventilating through the jet tube powered by an automatic ventilator with an automatic shutdown feature attached to the monitor tube to prevent inadvertent barotrauma. The third phase of this study compared fluoroplastic, used in a prototype jet ventilation tube, with 6-mm Silastic, Red Rubber, and polyvinyl chloride (PVC) tubes when struck by maximum power of CO2, Nd-YAG, and K-532 lasers. The test was performed in a closed chamber in which concentrations of oxygen and nitrogen were controlled. Although damaged by the CO2 laser beam, the fluoroplastic tubes did not continue burning when the laser was turned off in 100% oxygen, even when coated by blood. The other three tubes continued to burn in 23% oxygen. Neither the KTP nor Nd-YAG laser damaged the Teflon tube, while they ignited a sustained flame in 30% oxygen. This study supports the use of fluoroplastic for a laser safe jet ventilation tube. It also demonstrates the danger of tube fires, even in low oxygen concentrations, when using Silastic, rubber, and PVC tubes in laser laryngeal surgery. There was no difference in the flammability of Silastic, rubber or PVC when struck by these lasers in this study. For these reasons, subglottic ventilation using a fluoroplastic, monitored, self-centering, subglottic, jet ventilation tube driven by an automatic ventilator with a shutdown feature, in the event of excessive pressure buildup, is proposed for anesthetizing healthy patients undergoing suspension microlaryngoscopy, and who have no airway obstructing lesion. A large tube with inflatable cuff is indicated when a supraglottic lesion may obstruct the airway. PMID:8052087

  13. Additional Surgery after Breast-Conserving Surgery Varies Widely

    Cancer.gov

    A study published in the Feb. 1, 2012, issue of JAMA found that the number of women who have one or more additional surgeries to remove suspected residual tumor tissue (re-excisions) following breast-conserving surgery (BCS) for breast cancer varies widely across surgeons and hospitals.

  14. Eye Surgery Light

    NASA Technical Reports Server (NTRS)

    1978-01-01

    During eye surgery, the surgeon uses an illuminating instrument called an opthalmoscope for close examination of the retina or the interior of the eye. Ordinarily, electric power for the head-mounted light is supplied through a cord from an overhead swivel arm or a floor pedestal. Within limits of cord length and swivel arm movement, the surgeon has considerable freedom of motion. But when more than one opthalmoscope is involved, tangling and interference of the power cords becomes a problem. St. Luke's Hospital, Cleveland, Ohio asked Lewis Research Center for assistance in finding a solution. Lewis responded with a battery-powered system that totally frees the surgeon of attached cords and swivels. Borrowing from space technology, Lewis used small, lightweight nickel-cadmium batteries that can deliver high intensity light for an hour and can be recharged overnight. The Opthalmoscope Powerpack consists of eight batteries in three containers affixed to a webbed belt, and a novel on-off switch equipped with a springloaded plexiglass "flapper." The belt pack is worn underneath the surgical gown and the flapper permits the doctor to activate the switch by elbow pressure. Lewis built five units and they have been in service at St. Luke's Hospital for a year. Used for routine examinations as well as for surgery, they have demonstrated excellent reliability.

  15. Eye Surgery Light

    NASA Technical Reports Server (NTRS)

    1978-01-01

    During eye surgery, the surgeon uses an illuminating instrument called an opthalmoscope for close examination of the retina or the interior of the eye. Ordinarily, electric power for the head-mounted light is supplied through a cord from an overhead swivel arm or a floor pedestal. Within limits of cord length and swivel arm movement, the surgeon has considerable freedom of motion. But when more than one opthalmoscope is involved, tangling and interference of the power cords becomes a problem. St. Luke's Hospital, Cleveland, Ohio asked Lewis Research Center for assistance in finding a solution. Lewis responded with a battery-powered system that totally frees the surgeon of attached cords and swivels. Borrowing from space technology, Lewis used small, lightweight nickel-cadmium batteries that can deliver high intensity light for an hour and can be recharged overnight. The Opthalmoscope Powerpack consists of eight batteries in three containers affixed to a webbed belt, and a novel on-off switch equipped with a spring-loaded plexiglass 'flapper.' The belt pack is worn underneath the surgical gown and the flapper permits the doctor to activate the switch by elbow pressure. Lewis built five units and they have been in service at St. Luke's Hospital for a year. Used for routine examinations as well as for surgery, they have demonstrated excellent reliability.

