Soft Tissues In Patients Research Articles

Releases of subscapularis contracture: an anatomic and clinical study

Correction of anterior subscapularis contracture is an important step in soft-tissue balancing at the time of total shoulder replacement (TSR). An anatomic and clinical investigation was undertaken to investigate the effect of steps involved in subscapularis release. In 14 cadaveric shoulders studied, the subscapularis insertion consisted of three regions: a thick superior tubular tendon (STT), a flat middle tendon, and an inferior portion where the muscle fibers insert directly into the humerus. In 16 consecutive patients undergoing primary TSR for osteoarthritis, measurements of subscapularis length were taken after different releases. An average of 0.9 cm (confidence interval, 0.7-1.1 cm) of excursion was added after anterior capsular release, and an additional 0.7 cm (confidence interval, 0.5-0.9 cm) of excursion was obtained after STT release. Incision of the STT is an alternative means of gaining subscapularis length when balancing the soft tissues in patients with osteoarthritis undergoing TSR.

Craniofacial cephalometric morphology in six‐year‐old girls with submucous cleft palate and isolated cleft palate

Ninety‐three girls with cleft palate (53 submucous cleft palate (SMCP) and 40 isolated cleft palate (ICP)), mean age 6.2 years (range 5.5–7.5), were compared retrospectively from lateral cephalograms. Forty‐three patients with SMCP had had surgical treatment at the mean age of 3.4 years (range 0.9–6.8), 10 of the SMCP patients were unoperated. Twenty‐six patients with ICP had clefts of the hard and soft palate, and 14 had clefts of the soft palate only. Palatal closure of ICP had been done at the mean age of 1.5 years (range 1.0–2.1). The skeletal craniofacial morphology was similar in SMCP and ICP. The maxilla and mandible were well related to each other but slightly retrusive in relation to the cranial base. The slight skeletal retrusion was significantly more masked by soft tissue in patients with SMCP. The patients with SMCP showed higher values for soft tissue maxillary and mandibular prominence.

The value of ultrasound after shoulder arthroplasty

This study was undertaken to evaluate whether sonography is a useful tool in the diagnosis of soft tissue disorders as a possible cause for discomfort and/or pain after shoulder arthroplasty. Static and dynamic ultrasound examinations were performed in the standard sectional planes on 22 patients with 25 hemiprostheses and the results were correlated with the clinical outcome. The stability was determined in the transverse and frontal planes and the clinical results were evaluated according to the Constant and Swanson scores. Several pathological changes were detected: rotator cuff lesions, subdeltoid bursitis, changes around the long biceps tendon as well as an increase in intra-articular volume due to effusion and/or synovitis. The correlation of sonographic and clinical results demonstrated that patients with an excellent clinical result showed no or only a few pathological findings on sonography compared with those with a moderate or poor result. Pathological changes of the periarticular tissue in the direct neighbourhood of the implant can be detected by sonography, which can be recommended as a valuable examination technique to evaluate the soft tissue in patients after shoulder arthroplasty.

Operation of du toit/roux for recurrent anterior dislocation of the shoulder

Restoration of stability and function of the shoulder. Recurrent posttraumatic anterior shoulder dislocation with detachment of the anterior part of the labrum and the capsule. Absence of detachment of anterior soft tissues in patients with habitual dislocation or multidirectional instability. Big Hill-Sachs lesion. Poor local skin conditions Poor general health. Anterolateral deltoperatoral approach. External rotation and exposure of the tendinous part of the subscapularis which is cut in a tongue shaped fashion. Exposure of the detachment of labrum and capsule at the scapular neck. After freshening of the rim of the glenoid labrum and capsule are fixed there with a staple. Stuture of the capsule. Reattachment of the subscapularis. Wound closure in layers. Immobilization in a shoulder-arm bandage (Gilchrist). Early functional after treatment. Clinical and radiological follow-up of 48 out of 55 operated patients after a mean of 2.8 years (1 to 10 years). Of this group 20 patients filled in a questionnaire after 11 to 12 years. The incidence of early recurrence was 2% and of late recurrence 5%. An excellent to good subjective result was reported by 90% of the patients, even at the longer follow-up.

