Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome

This study presents an objective evaluation of both scapular upward and axial rotational tilts in shoulder impingement syndrome, using a scapular spine line defined on antero-posterior (AP) radiographs of the shoulder as the referential line. Twenty-seven patients with unilateral shoulder motion pain, who were diagnosed as having chronic shoulder impingement syndrome, were enrolled in the study. Scapular upward and axial rotational tilts were compared between the affected and contralateral shoulders. AP radiographs were obtained at shoulder abduction angles of 0°, 45°, and 90°, and the X-ray films were digitized by computer. The upward and axial rotational tilts of the scapula were then evaluated on the digital images. In shoulder impingement syndrome, both upward and axial external rotations of the scapula were impaired at the painful arc angle of abduction. This tended to be more apparent for the axial rotation of the scapula than for the upward rotation. These reductions in scapular rotations reduce available clearance for the rotator cuff and humeral greater tuberosity as the shoulder is abducted. Received: January 13, 2000 / Accepted: October 2, 2000     

Seven-year follow-up of vanishing bone disease in a 14-year-old girl

A review of the literature revealed 91 cases of massive osteolysis since the first report by Jackson in 1838, including 31 in the maxillofacial region meeting the Heffez criteria. In seven cases, early irradiation was performed, after which no further progression of bone lysis was observed. The young female patient reported here has been followed up clinically and radiologically for 7 years after radiotherapy, during which time she has remained stable, with no progression of the osteolysis. Our experience with this patient appears to confirm that early radiotherapy with a dose of 30–40 Gy prevents further progression of the disease and can even lead to recalcification. On this basis, and provided the patient remains symptom-free, reconstructive surgery appears a viable treatment option.     

Adaptive patterns of movement during arm elevation test in patients with shoulder impingement syndrome

The purpose of this study was to determine if a distinctive characteristic exists in the pattern of movement (scapular elevation and upward rotation to reduce impingement) and associated muscular activities during arm elevation in subjects with shoulder impingement (SI) that is associated with the severity of the disease. Fourteen subjects (7 amateur athletes and 7 student athletes) with SI and 7 controls performed arm elevation in the scapular plane. Scapular kinematics (upward rotation, elevation, tipping, and scapulohumeral rhythm) and muscular activity [upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and deltoid] were measured by an electromagnetic motion tracking system and surface electromyography, respectively. Subjects with SI had greater elevation of the scapula (11.9 mm, p < 0.005) and less peak scapular posterior tipping (10.6°, p < 0.02) than controls. In more severe subjects (amateur athletes), the elevation and posterior tipping of the scapula were correlated with an increase in the UT (R = ?0.818, p = 0.025) and a decrease in SA (R = 0.772, p = 0.040) activity, respectively. Our results identified a characteristic compensatory scapular elevation to reduce impingement during arm elevation in subjects with SI. Assessing scapular elevation during arm elevation may be a useful functional marker for evaluating impingement status and associated muscle function. Additionally, SA and LT muscle strengthening may improve SI. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:653–657, 2011     

Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: A case report

Cranial irradiation may lead to accelerated atherosclerotic changes to small or medium sized arteries, but stroke associated with pituitary irradiation is not frequent. A patient treated with Gamma Knife radio-surgery (GKRS) for a pituitary adenoma suffered a cerebral infarction with internal carotid artery occlusion 4 years after radiosurgery. The patient was a 35-year-old male presenting with a visual disturbance. Endocrinological tests were normal. MRI revealed a 4.3 by 4.3 cm diameter invasive macroadenoma of the pituitary, projecting toward the suprasellar region and with cavernous sinus involvement with encasement of both internal carotid arteries (ICAs). GKRS was performed for residual tumor after a transcranial resection. The maximum dose was 40 Gy and the dose to the right carotid artery was below 20 Gy. The delayed hemiparesis was accompanied by a right capsular lacunar infarct shown on MRI. The images also showed a marked reduction in tumor size. Total, right ICA occlusion was confirmed by Doppler ultrasound. The patient had no history or signs of heart disease or metabolic disorder which could predispose to cerebrovascular     

Toxicity of photodynamic therapy after combined external beam radiotherapy and intraluminal brachytherapy for carcinoma of the upper aerodigestive tract

