Massive Rupture Research Articles

Short-term functional outcomes of Whiteside transfer for massive rupture of gluteus medius tendon in native hips.

To assess the functional and clinical outcomes of patients who underwent either open or endoscopic Whiteside transfer of gluteus maximus and tensor fascia lata muscles in cases of massive rupture of gluteus medius tendon associated with muscle atrophy on a native hip METHODS: This retrospective, descriptive, single-centre study was conducted by a single operator with a minimum follow-up period of 12 months. All Whiteside palliative transfers performed on patients with Type 5 gluteus medius tendon rupture, according to Lall's classification, resulting in painful and treatment-resistant Trendeleburg gait between 2017 and 2022 were included. Functional evaluation was based on modified Harris Hip Scores (mHHS), iHOT-12, Non-Arthritic Hip Score (NAHS), and thepain on a Visual Analog Scale (VAS). Muscle strength was clinically assessed using the MRC classification. Between January 2017 and January 2022, a total of 15 Whiteside palliative transfers were identified, including nine (60%) open procedures and 6 (40%) endoscopic procedures, performed on 13 patients. One patient was excluded, and none were lost to follow-up. The median follow-up period was 41 (12; 59) months. The median age at the time of surgery was 74 (66; 76) years. The male-to-female sex ratio was 0.27. Functional results demonstrated a significant improvement in all scores: NAHS (45 vs. 72, p = 0.002), mHHS (22 vs. 55, p = 0.002), iHOT-12 (101 vs. 56, p = 0.002), and VAS (8 vs. 3, p = 0.002). Clinical outcomes also showed improvements in muscle strength (p = 0.003), single-leg stance (p = 0.01), and gait (p = 0.02). No significant differences were found in the various scores between the endoscopic and open techniques. Whiteside transfer surgery, whether performed through open surgery or endoscopically, is a palliative surgical approach that should be considered for patients with irreparable gluteus medius tendon tears, where the main symptom is trochanteric pain. This procedure yields satisfactory clinical and functional outcomes, although the gains in abduction strength recovery and gait improvement are modest.

Transport of pollutants in groundwater of domestic waste landfills in karst regions and its engineering control technologies

Domestic waste produces leachate with a high concentration of pollutants in the landfill process due to biochemical degradation stages like compaction and fermentation. A large number of cases show that anti-seepage membranes widely used in refuse landfills tend to rupture under long-term tension and corrosion, causing leachate to enter the groundwater system and pollute the environment. To reveal the phenomenon of groundwater contamination in refuse landfills, typical domestic waste landfills in karst regions were examined, on the basis of a summary of hydrogeological conditions and hydrochemical characteristics, a three-dimensional groundwater flow model and solute transport model were constructed to analyze the pattern of pollutant diffusion, and its controlling factors, under the current conditions and massive rupture of anti-seepage membrane. The results show that with a minor rupture of the anti-seepage membrane, the area of the low pollution region increases first and then decreases while that of the slight pollution region continuously increases; When a massive rupture of the anti-seepage membrane appears, the ranges of heavy pollution region and total pollution regions continue to grow; Pollutant migrates along the same direction as the groundwater flow and diffuse from high concentration region to low concentration regions under the differential concentration effect. Based on the temporal-spatial distribution characteristics of groundwater pollutants, two engineering control schemes, namely, curtain grouting blocking and group well pumping, were established. A comparison of the two control schemes shows that group well pumping stably maintains water quality safety over the long term, pollutants overflow from both sides of the curtain after they have accumulated to a certain point of concentration, causing damage to the groundwater environment in the conservation area.