Morphologic changes in the perioral soft tissues in patients with mandibular hyperplasia using a laser system for three-dimensional surface measurement

Soft tissue changes following correction of mandibular hyperplasia were studied using a laser system for three-dimensional (3-D) surface measurement. Twelve subjects (7 men and 5 women; age 17–48 years) were included in this study. Bilateral sagittal split ramus osteotomies were performed in ten patients and intraoral vertical ramus osteotomies in two patients. Pre- and postoperative images, obtained with the laser system, were superimposed to determine distribution of changes in the perioral soft tissue. Mean volume changes were 1032.3 mm3 in the Subnasale-UL area and 8700.9 mm3 in the LL-Menton area. Changes in both areas were symmetrical around the mid-sagittal plane in some patients and asymmetrical in others. This measurement system provided a simple method of determining 3-D changes in soft tissue following surgery and might be useful for clinical purposes.

Morphologic changes in the perioral soft tissues in patients with mandibular hyperplasia using a laser system for three-dimensional surface measurement

Soft tissue changes following correction of mandibular hyperplasia were studied using a laser system for three-dimensional (3-D) surface measurement. Twelve subjects (7 men and 5 women; age 17–48 years) were included in this study. Bilateral sagittal split ramus osteotomies were performed in ten patients and intraoral vertical ramus osteotomies in two patients. Pre- and postoperative images, obtained with the laser system, were superimposed to determine distribution of changes in the perioral soft tissue. Mean volume changes were 1032.3 mm 3 in the Subnasale-UL area and 8700.9 mm 3 in the LL-Menton area. Changes in both areas were symmetrical around the mid-sagittal plane in some patients and asymmetrical in others. This measurement system provided a simple method of determining 3-D changes in soft tissue following surgery and might be useful for clinical purposes.

Serial Evaluation of Increased Chest Wall F-18 Fluorodeoxyglucose (FDG) Uptake Following Radiation Therapy in Patients With Bronchogenic Carcinoma.

PURPOSE: Following radiation therapy for bronchogenic carcinoma, increased FDG accumulation within the irradiated tissue can be identified. This finding has not been well characterized. Therefore, we retrospectively evaluated the time course, frequency, and intensity of increased FDG uptake over a one-year period in patients who had been treated with radiation therapy. MATERIALS AND METHODS: Serial FDG-PET studies (n = 38) were performed in patients (n = 12) with bronchogenic carcinoma before and after radiation therapy. Regions of interest (ROIs) were placed in the chest wall and activity concentrations of posttherapy studies were compared to pretherapy studies. FDG uptake was also described qualitatively relative to mediastinal activity (1-4 scale) by two observers blinded from clinical information. RESULTS: Chest wall radiation port ROI uptake was 18% higher in the 2-month (P = 0.08), 40% higher in the 6-month (P = 0.003), and 32% higher in the 12-month (P = 0.04) posttherapy studies than in non-port ROIs. In 6 patients that clinically had radiation-induced chest wall fibrosis or pneumonitis, visual interpretation identified abnormal chest wall or pleural region FDG uptake in 5/6. In 2/6 patients without clinical chest wall fibrosis, abnormal, chest wall FDG uptake was seen. CONCLUSIONS: Radiation therapy occasionally causes modestly increased soft tissue FDG uptake within irradiated soft tissue in patients being treated for bronchogenic carcinoma, which persists for up to one year after therapy.