  16. Robotic surgery: urologic implications.

    PubMed

    Moran, Michael E

    2003-11-01

    Current medical robots have nothing in common with the anthropomorphic robots in science fiction classics. They are in fact, manipulators, working on a master-slave principle. Robots can be defined as "automatically controlled multitask manipulators, which are freely programmable in three or more spaces." The success of robots in surgery is based on their precision, lack of fatigue, and speed of action. This review describes the theory, advantages, disadvantages, and clinical utilization of mechanical and robotic arm systems to replace the second assistant and provide camera direction and stability during laparoscopic surgery. The Robotrac system (Aesculap, Burlingame, CA), the First Assistant (Leonard Medical Inc, Huntingdon Valley, PA), AESOP (Computer Motion, Goleta, CA), ZEUS (Computer Motion), and the da Vinci (Intuitive Surgical, Mountain View, CA) system are reviewed, as are simple mechanical-assist systems such as Omnitract (Minnesota Scientific, St. Paul, MN), Iron Intern (Automated Medical Products Corp., New York, NY), the Bookwalter retraction system (Codman , Somerville, NJ), the Surgassistant trade mark (Solos Endoscopy, Irvine, CA), the Trocar Sleeve Stabilizer (Richard Wolf Medical Instruments Corp., Rosemont, IL), and the Endoholder (Codman, Somerville, NJ). PMID:14642026

  17. [Computer-assisted surgery].

    PubMed

    Micali, Salvatore

    2011-01-01

    The broad range of Computer Assisted Surgery (CAS) represents the integration of computer technology in surgical procedures for presurgical planning, guiding or manipulation. Surgical robots and surgical endoscopic navigation are the most challenging applications to urology. A surgical robot is defined as a computer-controlled manipulator with artificial sensing which can be programmed to move, and position tools to carry out surgical tasks. In urology, robots have been tested in two areas: endourology and laparoscopy. Surgical navigation allows the surgeon to process data from pre- and intraoperative sources, aiming at purification and presentation of the most relevant information. Image-guided systems (IGS), augmented reality (AR) and navigation in endoscopic soft tissue surgery represent the three main topics of surgical urological navigation. IGS involve matching the coordinates from medical imaging (preoperative registration) with coordinates from the patient in the operating room (registration and updating images). IGS have become the standard of care in providing navigational assistance during neurosurgery, offering subsurface and functional information to the surgeon. PMID:21452161

  18. Future of robotic surgery.

    PubMed

    Lendvay, Thomas Sean; Hannaford, Blake; Satava, Richard M

    2013-01-01

    In just over a decade, robotic surgery has penetrated almost every surgical subspecialty and has even replaced some of the most commonly performed open oncologic procedures. The initial reports on patient outcomes yielded mixed results, but as more medical centers develop high-volume robotics programs, outcomes appear comparable if not improved for some applications. There are limitations to the current commercially available system, and new robotic platforms, some designed to compete in the current market and some to address niche surgical considerations, are being developed that will change the robotic landscape in the next decade. Adoption of these new systems will be dependent on overcoming barriers to true telesurgery that range from legal to logistical. As additional surgical disciplines embrace robotics and open surgery continues to be replaced by robotic approaches, it will be imperative that adequate education and training keep pace with technology. Methods to enhance surgical performance in robotics through the use of simulation and telementoring promise to accelerate learning curves and perhaps even improve surgical readiness through brief virtual-reality warm-ups and presurgical rehearsal. All these advances will need to be carefully and rigorously validated through not only patient outcomes, but also cost efficiency. PMID:23528717

  19. Leadership in cardiac surgery.

    PubMed

    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos

    2011-06-01

    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance. PMID:20884217

  20. Fibronectin and craniofacial surgery.

    PubMed

    Al-Qattan, Mohammad M; AlShomer, Feras; Alqahtani, Abdullah; Alhadlg, Ahmad

    2014-12-01

    Fibronectin is an essential component of the extracellular matrix. The role of fibronectin in craniofacial surgery has not been previously reviewed. Fibronectin mediates bone differentiation and development of the skull. Studies have shown that normal development of the skull requires a specific pattern of expression around the epithelial-mesenchymal interface of the neurocranium. Fibronectin is also essential in mediating the migration of neural crest cells to form the facial skeleton. The calvaria of patients with Apert and Crouzon syndromes have an abnormally elevated collagen level. However, fibronectin levels are elevated in the former syndrome and decreased in the latter syndrome. The significance of this requires further research. Fibronectin gene expression is increased in port wine-derived fibroblasts in patients with Sturge-Weber syndrome. Normal palatogenesis also requires a specific pattern of expression of fibronectin around the maxillary process as well as the roof of the stomodeum, and several studies have linked the development of cleft lip/palate to an imbalance of fibronectin content of the extracellular matrix. Fibronectin mediates cell-to-cell attachment during repair of calvarial defects; hence, fibronectin has been used as a carrier for bone morphogenetic proteins to treat calvarial defects. Finally, fibronectin is now an essential component in stem cell technology related to craniofacial surgery. PMID:24322634

  1. THE OLD ROTATION, 2005

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Old Rotation (circa 1896) is the oldest, continuous cotton experiment in the world. Its 13 plots on 1 acre of land on the campus of Auburn University continue to document the long-term effects of crop rotations with and without winter legumes (crimson clover) as a source of nitrogen for cotton,...