Socioeconomic reforms in times of political transformation: Conflicts over the political economy in Egypt and Tunisia post-2011

While ample research on the political economy of the MENA has pointed to the underlying causes of the Arab uprisings, little analysis has been done on the political economies after this massive rupture. To fill this gap, the contributions in this themed section use in-depth case studies from Egypt and Tunisia post-2011, and look at how socioeconomic challenges were addressed once political institutions – in very different regime contexts – were back in place. Given the fairly similar political economies, the case studies offer intriguing insights into obstacles that both a democracy and an autocracy face in tackling socioeconomic problems in issue areas such as fiscal policy, labour laws and decentralisation reforms. Studying these conflicts helps us to identify the relevant actors and their relative power at a given moment. The analysis also provides an opportunity to identify how formal and informal institutions are used and if the new institutional setting allows for effective conflict management. The results uncover a mixed depiction of capacities to implement reforms, which cannot be explained by the regime variable or absolute state capacity alone. Instead, explanatory power is found in a dynamic, relational, agency-oriented approach to analyzing state and social actors in issue-specific socioeconomic reform conflicts.

Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and 40 % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In the treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.

Treatment of Chronic and Complicated Ruptures of the Rotator Cuff of the Shoulder

Relevance. The etiology of ruptures of the rotator cuff of the shoulder (RC) is represented by a variety of diseases, including age-related degeneration, low- and high-energy trauma. Most often, a rupture of the RC, combined with trauma, occurs with anterior dislocation of the shoulder – in 56% of patients. The “terrible triad” of the shoulder, which leads to a loss of function and disability in patients, is diagnosed in 9-18% of patients. RC ruptures of <1-1.5 cm throughout the entire thickness of the tendon have a high risk of progression and formation of a massive rupture of the RC. According to various authors, massive ruptures occur in 40% of all RC ruptures.
 Objective: to evaluate the results of surgical treatment of patients with old and complicated ruptures of the RC.
 Materials and Methods. From 2016 to 2021, in the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”, Department of Microsurgery and Surgery of the Upper Limb, 140 patients with a ruptured RC were treated. The patients underwent: suture of the RC under arthroscopic control, open RC suture, transposition of the latissimus dorsi tendon into the RC defect, implantation of biodegradable InSpace balloon, or implantation of a biomatrix into the RC defect and reverse shoulder arthroplasty.
 Results. The function was assessed before surgery and in the long-term postoperative period using the Constant-Murley Score. In 5 patients with an implanted balloon, the score increased from 34-38 to 56-61 in 8-12 months. In 7 patients with reinforced biomatrix implantation, the score increased from 34-38 to 65-69 in 9-12 months. In 7 patients with transposition of the latissimus dorsi tendon, the score increased from 35-37 to 68-75 in 9-12 months. In 10 patients with reverse arthroplasty, the score increased from 30-34 to 58-65 in 12-18 months. In 82 patients, after the suture of the RC under arthroscopic control of the shoulder, the score increased from 36-40 to 78-82 in 12-18 months. In 29 patients with an open suture of the RC, the score increased from 34-38 to 68-75 in 12-18 months.
 Conclusions. Early diagnosis and timely surgical treatment for the pathology of the RC make it possible to obtain the best results in the long-term postoperative period. Massive and old ruptures of the RC require a complete instrumental examination in the preoperative period. The degree of adipose degeneration and rotator arthropathy is of key importance for determining the operative tactics of surgical treatment.

A novel co-graft tannin-based flocculant for the mitigation of harmful algal blooms (HABs): The effect of charge density and molecular weight