長期透析患者の上位頚椎病変の分析

In 1990 Rousselin et al. reported a pseudotumor of the periodontoid soft tissue in patients on long-term hemodialysis. Our study of the upper cervical spine was performed using magnetic resonance imaging and X-ray in 20 patients (15 males and 5 females). The mean age of subjects was 53 years (ranging from 35 to 78 years). They were treated with long-term hemodialysis for a mean of 9 years (ranging from 4 to 24 years).Plain radiography demonstrated vertical atlantoaxial subluxation in two, and one showed a fracture of the odontoid process. The other showed an irregular feature of the atlantoaxial joint.Pseudotumor of the periodontoid soft tissue was observed in 5 cases (25%) by MRI. The mean duration of dialysis in patients with pseudotumor was 17.7 years, and that in patients without it was 7.4 years. The duration of dialysis in the pseudotumor group was significantly older than that in the non pseudotumor group (P<0.01). There was no significant difference in β2 microglobulin between the 2 groups. In T1-weighted MRI sequences, the signal intensity of the soft tissue mass was lower or equal than that of the spinal cord.

Cytogenetic Characterization of Sarcomas of Bone and Soft Tissues

Specific chromosome rearrangements in different types of solid tumors have been described recently in a number of studies. However, the frequency and diagnostic importance of these chromosome rearrangements are currently under intensive investigation. The objective of this study is to provide a preliminary report on the types of clonal chromosome abnormalities observed in sarcomas of bone and soft tissues. Included in this report are osteosarcoma (five), synovial sarcoma (three), Ewing sarcoma (two), leiomyosarcoma (one), and spindle cell sarcoma (one). Cytogenetic analysis revealed clonal chromosome rearrangements in all of the tumors studied. Our findings correlated well with previously reported cytogenetic data on various types of solid tumors.

Oxalate Removal by Hemodialysis in End-Stage Renal Disease

Because of mounting evidence of precipitation of calcium oxalate in the soft tissues of patients with end-stage renal disease (ESRD) on maintenance hemodialysis, the plasma oxalate concentrations and calculated dialysis removal of oxalate were studied in seven patients without evidence of either primary or absorption hyperoxaluria prior to ESRD. A reversed-phase high-pressure liquid chromatographic method was developed to quantitate serum oxalate. Mean value +/- SE in four healthy controls was 28 +/- 5 mumol/L, and in the seven patients it was 187 +/- 15 mumol/L predialysis and 89 +/- 11 mumol/L postdialysis. Oxalate deposition in the soft tissues of ESRD patients is the consequence of sustained hyperoxalemia. Oxalate removal by dialysis was calculated from the four-hour oxalate clearance. Since the ionic radii of phosphate and oxalate are similar, total oxalate clearance was calculated midpoint of dialysis. Mean oxalate removal/dialysis was 3.01 +/- 0.283 mmol. On a daily basis this value was 1.645 +/- 0.155 mmol, which is about threefold the normal oxalate excretion rate. It is not significantly different from the excretion rate in absorption oxalurias but is less than that in primary hyperoxaluria. Therefore, it is concluded that hyperoxalemia in ESRD results from loss of renal excretion, failure of hemodialysis to remove enough oxalate to maintain a normal serum concentration, and increased intestinal absorption of oxalate and/or increased endogenous production.

The Wake-up Technique as a Dual Protector of Spinal Cord Function During Spine Fusion

Intraoperative awakening is commonly used to evaluate voluntary motor function to lessen the risks of nerve damage during posterior spine fusion and Harrington rod instrumentation for idiopathic scoliosis. This is a report of intraoperative monitoring of tension in the soft tissues of patients with idiopathic scoliosis utilizing a strain-gauged distraction outrigger. The tension in soft tissues was found to drop following intraoperative awakening by an average of 52 N in the 14 patients monitored. The "wake-up" technique may aid in protecting the spinal cord from overdistraction by the increase in soft tissue tension present at the time of Harrington rod replacement in addition to providing a spot check of motor function. This increased tension may slightly repress curve correction.

Current status of total joint replacement in the upper extremity.