  2. Diamagnetism of rotating plasma

    SciTech Connect

    Young, W. C.; Hassam, A. B.; Romero-Talamas, C. A.; Ellis, R. F.; Teodorescu, C.

    2011-11-15

    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.

  3. Rotational cavity optomechanics

    E-print Network

    Bhattacharya, M

    2015-01-01

    We theoretically examine the optomechanical interaction between a rotating nanoparticle and an orbital angular momentum-carrying optical cavity mode. Specifically, we consider a dielectric nanosphere rotating uniformly in a ring-shaped optical potential inside a Fabry-Perot resonator. The motion of the particle is probed by a weak angular lattice, created by introducing two additional degenerate Laguerre-Gaussian cavity modes carrying equal and opposite orbital angular momenta. We demonstrate that the rotation frequency of the nanoparticle is imprinted on the probe optical mode, via the Doppler shift, and thus may be sensed experimentally using homodyne detection. We show analytically that the effect of the optical probe on the particle rotation vanishes in the regime of linear response, resulting in an accurate frequency measurement. We also numerically characterize the degradation of the measurement accuracy when the system is driven in the nonlinear regime. Our results are relevant to rotational Doppler ve...

  4. Anti-reflux surgery - discharge

    MedlinePLUS

    ... people go back to work 2 to 3 weeks after laparoscopic surgery and 4 to 6 weeks after open surgery. You may have a feeling ... tightness when you swallow for 6 to 8 weeks. This is from the swelling inside your esophagus. ...

  5. Robotic assisted surgery. Part One.

    PubMed

    Martin, Shirley; Murz, Yaron; Darzi, Ara

    2004-01-01

    Since the first laparoscopic cholecystectomies were performed by Muhe in 1986 and Mouret in 1987, minimal access surgery has been widely accepted and applied to many procedures. By the end of the 1990s, surgical robots had emerged in operating theatres around the world. This technology has the potential to revolutionise minimal access surgery. PMID:14768124

  6. A History of Shoulder Surgery

    PubMed Central

    Iqbal, S; Jacobs, U; Akhtar, A; Macfarlane, R.J; Waseem, M

    2013-01-01

    Shoulder surgery has emerged from being a marginalised sub-speciality to being an area of much research and advancement within the last seventy years. This has been despite the complexity of the joint, and success majorly rests on parallel development of biomedical technology. This article looks at the past and present of shoulder surgery and discusses future directions in the speciality. PMID:24082968

  7. Telemedicine, virtual reality, and surgery

    NASA Technical Reports Server (NTRS)

    Mccormack, Percival D.; Charles, Steve

    1994-01-01

    Two types of synthetic experience are covered: virtual reality (VR) and surgery, and telemedicine. The topics are presented in viewgraph form and include the following: geometric models; physiological sensors; surgical applications; virtual cadaver; VR surgical simulation; telesurgery; VR Surgical Trainer; abdominal surgery pilot study; advanced abdominal simulator; examples of telemedicine; and telemedicine spacebridge.

  8. Weight Loss Surgery: An Option for Teens?

    MedlinePLUS

    ... Español Text Size Email Print Share Weight Loss Surgery: An Option for Teens? Article Body Although the ... not be made hastily. Candidates for Weight Loss Surgery Weight loss surgery is advisable only for extremely ...

  9. Carpal Tunnel Release Surgery Learning Module

    MedlinePLUS

    ... Sections Introduction Your Hand and Wrist Causes of Carpal Tunnel Syndrome Symptoms Diagnosis Nonsurgical Treatment Surgical Treatment Your Surgery After Surgery Risks and Complications Conclusion Related Topics Exit This ... Patient - Carpal Tunnel Release Surgery Help Introduction Welcome to the ...

  10. Cosmetic Foot Surgery: Fashion's Pandora's Box

    MedlinePLUS

    ... Cosmetic Foot Surgery: Fashion’s Pandora’s Box? Foot and Ankle Surgeons Warn Against Taking Part in Growing Surgery ... members of the American College of Foot and Ankle Surgeons, who specialize in foot surgery, are taking ...