In this study, for the first time, we developed a series of co-graft tannin-based flocculants, TA-g-P(AM-DMDAAC), with different charge densities (CDs) and molecular weights (MWs) and evaluated their algal-removal performances. The effects of TA-g-P(AM-DMDAAC) on the cell integrity of Microcystis aeruginosa and release of extracellular organic matter (EOM) and microcystin-leucine-arginine (MC-LR) in flocculation and floc storage were also studied. Results suggested that TA-g-P(AM-DMDAAC) could not only efficiently remove algal cells over a wide pH range (pH 3–11) but also EOM. CD and MW significantly affected flocculation performance and floc characteristics of TA-g-P(AM-DMDAAC). A higher CD helped achieve a higher removal efficiency of algal cells and EOM, whereas a higher MW resulted in the formation of larger and more compact flocs. Furthermore, the larger and denser flocs could better protect algal cells and reduce the release of EOM during floc storage. Notably, algal cells in the TA-g-P(AM-DMDAAC) flocs did not appear to show signs of massive rupture nor did they release EOM and MC-LR extensively for at least 20 days of storage. The abundance and easy availability of tannin resources effectively reduce the cost of preparing tannin-based flocculants. Therefore, TA-g-P(AM-DMDAAC) can have broad application prospects in the management of cyanobacteria bloom.

MODERN ULTRASONOGRAPHY TECHNIQUES FOR MASSIVE INJURIES OF SHOULDER JOINT ROTATOR CUFF TENDONS

Recently the development of medical technologies has led to a significant progress in diagnosis of the shoulder joint diseases. The leading role in this was played by an improvement of such imaging methods as magnetic resonance imaging, high−resolution ultrasound scanning, having an advantage over traditional radiography, as they allow the diagnosis the pathology not only of bone structures but also of soft tissues. Magnetic resonance imaging has become the main method of visualizing the soft tissue structures of musculoskeletal system, but the high cost of the study, lack of clear and distinct indications for it reduce the number of patients. Ultrasound has proven to be one of the main methods of objective diagnosis in patients with musculoskeletal pathology, and high−frequency sensors can visualize articular cartilage and its structure, tendons of the shoulder rotator cuff and tendons of the long head of the biceps. In order to determine the most significant differential diagnostic criteria for massive rupture of the shoulder rotational cuff with the help of two−dimensional mode, color and energy Doppler mapping and functional ultrasonography, 32 patients operated on this subject were examined. The following ultrasound data were evaluated: homogeneity, echogenicity, integrity of tendon contours, presence of effusion in bursae and tendon sheaths, number of vascular signals in the affected area during color and energy Doppler mapping, if needed − the results of functional tests. Thus, modern ultrasound capabilities allow its use both for primary diagnosis and for monitoring the treatment process, which, in turn, directly affects the choice of treatment. Key words: shoulder joint, rotator cuff, ultrasound, diagnostics.

Bicontinuous nanoporous design induced homogenization of strain localization in metallic glasses

Bicontinuous nanoporous metallic glasses (MG) synergize the outstanding properties of MGs and open-cell nanoporous materials. The low-density and high-specific-surface-area of bicontinuous nanoporous structures have the potential to enhance the applicability of MGs in catalysis, sensors, and lightweight structural designs. Here, we report molecular dynamics simulations of tensile loading deformation and failure of bicontinuous nanoporous Cu64Zr36 MG with 55% porosity and 4.4 nm ligament size. Results indicate an anomalous mechanical behavior featuring delocalized plastic deformation preceding ductile failure. The deformation follows two mechanisms: i) Necking of ligaments aligned with the loading direction and ii) progressive alignment of randomly oriented ligaments. Failure occurs at 0.16 strain, following massive rupture of ligaments. This work indicates that a bicontinuous nanoporous design is able to effectively delocalize strain localization in a MG due to a combination of size effect on the ductility of MGs resulting in nano ligaments necking and progressive asynchronous alignment of ligaments.

An investigation for the fuel temperature of the Tehran research reactor during a complete loss of coolant accident

Safety in a nuclear research reactor such as the Tehran Research Reactor (TRR) is a significant concern mainly after the Fukushima nuclear accident and satisfied by a continuous upgrade in the whole reactor facility and its personnel. Happening of total complete of Coolant Accident (LOCA) due to a massive rupture in the TRR primary cooling pipe is conceivable after a severe accident such as an earthquake. This accident could lead to the pool dewatering, and, finally the reactor core uncovering. Consequences of this accident are the fuel blistering, swelling, and melting depending on its severity. In this study we analyze the possibility of passively cooling the TRR reactor core by thermal radiation and conduction to the surrounding structures and natural convection to air in the complete LOCA accident. In this way, the contribution of various heat lost mechanisms are demonstrated.