The principles ot total joint arthroplasty recently have been expanded to the upper extremity, following the dramatic success with total hip and total knee replacement procedures. New problems have been encountered with the rebalancing of the soft tissues and the technical nature of joint mechanics in the upper extremities. Work on shoulder joint replacement is in the very early stages and of unknown success. Several prostheses are being used and tested. For elbow and wrist replacement, early and predictable success has been accomplished, enabling relief of pain and satisfactory motion. Total joint replacement in the fingers and thumb has provided excellent relief of pain but has been hindered by difficulties in rebalancing the soft tissues in patients with rheumatoid arthritis. It appears that total reconstruction of arthritic upper-extremity joints will be commonplace in the not-too-distant future. Clinical trials are being expanded, with increasing success.

Radiodensities in Long-Standing Acne

To the Editor.— Roentgenographic identification of opaque deposits in the soft tissues of patients with moderate to severe acne vulgaris has been described in the dermatologic literature. 1 These densities, in some cases, represent true metaplastic bone formation 2 and are clinically significant, while in other cases, the deposits are clinically obscure and may represent only dystrophic calcification. 3 These osteomas can be demonstrated by soft-tissue roentgenograms. Report of a Case.— A 19-year-old woman had had moderately severe acne of the face and back for approximately seven years. The condition was under fairly good control, with a few comedones and pustules, and she showed minimal scarring over her cheeks. In the area of acne involvement, multiple 1- 2-mm pigmented, firm nodules were noted. Nine of these nodules were incised and the osteomas removed (Fig 1). Tangential roentgenograms of the face showed the osteomas as multiple soft-tissue radiodensities (Fig 2). Comment.—

Abdominal‐Wall Pain of Bony Origin: Two Clinical Entities in Geriatric Patients

ABSTRACT:Two clinical entities of pain in the anterior abdominal wall are described. One of these is due to the lower ribs “kissing” the iliac crest and bruising the soft tissues in patients with dorsal kyphosis. The other is due to referred pain from spondylosis of the lower dorsal spine. Both may be mistaken for acute or chronic intra‐abdominal disease, and the patient subjected to unnecessary laparotomy in error.

Results Obtained with N-Ottil-enolic-ether of Dihydrotestosterone in Advanced Breast Cancer

Twenty-five women with advanced breast cancer were treated with n-ottil-enolic-ether of dihydrotestosterone. Objective regression of all lesions or of part of them was observed in 8 patients (32% of the cases), with an average duration of 5.5 months (max. 9 months). The highest incidence of regression was observed in lesions of soft tissues in patients in advanced post-climaterium. Subjective results were good, especially on pain caused by bone metastases, even in the absence of an objective regression of the neoplastic localization. There were mild side effects; a slight hypertricosis was observed in 6 patients. The authors emphasize the analogy between the incidence, type and degree of neoplastic regressions obtained with the present compound and those obtained with testosterone propionate. They conclude that the antitumoral effect of this class of steroids is not necessarily related to the degree of their androgen or gonadotropic activity.

Muscular dystrophy. II. Radiologic findings in relation to severity of disease.

Changes demonstrable by x-rays occur in long bones, spine, and soft tissues of patients with muscular dystrophy.* Most authors have regarded these findings as part of disease; they have not correlated them with severity of disease. Lewitan and Nathanson15pointed out that, the bone changes are purely secondary to muscle involvement. The hospitalization of a group of children with muscular dystrophy has provided opportunity for a study correlating radiographic changes with severity of disease. MATERIAL AND METHODS Roentgenograms of vertebral column, skull, long bones, wrists, and thorax were made of 31 children whose history, physical findings, laboratory studies, and muscle biopsy were compatible with diagnosis of juvenile form of muscular dystrophy. Films of spine were examined for signs of scoliosis, lordosis, kyphosis, and caninization (i. e., apparent increase in altitude of vertebral bodies) and films