Rupture of the Distal Biceps Tendon: Report of Five Cases

Five cases of rupture of the distal biceps tendon are described. Three were operated on—two in the acute stage and one after 3 months—and the other two were managed conservatively. The literature on this condition is reviewed and alternative forms of treatment are discussed.     

One- Versus Two-Incision Technique for Distal Biceps Tendon Repair

There are several techniques that have been described for distal biceps tendon repair but there is still controversy regarding the optimal technique. Our hypothesis is that the single-incision technique will have a similar complication rate and functionally equivalent restoration of function compared with the two-incision approach. A retrospective review of consecutive biceps tendon repairs was performed at one institution over a 5-year period. Thirty-six patients met the inclusion criteria and 26 were available for follow-up including subjective assessment, physical examination, and strength testing. Patients were divided into two groups based on the surgical approach utilized: 12 patients underwent single-incision repair and 14 had a two-incision repair. The average follow-up was 33 months (minimum 13; maximum 75). There were no statistically significant differences in regards to flexion strength or endurance, supination strength or endurance, or complication rates between the two techniques. In conclusion, both surgical techniques led to adequate restoration of strength with a low complication rate. Both techniques are safe to perform and should be guided by surgeon comfort with the approach.     

Operative Versus Nonoperative Management of Nonfunctioning Pancreatic Neuroendocrine Tumors

Introduction

Surgical resection is the only curative treatment for pancreatic neuroendocrine tumors (PNETs), but pancreatic operations carry a significant morbidity. We investigated whether the resection of small, asymptomatic nonfunctioning PNETs is beneficial. Clinicopathologic factors were retrospectively reviewed for all PNET cases from 1998 to 2014.

Methods

Kaplan-Meier survival and multivariable regression analyses were performed. A total of 249 patients had nonfunctioning PNETs with adequate follow-up, of whom 193 were resected and 56 were observed. Median age was 56 years, and 48 % of the patients were female.

Results

Overall, the resected patients had a significantly longer survival (OS) (p?=?0.001). However, for the patients with PNETs ≤2.5 cm in size and without metastasis at presentation, tumor size significantly modified the effect of resection on overall survival (p?<?0.05). The protective effect of resection increased as tumor size increased. An operation became a significant predictor of overall survival for tumors >1.5 cm (p?=?0.050 or less for larger tumors) but was not significant for tumors <1.5 cm (p?=?0.317 or more for smaller tumors), controlling for age-adjusted Charlson comorbidity index.

Conclusion

Resection of nonfunctioning PNETs over 1.5 cm is independently and significantly associated with a longer survival. However, the benefit of resection for tumors under 1.5 cm is unclear.

     

Operative Treatment of Acute Achilles Tendon Rupture: Open End-to-End-Reconstruction Versus Reconstruction with Mitek-Anchors

Purpose: To retrospectively compare the open end-to-end repair versus repair using the Mitek-anchor system in acute Achilles tendon rupture.

Method: Forty-seven consecutive patients with Achilles tendon rupture, all operated on between 2004 and 2005, were included. Their medical records were reviewed and they were interviewed for surveillance of post-operative function at follow-up. Functional outcome was determined using an adapted VISA tendinopathy questionnaire and by testing the isometric ankle plantar flexion strength. Post-operative complications and recurrence rate of rupture were noted. Results: Seven patients were lost to follow-up. From a total of 40 patients, twenty-eight (68% of total) underwent classic repair and 12 (32%) were treated by the Mitek-anchor system. Median age was 43 years (range 29–63). Median post-operative follow-up was 29 months (range 17–40). Median time to resume work was nine weeks in the classic group versus 12 weeks in the Mitek-group. Median time to resume sports was 19 versus 31 weeks respectively. Wound infections occurred in five percent of the total (one in each group) and rupture recurrence rate was three percent of the total (nil in classic group, one in Mitek-group). Loss of strength in the injured leg compared to the non-injured leg was greater in the Mitek-group than in the classic group.

Conclusion: We conclude that in comparing classical end-to-end repair of acute Achilles tendon ruptures with repair using Mitek-anchors, it took patients in the Mitek-group longer to return to work and sport activities than in the classic group. Greater loss of strength in the injured leg was seen in the Mitek-group. Therefore we do not advocate the use of Mitek-anchors for the repair of acute ruptured Achilles tendons.     

Hemoptysis and Pulmonary Aspergilloma: Operative versus Nonoperative Treatment

The clinical experience with 42 patients with pulmonary aspergilloma evaluated at the Vanderbilt University Affiliated Hospitals in a 22-year period was reviewed to determine the necessity and advisability of pulmonary resection. Twenty-nine patients (69%) had sustained one or more episodes of gross hemoptysis. Eleven of the 42 patients were treated operatively with lobectomy, wedge resection, or cavernostomy. Five of them had had hemoptysis preoperatively, but in only 1 patient was massive hemoptysis the primary indication for operation. The single death among these 11 patients occurred in the patient undergoing operation for control of massive hemoptysis. Nonoperative treatment was selected in 31 patients because of advanced chronic lung disease. Twenty-four of these 31 patients experienced 41 episodes of gross hemoptysis during observation periods up to 8 years (average, 32 months). Superimposed bacterial infection usually accompanied the episodes of hemoptysis, and medical therapy with bedrest, antibiotics, and postural drainage was successful in controlling the hemorrhage in 40 of the 41 episodes. One patient died from massive hemoptysis. On the basis of this experience, pulmonary resection for aspergilloma in patients with hemoptysis seems rarely indicated.     

手术与非手术治疗股骨粗隆间骨折的比较分析

目的：分析比较保守与手术治疗股骨粗隆间骨折的疗效。方法：87例用牵引治疗,42例用角形钢板内固定,结果：术后经3－36月随访,牵引治疗及手术治疗的优良率分别为93．1％和92．86％,结论：角形钢板内固定是治疗股骨粗隆间骨折较好方法,采用牵引方法治疗也能取得较好的疗效。