Organ-preserving operation in case of massive testicular rupture

The objective is to present a clinical case of blunt trauma of the scrotum with a massive testicular crush. The presented nosology, methods of diagnosis and surgical treatment is highlighted.Clinical case. Patient, 18 years old, was admitted to the clinic with acute symptoms and complaints of pain and increased size of the right part of the scrotum. Questioning revealed that 48 hours prior the patient received a blunt injury of the scrotum. Ultrasound of the scrotal organs showed that in the right part of the scrotum testicle is not clearly differentiated, in the lower pole hypoechogenic signal is observed, no blood flow was evident using the color Doppler mode, but examination of the upper pole showed weak blood flow, the epididymis was partially differentiated. Hematocele was observed. The diagnosis of injury of the scrotal organs was confirmed, traumatic injury of the right testicle. Emergency surgery was performed: necrotized areas of the lower pole of the testicle were resected, plastic sealing of the upper pole of the right testicle to the epididymis was performed. Postoperative period was free of complications. The patient was discharged on day 6 after the surgery. Control ultrasound after 3 months showed that the right testicle was smaller, its echostructure was homogenous, blood flow in the testicular parenchyma was observed. Hormonal status, blood testosterone levels, ejaculate parameters were normal.Conclusion. The presented clinical observation confirms that organ-sparing interventions for massive crush injury of the testicle with minimal volume of viable tissue are possible but patient’s age and time after injury should be taken into account.

Latissimus Dorsi Transposition in Supraspinatus Tendon Retraction (Patte III) and Thomazeau Grade 3 Fatty Degeneration (Clinical Case)

Introduction. The proportion of injuries of the rotational cuff is from 65 to 84 % of all injuries of the shoulder joint. This pathology is more often registered in people over 60 years old. It is far from always that during initial visits, patients are given the correct diagnosis. Most patients are treated conservatively with short-term improvement or without dynamics. The main diagnostic method is an MRI of the shoulder joint, where we can see soft tissue structures. The proportion of massive rupture of the tendons of the supraspinatus muscle is 10-40 % of all ruptures of the rotator cuff. The more time passes from the moment of injury to surgical treatment, the more pronounced are the retraction and degenerative changes in tendons. A special category is occupied by patients with chronic rupture of the tendon of the supraspinatus muscle with a retraction of more than 5 cm (Patte grade III) and Thomazeau grade 3 fatty degeneration. In this category of patients, it is not possible to re-insert the tendons of the rotational cuff of the shoulder. Objective: to evaluate the clinical effectiveness of surgical treatment of a patient with retinal tendon retraction (Patte grade III) and Thomazeau grade 3 fatty degeneration. Materials and methods. The clinical case is presented: a man with a chronic total rupture of the tendon of the supraspinatus, infraspinatus muscle (Patte grade III) and Thomazeau grade 3 fatty degeneration. Secondary upper subluxation of the head of the humerus is revealed. The patient underwent surgical treatment: transposition of the latissimus dorsi muscle on the large tubercle of the humerus. Results. Six months after the operation, the patient restored the function of the upper limb, pain was stopped. Conclusion. Given the functional result, transposition of the latissimus dorsi tendon can be considered the technique of choice for inoperable tendon rupture of the supraspinatus muscle.