  11. Weight-loss surgery and children

    MedlinePLUS

    ... on growth for teens that undergo weight loss surgery. Teenagers‘ bodies are still changing and developing. They will need to be careful to get enough nutrients during the period of ... surgery. Gastric bypass surgery changes the way some nutrients ...

  12. The Future of Glaucoma Surgery

    PubMed Central

    Sheybani, Arsham

    2015-01-01

    Glaucoma surgery is ripe for innovation. In the last few years, there has been a substantial increase in the number of devices approaching commercialization. While not all that is new is necessarily good, the role of these devices in changing glaucoma surgery is equally important in terms of both success and failure. Trabeculectomy, the most commonly performed incisional filtration surgery for glaucoma, is subjective by nature and certainly has risks. As devices aim to standardize glaucoma surgery, specifically subconjunctival filtration surgery, predictability and in turn safety should theoretically improve. This may allow the glaucoma surgeon to intervene earlier in the disease process, prevent more advanced vision loss and potentially decrease the burden of medications.

  13. Neurological Complications of Bariatric Surgery.

    PubMed

    Goodman, Jerry Clay

    2015-12-01

    Obesity has attained pandemic proportions, and bariatric surgery is increasingly being employed resulting in turn to more neurological complications which must be recognized and managed. Neurological complications may result from mechanical or inflammatory mechanisms but primarily result from micro-nutritional deficiencies. Vitamin B12, thiamine, and copper constitute the most frequent deficiencies. Neurological complications may occur at reasonably predictable times after bariatric surgery and are associated with the type of surgery used. During the early post-operative period, compressive or stretch peripheral nerve injury, rhabdomyolysis, Wernicke's encephalopathy, and inflammatory polyradiculoneuropathy may occur. Late complications ensue after months to years and include combined system degeneration (vitamin B12 deficiency) and hypocupric myelopathy. Bariatric surgery patients require careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-operatively and then annually after surgery and multivitamin supplementation for life. Sustained vigilance for common and rare neurological complications is essential. PMID:26493558

  14. Excimer laser refractive surgery.

    PubMed Central

    Manche, E E; Carr, J D; Haw, W W; Hersh, P S

    1998-01-01

    Excimer laser photorefractive keratectomy and excimer laser in situ keratomileusis are relatively new treatment modalities that can be used to correct refractive errors of the eye. They are most commonly used to correct myopia (nearsightedness) but can also be used to correct hyperopia (farsightedness) and astigmatism. The excimer laser alters the refractive state of the eye by removing tissue from the anterior cornea through a process known as photoablative decomposition. This process uses ultraviolet energy from the excimer laser to disrupt chemical bonds in the cornea without causing any thermal damage to surrounding tissue. The modified anterior corneal surface enables light to be focused on the retina, thereby reducing or eliminating the dependence on glasses and contact lenses. We discuss in detail all aspects of excimer laser refractive surgery--techniques, indications and contraindications, clinical outcomes, and complications. PMID:9682628

  15. Rotating Globular Clusters

    NASA Astrophysics Data System (ADS)

    Bianchini, P.; Varri, A. L.; Bertin, G.; Zocchi, A.

    2013-07-01

    Internal rotation is thought to play a major role in the dynamics of some globular clusters. However, in only a few cases has internal rotation been studied by the quantitative application of realistic and physically justified global models. Here, we present a dynamical analysis of the photometry and three-dimensional kinematics of ? Cen, 47 Tuc, and M15, by means of a recently introduced family of self-consistent axisymmetric rotating models. The three clusters, characterized by different relaxation conditions, show evidence of differential rotation and deviations from sphericity. The combination of line-of-sight velocities and proper motions allows us to determine their internal dynamics, predict their morphology, and estimate their dynamical distance. The well-relaxed cluster 47 Tuc is interpreted very well by our model; internal rotation is found to explain the observed morphology. For M15, we provide a global model in good agreement with the data, including the central behavior of the rotation profile and the shape of the ellipticity profile. For the partially relaxed cluster ? Cen, the selected model reproduces the complex three-dimensional kinematics; in particular, the observed anisotropy profile, characterized by a transition from isotropy to weakly radial anisotropy and then to tangential anisotropy in the outer parts. The discrepancy found for the steep central gradient in the observed line-of-sight velocity dispersion profile and for the ellipticity profile is ascribed to the condition of only partial relaxation of this cluster and the interplay between rotation and radial anisotropy.

  16. ROTATING GLOBULAR CLUSTERS

    SciTech Connect

    Bianchini, P.; Varri, A. L.; Bertin, G.; Zocchi, A.

