Isolated atrophy and fatty infiltration of supraspinatus: A rare finding

Isolated atrophy and fatty infiltration of supraspinatus is very rare. We report the case of a 53 year old male with isolated atrophy and complete fatty replacement of supraspinatus and discuss potential aetiologies.     

改良HELPERR程序预防肩难产致新生儿产伤及对产妇身心状况的影响

目的探讨改良HELPERR程序预防肩难产致新生儿产伤及对产妇身心状况的影响。方法选择2010年1月~2011年7月我科收治的175例肩难产产妇设为对照组,采取常规HELPERR程序助产接生;选取2013年1月~2014年7月收治的184例肩难产产妇设为研究组,采取改良HELPERR程序应用于阴道分娩全程。比较两组新生儿产伤、产后并发症发生率、产后抑郁症发生率及满意度。结果研究组窒息、骨骼损伤、臂丛神经损伤及胸锁乳突肌血肿发生率均低于对照组,有显著性差异(P0.05)。产后出血、产道损伤、产褥感染及耻骨联合分离发生率低于对照组,有显著性差异(P0.05)。研究组产褥期抑郁症发生率低于对照组,有显著性差异(P0.05)。研究组满意度高于对照组,有显著性差异(P0.05)。结论改良HELPERR程序能降低肩难产致新生儿产伤及产妇并发症发生率,同时还能提高产妇心理舒适度,降低产后抑郁症发生率,取得较为满意的临床效果。     

Trends in Medicare physician reimbursement and utilization for proximal humerus fixation and shoulder arthroplasty

BackgroundFixation and arthroplasty remain the mainstays of surgical treatment of degenerative and traumatic shoulder pathology. They also constitute an appreciable sum of Medicare expenditure. With continued concern for declines in Medicare reimbursement across orthopedic surgery, it is important to understand how trends in reimbursement correlate with relative procedure volumes. Our aims were to describe temporal changes in procedure volumes, physician payment, and patient charges for proximal humerus open reduction internal fixation (ORIF) and shoulder arthroplasty.MethodsUsing Medicare's Physician Fee Schedules from 2012 to 2017, we examined procedure volumes, number of unique surgeons performing, actual submitted patient charges, and surgeon payments from 2012 to 2017 for six shoulder procedures: proximal humerus ORIF (CPT-23615), traumatic hemiarthroplasty (HEMI) (CPT-23616), degenerative HEMI (CPT-23470), primary total shoulder arthroplasty (TSA) (CPT-23472), partial TSA revision (humeral or glenoid component, CPT-23473), and total TSA revision (CPT-23474). The reimbursement ratio was calculated by dividing surgeon payment by patient charges. Growth rates of charges and payment were adjusted for inflation using annual consumer price index inflation rates over the same time period.ResultsThe total number of traumatic and degenerative HEMI cases fell over ?60%. Similarly, the number of unique surgeons performing traumatic and degenerative HEMI fell over ?53%. In contrast, the number of TSA procedures rose by +70%, whereas partial and total revision TSA rose by +62% and +88%, respectively. The number of unique surgeons rose +28% and over +73% for primary and revision TSA, respectively. There was a large gap (between 3.4 and 4.4 times) between submitted charges and surgeon payment for all years analyzed. After adjusting for inflation, Medicare payment to surgeons decreased for all types of surgery (?6% to ?9%) other than ORIF, which increased +10%. Submitted patient charges during this period increased +14% and +9.7% for ORIF and revision TSA (total), respectively, but decreased by ?6% for traumatic HEMI. The reimbursement ratio was ≤29% for all procedures analyzed across all years and fell the most for revision TSA (partial and total).ConclusionFrom 2012 to 2017, there was a sharp decline in the use of shoulder HEMI with a correspondingly high increase in TSA. After accounting for inflation, HEMI and TSA showed appreciable declines in surgeon payment over time, whereas ORIF was the only surgery with increased surgeon payment. Revision TSA saw the largest declines in the reimbursement rate. Physicians and health care policy makers must be aware of these trends to ensure both a sustainable payment infrastructure for surgeons as well as to maintain access to care for these procedures.Level of evidenceLevel III; Economic Study     

The Basics of Intraoperative Diagnosis in Neuropathology

Intraoperative pathologic consultation continues to be an essential tool during neurosurgical procedures, helping to ensure adequacy of material for achieving a pathologic diagnosis and to guide surgeons. For pathologists, successful consultation with central nervous system lesions involves not only a basic familiarity with the pathologic features of such lesions but also an understanding of their clinical and radiologic context. This review discusses a basic approach to intraoperative diagnosis for practicing pathologists, including preparation for, performance of, and interpretation of an intraoperative neuropathologic evaluation. The cytologic and frozen section features of select examples of common pathologic entities are described.