Massive Tracheal Rupture in Blunt Chest Trauma: Reconstruction with Autologous Pericardium

Massive Tracheal Rupture in Blunt Chest Trauma: Reconstruction with Autologous Pericardium

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

Introduction: Resuscitative endovascular balloon occlusion of the aorta has been used in various clinical settings to elevate blood pressure in the setting of shock, even if the evidence base is weak with no clear indications. Case presentation: We report a case of traumatic hemorrhagic shock in which this technique was used in an unusual manner, treating obvious arterial abdominal bleeding associated with suspected pelvic arterial bleeding, in a Trauma Center where hybrid angiographic-surgical suite is not available. A 35-year-old man was involved in a traffic accident within 2 trucks. He was transported to the Major Trauma Center of an Integrated Trauma System where emergent laparotomy confirmed massive hepatic rupture and a bleeding control was obtained by large abdominal packing. Trauma team decided to considerate Resuscitative Endovascular Balloon Occlusion of the Aorta, positioning a deflated balloon in zone III to eventually manage a pelvic arterial hemorrhage, while performing Bogota Bag. Suddenly a new abdominal arterial bleeding was noted through Bogota Bag. Because Pringle maneuver was considered too difficult in this case because of liver hilum injury, the balloon was moved cranially with the aim to reach zone I. Introducer sheath displacement occurred at this time, and the balloon was then only partially inflated in zone II, usually considered too dangerous, and immediately the target systolic blood pressure of 90 mmHg was obtained. Transfer the patient into interventional radiology suite was then feasible and embolization of active bleeding by right hepatic artery and superior mesenteric artery branch, missed during first laparotomy, were performed. Balloon was definitely deflated after 50 minutes. The patient was discharged by the hospital 113 days later, fully recovered with long lasting motor rehabilitation program. Discussion: Partial zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in this particular case allowed overcoming procedural mistakes without major complications and with good clinical outcome. Conclusion: Judicious manage of REBOA inflation time and amount, together with multidisciplinary contemporary damage control strategy with clear and effective team leading, is the key to effectively resuscitate multiple trauma shocked patients.

“You have a secret that you don't want to tell me”: The Child as Trauma in Spanish and American Horror Film

“You have a secret that you don't want to tell me”: The Child as Trauma in Spanish and American Horror Film

Continuing Professional Development: Major trauma and catastrophic haemorrhage

Overview Major trauma is a leading worldwide cause of mortality, killing or seriously injuring thousands of people each day. Casualties have the potential to die immediately as a result of massive head injury or rupture of major vessels, or shortly afterwards as a result of progressive blood loss and hypoxia. A third group survive the initial insult, but succumb to their wounds days or weeks later as a result of secondary conditions including multiple organ failure and sepsis. This Continuing Professional Development (CPD) module will focus on the rapid assessment and timely management of casualties of major trauma, with particular emphasis placed on the catastrophically haemorrhaging patient. Learning Outcomes After completing this module you will be able to: • Define the concepts of major trauma and catastrophic haemorrhage • Appreciate the range of traumatic injuries sustained in the United Kingdom • Revise the pathophysiology of haemorrhage and hypovolaemic shock • Understand the management of the traumatically injured patient • Learn about a range of recent developments in trauma care