    2013-07-20

    Internal rotation is thought to play a major role in the dynamics of some globular clusters. However, in only a few cases has internal rotation been studied by the quantitative application of realistic and physically justified global models. Here, we present a dynamical analysis of the photometry and three-dimensional kinematics of {omega} Cen, 47 Tuc, and M15, by means of a recently introduced family of self-consistent axisymmetric rotating models. The three clusters, characterized by different relaxation conditions, show evidence of differential rotation and deviations from sphericity. The combination of line-of-sight velocities and proper motions allows us to determine their internal dynamics, predict their morphology, and estimate their dynamical distance. The well-relaxed cluster 47 Tuc is interpreted very well by our model; internal rotation is found to explain the observed morphology. For M15, we provide a global model in good agreement with the data, including the central behavior of the rotation profile and the shape of the ellipticity profile. For the partially relaxed cluster {omega} Cen, the selected model reproduces the complex three-dimensional kinematics; in particular, the observed anisotropy profile, characterized by a transition from isotropy to weakly radial anisotropy and then to tangential anisotropy in the outer parts. The discrepancy found for the steep central gradient in the observed line-of-sight velocity dispersion profile and for the ellipticity profile is ascribed to the condition of only partial relaxation of this cluster and the interplay between rotation and radial anisotropy.

  17. [Andreas Vesalius and surgery].

    PubMed

    Van Hee, R

    1993-01-01

    By publishing De Humani Corporis Fabrica Libri Septem in 1543, Andries van Wesel (1514-1564) gave surgical science an immense impulse. The revolutionary renovation in the knowledge of man's anatomical structure changed slowly and progressively into topographical and physiological understanding of surgical diseases. At the same time, this made better aimed and more secure operations possible. Apart from the importance of this anatomical publication, Andreas Vesalius also won his spurs as a surgeon. He taught surgery in Padua for many years. He was appointed court physician and surgeon at the Habsburg Court of Charles V and Philip II. He personally performed lots of operations known at the time as major ones. He not only quickly adopted the surgical innovations of his fellow-surgeon Ambroise Paré, but he even performed operations that had been forgotten during several centuries, among which thoracocentesis for pleural empyema. His clinical perspicacity in discovering the indication for some operations was staggering and was appreciated by all great monarchs of Europe in the 16th century. In his several consilia, numerous pieces of advice were given for the treatment of surgical patients. The surgical practice which Vesalius had in Brussels for many years, consequently became most successful. Many publications by Vesalius about surgery and blood-letting are well-known. His Chirurgia magna in septem Libros digesta still remains controversial; these books were published by Prospero Borgarruccio (1560) in 1568 by the Venetian editor Valgrisi. This book gives an excellent survey of surgical pathology as it was taught and treated in the 16th century. The scientific method that Vesalius used, not only in his anatomical studies but also in his surgical practice, deserves not only our full appraisal but should still be studied in our own time. PMID:8209577

  18. Robotics and general surgery.

    PubMed

    Jacob, Brian P; Gagner, Michel

    2003-12-01

    Robotics are now being used in all surgical fields, including general surgery. By increasing intra-abdominal articulations while operating through small incisions, robotics are increasingly being used for a large number of visceral and solid organ operations, including those for the gallbladder, esophagus, stomach, intestines, colon, and rectum, as well as for the endocrine organs. Robotics and general surgery are blending for the first time in history and as a specialty field should continue to grow for many years to come. We continuously demand solutions to questions and limitations that are experienced in our daily work. Laparoscopy is laden with limitations such as fixed axis points at the trocar insertion sites, two-dimensional video monitors, limited dexterity at the instrument tips, lack of haptic sensation, and in some cases poor ergonomics. The creation of a surgical robot system with 3D visual capacity seems to deal with most of these limitations. Although some in the surgical community continue to test the feasibility of these surgical robots and to question the necessity of such an expensive venture, others are already postulating how to improve the next generation of telemanipulators, and in so doing are looking beyond today's horizon to find simpler solutions. As the robotic era enters the world of the general surgeon, more and more complex procedures will be able to be approached through small incisions. As technology catches up with our imaginations, robotic instruments (as opposed to robots) and 3D monitoring will become routine and continue to improve patient care by providing surgeons with the most precise, least traumatic ways of treating surgical disease. PMID:14712875

  19. Rotating reactor studies

    NASA Technical Reports Server (NTRS)

    Roberts, Glyn O.