Introduction to the Special Issue on the 2011 Tohoku Earthquake and Tsunami

Research Article| May 01, 2013 Introduction to the Special Issue on the 2011 Tohoku Earthquake and Tsunami T. Lay; T. Lay Department of Earth and Planetary Sciences, University of California Santa Cruz, 1156 High Street, Santa Cruz, California 95064 Search for other works by this author on: GSW Google Scholar Y. Fujii; Y. Fujii International Institute of Seismology and Earthquake Engineering Building Research Institute, 1 Tachihara, Tsukuba, Ibaraki 305‐0802, Japan Search for other works by this author on: GSW Google Scholar E. Geist; E. Geist U.S. Geological Survey, 345 Middlefield Rd., Menlo Park, California 94025 Search for other works by this author on: GSW Google Scholar K. Koketsu; K. Koketsu Earthquake Research Institute, University of Tokyo, 1‐1‐1, Yayoi, Bunkyo‐ku, Tokyo, 113‐0032 Japan Search for other works by this author on: GSW Google Scholar J. Rubinstein; J. Rubinstein U.S. Geological Survey, 345 Middlefield Rd., Menlo Park, California 94025 Search for other works by this author on: GSW Google Scholar T. Sagiya; T. Sagiya Disaster Mitigation Research Center, Nagoya University, Furo‐cho, Chikusa‐ku, Nagoya 464‐8601, Japan Search for other works by this author on: GSW Google Scholar M. Simons M. Simons Seismological Laboratory, California Institute of Technology, 252‐21 Pasadena, California 91125 Search for other works by this author on: GSW Google Scholar Author and Article Information T. Lay Department of Earth and Planetary Sciences, University of California Santa Cruz, 1156 High Street, Santa Cruz, California 95064 Y. Fujii International Institute of Seismology and Earthquake Engineering Building Research Institute, 1 Tachihara, Tsukuba, Ibaraki 305‐0802, Japan E. Geist U.S. Geological Survey, 345 Middlefield Rd., Menlo Park, California 94025 K. Koketsu Earthquake Research Institute, University of Tokyo, 1‐1‐1, Yayoi, Bunkyo‐ku, Tokyo, 113‐0032 Japan J. Rubinstein U.S. Geological Survey, 345 Middlefield Rd., Menlo Park, California 94025 T. Sagiya Disaster Mitigation Research Center, Nagoya University, Furo‐cho, Chikusa‐ku, Nagoya 464‐8601, Japan M. Simons Seismological Laboratory, California Institute of Technology, 252‐21 Pasadena, California 91125 Publisher: Seismological Society of America First Online: 14 Jul 2017 Online ISSN: 1943-3573 Print ISSN: 0037-1106 Bulletin of the Seismological Society of America (2013) 103 (2B): 1165–1170. https://doi.org/10.1785/0120130001 Article history First Online: 14 Jul 2017 Cite View This Citation Add to Citation Manager Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Search Site Citation T. Lay, Y. Fujii, E. Geist, K. Koketsu, J. Rubinstein, T. Sagiya, M. Simons; Introduction to the Special Issue on the 2011 Tohoku Earthquake and Tsunami. Bulletin of the Seismological Society of America 2013;; 103 (2B): 1165–1170. doi: https://doi.org/10.1785/0120130001 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyBulletin of the Seismological Society of America Search Advanced Search The 11 March 2011 Tohoku earthquake (05:46:24 UTC) involved a massive rupture of the plate‐boundary fault along which the Pacific plate thrusts under northeastern Honshu, Japan. It was the fourth‐largest recorded earthquake, with seismic‐moment estimates of 3–5×1022 N·m (Mw 9.0). The event produced widespread strong ground shaking in northern Honshu; in some locations ground accelerations exceeded ⁠. Rupture extended ∼200 km along dip, spanning the entire width of the seismogenic zone from the Japan trench to below the Honshu coastline, and the aftershock‐zone length extended ∼500 km along strike of the subduction zone. The average fault... You do not have access to this content, please speak to your institutional administrator if you feel you should have access.

Programmable mechanical stimulation influences tendon homeostasis in a bioreactor system

Identification of functional programmable mechanical stimulation (PMS) on tendon not only provides the insight of the tendon homeostasis under physical/pathological condition, but also guides a better engineering strategy for tendon regeneration. The aims of the study are to design a bioreactor system with PMS to mimic the in vivo loading conditions, and to define the impact of different cyclic tensile strain on tendon. Rabbit Achilles tendons were loaded in the bioreactor with/without cyclic tensile loading (0.25 Hz for 8 h/day, 0-9% for 6 days). Tendons without loading lost its structure integrity as evidenced by disorientated collagen fiber, increased type III collagen expression, and increased cell apoptosis. Tendons with 3% of cyclic tensile loading had moderate matrix deterioration and elevated expression levels of MMP-1, 3, and 12, whilst exceeded loading regime of 9% caused massive rupture of collagen bundle. However, 6% of cyclic tensile strain was able to maintain the structural integrity and cellular function. Our data indicated that an optimal PMS is required to maintain the tendon homeostasis and there is only a narrow range of tensile strain that can induce the anabolic action. The clinical impact of this study is that optimized eccentric training program is needed to achieve maximum beneficial effects on chronic tendinopathy management.

Treatment of severe cuff tear arthropathy with the humeral head resurfacing arthroplasty: two-year minimum follow-up

The aim of the study was to evaluate the outcome of a humeral head resurfacing arthroplasty implanted toward valgus for patients with cuff tear arthropathy (CTA). We monitored 24 patients with CTA who underwent resurfacing arthroplasty. Patients were assessed with use of the Constant score and a subjective satisfaction score. The rotator cuff was evaluated preoperatively by magnetic resonance imaging. The Sirveaux classification of glenoid erosion in glenohumeral osteoarthritis with massive rupture of the cuff was used to grade the preoperative status of the glenoid. The mean absolute Constant score for the entire cohort improved from 21 points (range, 7-44 points) to 63 points (range, 23-89 points) at a mean of 38 months (range, 24-56 months). Patients with an intact or moderately atrophied teres minor muscle (n = 16) showed a significantly better Constant score (P = .011) and greater active external rotation (P = .034) than patients with severe atrophy. Neither the type of glenoid erosion according to Sirveaux nor the inclination angle of the implant has an effect on the clinical or functional outcome. For selected patients with CTA, resurfacing arthroplasty of the humeral head provides satisfactory medium-term outcomes. The teres minor muscle is necessary for maintaining or establishing external rotation. In patients with massive limitation of motion and total absence of the subscapularis tendon, the implantation of a humeral surface replacement should be seriously considered.

Effects of rotator cuff ruptures on the cellular and intracellular composition of the human supraspinatus muscle

Ruptures of the rotator cuff tendons of the human shoulder are a common incidence and lead to functional impairment of the four muscles connected to the cuff, entailing profound changes of their cellular tissue composition. Most importantly, such tendon tears lead to atrophy, fatty degeneration and fibrosis of the corresponding muscles. The muscle most commonly affected with such changes is the M. supraspinatus. The present study uses biopsy samples from the supraspinatus muscle of 12 elderly patients and 6 controls to examine the rupture-induced muscle change at both the cellular and the intracellular (ultrastructural) levels. Amounts of fatty tissue, connective tissue and muscle were assessed by light microscopy-based morphometry and stereology. Stereology of electron micrographs was employed to determine volume densities of muscle fibre mitochondria, myofibrils and intracellular lipid. Results demonstrate that the supraspinatus muscles of patients with a massive rupture contain significantly higher amounts not only of fatty tissue but also of intracellular lipid than those of control subjects. These patients further exhibit a major decrease in relative amounts of myofibrils, thus confirming that change of intracellular composition is a major component of the observed muscle degeneration. The results contribute to establish the true spectrum of supraspinatus muscle damage in humans induced by tendon rupture.

Spontaneous retroperitoneal hemorrhage due to massive rupture of renal angiomyolipoma treated with nephrectomy: an unusual onset of tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is a genetic and systemic disorder characterized by benign hamartomatous tumors that involve multiple organ systems. The classical clinical triad of TSC consists of seizure, adenoma sebaceum (facial angiofibromata) and mental retardation. Renal angiomyolipomas are documented in approximately 40 - 80% of tuberous sclerosis patients and usually are small and asymptomatic. Less frequently nodules are large and lead to retroperitoneal hemorrhage. In these cases diagnosis can be difficult but definitive only after the histological examination or the systemic investigation of other possible tissue involvements. We describe the case of a 28 year old woman who came to the emergency department with acute postprandial abdominal pain and severe anemia due to hemorrhagic renal angiomyolipoma treated by nephrectomy in whom the following examination led to the diagnosis of TSC.