    1991-01-01

    Undesired gravitational effects such as convection or sedimentation in a fluid can sometimes be avoided or decreased by the use of a closed chamber uniformly rotated about a horizontal axis. In a previous study, the spiral orbits of a heavy or buoyant particle in a uniformly rotating fluid were determined. The particles move in circles, and spiral in or out under the combined effects of the centrifugal force and centrifugal buoyancy. A optimization problem for the rotation rate of a cylindrical reactor rotated about its axis and containing distributed particles was formulated and solved. Related studies in several areas are addressed. A computer program based on the analysis was upgraded by correcting some minor errors, adding a sophisticated screen-and-printer graphics capability and other output options, and by improving the automation. The design, performance, and analysis of a series of experiments with monodisperse polystyrene latex microspheres in water were supported to test the theory and its limitations. The theory was amply confirmed at high rotation rates. However, at low rotation rates (1 rpm or less) the assumption of uniform solid-body rotation of the fluid became invalid, and there were increasingly strong secondary motions driven by variations in the mean fluid density due to variations in the particle concentration. In these tests the increase in the mean fluid density due to the particles was of order 0.015 percent. To a first approximation, these flows are driven by the buoyancy in a thin crescent-shaped depleted layer on the descending side of the rotating reactor. This buoyancy distribution is balanced by viscosity near the walls, and by the Coriolis force in the interior. A full analysis is beyond the scope of this study. Secondary flows are likely to be stronger for buoyant particles, which spiral in towards the neutral point near the rotation axis under the influence of their centrifugal buoyancy. This is because the depleted layer is thicker and extends all the way around the reactor.

  20. OSAS Surgery and Postoperative Discomfort: Phase I Surgery versus Phase II Surgery

    PubMed Central

    Gasparini, Giulio; Pelo, Sandro; Foresta, Enrico; Boniello, Roberto; Romandini, Mario; Cervelli, Daniele; Azzuni, Camillo; Marianetti, Tito Matteo

    2015-01-01

    Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation. PMID:25695081

  1. Coherent Perfect Rotation

    E-print Network

    Crescimanno, Michael; Andrews, James H

    2012-01-01

    Two classes of conservative, linear, optical rotary effects (optical activity and Faraday rotation) are distinguished by their behavior under time reversal. In analogy with coherent perfect absorption, where counterpropagating light fields are controllably converted into other degrees of freedom, we show that only time-odd (Faraday) rotation is capable of coherent perfect rotation in a linear and conservative medium, by which we mean the complete transfer of counterpropagating coherent light fields into their orthogonal polarization. This highlights the necessity of time reversal odd processes (not just absorption) and coherence in perfect mode conversion and may inform device design.

  2. Rotational Quantum Friction

    E-print Network

    Rongkuo Zhao; Alejandro Manjavacas; F. Javier García de Abajo; J. B. Pendry

    2012-09-25

    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.

  3. Chaotic rotation of Hyperion?

    NASA Technical Reports Server (NTRS)

    Binzel, R. P.; Green, J. R.; Opal, C. B.

    1986-01-01

    Thomas et al. (1984) analyzed 14 Voyager 2 images of Saturn's satellite Hyperion and interpreted them to be consistent with a coherent (nonchaotic) rotation period of 13.1 days. This interpretation was criticized by Peale and Wisdom (1984), who argued that the low sampling frequency of Voyager data does not allow chaotic or nonchaotic rotation to be distinguished. New observations obtained with a higher sampling frequency are reported here which conclusively show that the 13.1 day period found by Thomas et al. was not due to coherent rotation.

  4. The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation.

    PubMed

    Cruz, Antonio A V; Akaishi, Patricia M S; Al-Dufaileej, Mohammed; Galindo-Ferreiro, Alicia

    2015-01-01

    Lid margin rotational procedures have been used to correct cicatricial trachomatous entropion since the 19(th) century. There are two basic types of surgeries used for lid margin rotation. The first type is based on through-and-through approach combining tarsotomy and the use of sutures on the anterior lamella. The second type of surgery was suggested by Trabut, who proposed a tarsal advancement by posterior approach. We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion. After tarsal plate exposure, a tarsotomy through conjunctiva is performed as described by Trabut. Then, instead of using external sutures secured by bolsters, internal absorbable sutures can be used to simultaneously advance the distal tarsal fragment and exert strong tension on the marginal orbicularis muscle. Sixty lids of 40 patients underwent surgery with a lid crease incision. The follow-up ranged from 1 to 12 months (mean 3.0 months ± 2.71). Forty percent of the patients (24 lids) had more than 3 months of follow-up. Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea. PMID:26692708

  5. Rotatable seal assembly. [Patent application; rotating targets

    DOEpatents

    Logan, C.M.; Garibaldi, J.L.

    1980-11-12

    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.

  6. Arpad Gerster and Max Thorek contributions to American surgery.

    PubMed

    Langer, Robert M

    2009-01-01

    The legacy and the influence on American surgery is discussed of two Hungarian born surgeons: Arpad Gerster (1848-1923) and Max Thorek (1880-1960). Both of them were born in Northern Hungary, then part of the Austro-Hungarian Monarchy, today Slovakia. Gerster got his medical education in Vienna The influence of Theodor Billroth left everlasting impressions in him. In 1874 he arrived in New York and became the first doctor in town who practiced exclusively surgery. He became an attending surgeon in The German Hospital and later at Mount Sinai Hospital. Gerster modernized the hospital's functions and services, introducing the rotation system, and also made the original observation that dissemination of cancer may be caused by surgery. His aseptic methods were revolutionary at the time. Max Thorek arrived in Chicago in 1897. With a fantastic endurance he overwhelmed all barriers and became a doctor. He started his practice in one of Chicago's poor immigrant neighborhoods, but stepwise he could excel and in 1911 he co-founded The American Hospital. His ideas of modernizing surgery became reality. Thorek is one of the first who practiced plastic surgery, and his contribution by writing about surgical errors and safeguards became a great success. He founded the International College of Surgeons, a result of his widespread relations among surgeons all over the world. The parallels in the lives of these great surgeons: solid education, knowledge of languages, talent for music, literature, and arts, creative thinking combined with hard work, good humor, as well as a social conscience led them to make groundbreaking contributions to American and international surgery. PMID:19466652

  7. Review of single incision laparoscopic surgery in colorectal surgery

    PubMed Central

    Madhoun, Nisreen; Keller, Deborah S; Haas, Eric M

    2015-01-01

    As surgical techniques continue to move towards less invasive techniques, single incision laparoscopic surgery (SILS), a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery, was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis, postoperative pain, recovery time, and quality of life at the drawback of higher technical skill required. In this article, we review the history, describe the available technology and techniques, and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature. PMID:26478673

  8. The rotation of Uranus

    NASA Technical Reports Server (NTRS)

    Goody, R. M.

    1982-01-01

    The determination of the rotation rate of Uranus based on available observational evidence is discussed. Previous determinations of the rotation rate since the work of Lowell and Slipher (1912), which tended to converge on a period of 10.8 days until the mid 1970s, most likely due to mutual reinforcement between unreliable results, are reviewed. Recent independent determinations based on (1) the use of theoretical interior models together with observations of oblateness and the gravitational moment J2; (2) periodic brightness fluctuations; and (3) spectrographic measurements of Doppler shifts are then presented which yield a weighted mean value of 16.31 + or - 0.27 h for the rotational period of Uranus. It is noted that the detection of the motion of surface features across the disk by future high-resolution imaging and Voyager 2 observations may allow a direct determination of the rotational period of Uranus.

  9. Rotating mobile launcher

    NASA Technical Reports Server (NTRS)

    Gregory, T. J.

    1977-01-01

    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.

  10. The Rotating Mirror.

    ERIC Educational Resources Information Center

    Greenslade, Thomas B., Jr.

    1981-01-01

    Discusses theory of the rotating mirror, its use in measuring the velocity of the electrical signal in wires, and the velocity of light. Concludes with a description of the manometric flame apparatus developed for analyzing sound waves. (SK)

  11. Army orthopaedic surgery residency program directors' selection criteria.

    PubMed

    Orr, Justin D; Hoffmann, Jeffrey D; Arrington, Edward D; Gerlinger, Tad L; Devine, John G; Belmont, Philip J

    2015-01-01

    Factors associated with successful selection in U.S. Army orthopaedic surgical programs are unreported. The current analysis includes survey data from all Army orthopaedic surgery residency program directors (PDs) to determine these factors. PDs at all Army orthopaedic surgery residency programs were provided 17 factors historically considered critical to successful selection and asked to rank order the factors as well as assign a level of importance to each. Results were collated and overall mean rankings are provided. PDs unanimously expressed that performance during the on-site orthopaedic surgery rotation at the individual program director's institution was most important. Respondents overwhelmingly reported that Steps 1 and 2 licensing exam scores were next most important, respectively. Survey data demonstrated that little importance was placed on letters of recommendation and personal statements. PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants. PMID:25988694

  12. Rotational rate sensor

    DOEpatents

    Hunter, Steven L. (Livermore, CA)

    2002-01-01

    A rate sensor for angular/rotational acceleration includes a housing defining a fluid cavity essentially completely filled with an electrolyte fluid. Within the housing, such as a toroid, ions in the fluid are swept during movement from an excitation electrode toward one of two output electrodes to provide a signal for directional rotation. One or more ground electrodes within the housing serve to neutralize ions, thus preventing any effect at the other output electrode.

  13. Electromagnetic rotational actuation.

    SciTech Connect

    Hogan, Alexander Lee

    2010-08-01

    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.

  14. Instability in Rotating Machinery

    NASA Technical Reports Server (NTRS)

    1985-01-01

    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.

  15. Faraday rotation in graphene

    E-print Network

    I. V. Fialkovsky; D. V. Vassilevich

    2012-11-29

    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.

  16. Department of Surgery Division of Surgical Oncology and Endocrine Surgery

    E-print Network

    ­ Workup and Management 4. Parathyroidectomy for Secondary Hyperparathyroidism 5. Adrenal Incidentaloma Surgery Education Topics 1. Management of Thyroid Nodules 2. Thyroid Cancer 3. Primary Hyperparathyroidism Colorectal Cancer Syndromes 27. Management of Primary Hyperparathyroidism 28. Medullary Thyroid Cancer #12;

  17. Skin changes after bariatric surgery*

    PubMed Central

    Manzoni, Ana Paula Dornelles da Silva; Weber, Magda Blessmann

    2015-01-01

    Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses. PMID:25830984

  18. Pediatric Auditory Brainstem Implant Surgery.

    PubMed

    Puram, Sidharth V; Lee, Daniel J

    2015-12-01

    Auditory brainstem implants (ABIs) provide auditory perception in patients with profound hearing loss who are not candidates for the cochlear implant (CI) because of anatomic constraints or failed CI surgery. Herein, the authors discuss (1) preoperative evaluation of pediatric ABI candidates, (2) surgical approaches, and (3) contemporary ABI devices and their use in the pediatric population. The authors also review the surgical and audiologic outcomes following pediatric ABI surgery. The authors' institutional experience and the nearly 200 cases performed in Europe and the United States indicate that ABI surgery in children can be safe and effective. PMID:26553310

  19. Physiology of vitreous surgery.

    PubMed

    Stefánsson, Einar

    2009-02-01

    Vitreous surgery has various physiological and clinical consequences, both beneficial and harmful. Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes-Einstein and Hagen-Poiseuille state that molecular transport by diffusion or convection is inversely related to the viscosity of the medium. When the vitreous gel is replaced with less viscous saline, the transport of all molecules, including oxygen and cytokines, is facilitated. Oxygen transport to ischemic retinal areas is improved, as is clearance of VEGF and other cytokines from these areas, thus reducing edema and neovascularization. At the same time, oxygen is transported faster down a concentration gradient from the anterior to the posterior segment, while VEGF moves in the opposite direction, making the anterior segment less oxygenated and with more VEGF, stimulating iris neovascularization. Silicone oil is the exception that proves the rule: it is more viscous than vitreous humour, re-establishes the transport barrier to oxygen and VEGF, and reduces the risk for iris neovascularization in the vitrectomized-lentectomized eye. Modern vitreous surgery involves a variety of treatment options in addition to vitrectomy itself, such as photocoagulation, anti-VEGF drugs, intravitreal steroids and release of vitreoretinal traction. A full understanding of these treatment modalities allows sensible combination of treatment options. Retinal photocoagulation has repeatedly been shown to improve retinal oxygenation, as does vitrectomy. Oxygen naturally reduces VEGF production and improves retinal hemodynamics. The VEGF-lowering effect of photocoagulation and vitrectomy can be augmented with anti-VEGF drugs and the permeability effect of VEGF reduced with corticosteroids. Starling's law explains vasogenic edema, which is controlled by osmotic and hydrostatic gradients between vessel and tissue. It explains the effect of VEGF-induced vascular permeability changes on plasma protein leakage and the osmotic gradient between vessel and tissue. At the same time, it takes into account hemodynamic changes that affect the hydrostatic gradient. This includes the influence of arterial blood pressure, and the effect oxygen (laser treatment) has in constricting retinal arterioles, increasing their resistance, and thus reducing the hydrostatic pressure in the microcirculation. Reduced capillary hydrostatic pressure and increased osmotic gradient reduce water fluxes from vessel to tissue and reduce edema. Finally, Newton's third law explains that vitreoretinal traction decreases hydrostatic tissue pressure in the retina, increases the pressure gradient between vessel and tissue, and stimulates water fluxes from vessel into tissue, leading to edema. PMID:19034481

  20. Surgery for Peyronie's disease

    PubMed Central

    Levine, Laurence A; Larsen, Stephen M

    2013-01-01

    Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems. PMID:23178395