BACKGROUND AND OBJECTIVE: To describe the toxicity of photodynamic therapy (PDT) in patients with carcinoma of the upper aerodigestive tract who received prior treatment with external beam irradiation and intraluminal brachytherapy (IB). STUDY DESIGN/MATERIALS AND METHODS: Hospital records of PDT patients were reviewed. Three patients who received prior treatment with external beam irradiation and IB were identified. Two patients had esophageal carcinoma treated with combined chemotherapy and external beam irradiation (55.8 and 50.4 Gy) followed by IB (12 Gy and 35 Gy at 1 cm). These patients then received PDT for treatment of recurrence (2 mg/kg Photofrin injection and 2 light applications: 630 nm, 150--200 J/cm, 200--400 mW/cm). One patient had non-small cell lung cancer treated with external beam irradiation (60 Gy) followed by IB (36.1 Gy at 1 cm) and then received PDT for recurrence (1 mg/kg Photofrin injection and one light application: 630 nm, 150 J/cm, 200 mW/cm). RESULTS: One patient with esophagus cancer had formation of a tracheoesophageal fistula, which required stent placement. The other esophageal cancer patient developed quadriplegia due to an epidural abscess arising from a fistula with the diseased portion of the esophagus. The lung cancer patient had massive hemoptysis after the procedure and died 2 days later. Autopsy showed necrotizing arteritis of the right pulmonary artery. CONCLUSION: Patients with upper aerodigestive tract carcinoma who have received treatment with both external beam irradiation and IB seem to be at higher risk for complications when treated with PDT.     

Thinking outside the glenohumeral box: Hierarchical shape variation of the periarticular anatomy of the scapula using statistical shape modeling

Variation in the shape of the glenoid and periarticular anatomy of the scapula has been associated with shoulder pathology. The goal of this study was to identify the modes of shape variation of periarticular scapular anatomy in relation to the glenoid in nonpathologic shoulders. Computed tomography scans of 31 cadaveric scapulae, verified to be free of pathology, were three-dimensionally reconstructed. Statistical shape modeling and principal component analysis identified the modes of shape variation across the population. Corresponding linear and angular measurements quantified the morphometric variance identified by the modes. Linear measures were normalized to the radius of the inferior glenoid to account for differences in the scaling of the bones. Five modes captured 89.7% of total shape variation of the glenoid and periarticular anatomy. Apart from size differences (mode 1: 33.0%), acromial anatomy accounted for the largest variation (mode 2: 32.0%). Further modes described variation in glenoid inclination (mode 3: 11.8%), coracoid orientation and size (mode 4: 9.0%), and variation in coracoacromial (CA) morphology (mode 5: 3.1%). The average scapula had a mean acromial tilt of 49 ± 7°, scapular spine angle of 61 ± 6°, the glenoid inclination of 84 ± 4°, coracoid deviation angle of 26 ± 4°, coracoid length of 3.7 ± 0.3 glenoid radii, and a CA base length of 5.6 ± 0.5 radii. In this study, the identified shape modes explain almost all of the variance in scapular anatomy. The acromion exhibited the highest variance of all periarticular anatomic structures of the scapula in relation to the glenoid, which may play a role in many shoulder pathologies.     

Deviation of skin marker from bone target during movement of the scapula

Background Recording movement of the scapula by non-invasive techniques is fraught with technical difficulty. One convenient method involves placing a single marker on the skin overlying the acromion. The purpose of this study was to compare translatory discrepancies between marker and underlying bone for seven markers affixed to the skin overlying different parts of the scapula. Methods The markers were small plastic spheres filled with machine oil, clearly visible on magnetic resonance imaging (MRI), placed over seven loci of the scapula, including the acromion, spine, medial border, lateral border, and inferior angle. Nine healthy men participated, assuming three positions in the MRI apparatus: (1) arm at the side of the trunk (starting position); (2) arm in full elevation over the head; and (3) hand placed behind the back at the thoracolumbar area. Visible markers and three loci of the scapula itself were digitized on each MRI scan, enabling calculation of changes in location of each marker relative to the scapula between the starting position and either of the other two positions. Results Among the seven loci examined, the marker placed atop the acromion deviated least from its target, 39 ± 1mm (mean ± standard deviation) for full elevation and 15 ± 1mm for moving the hand behind the back. Markers along the medial border and at the inferior angle exhibited relatively large deviations, on the order of 8mm for full elevation and 3mm for moving the hand behind the back. Conclusions For the two movements studied, involving full range of motion in the shoulder complex, translation of the scapula is most accurately recorded if the marker is placed over the acromion, but the systematic error is too large for such tracking to be deemed precise.     

Intraoperative microwave inactivation in‐situ of malignant tumors in the scapula

Objective: To explore the feasibility and effect of microwave in situ inactivation of malignant primary or metastatic tumors in the scapula. Methods: Seventeen patients (12 men, 5 women, mean age 48 years [range, 13–59 years]) with malignant primary or metastatic tumors involving the scapula were treated by microwave inactivation between June 1998 and February 2008. There were12 malignant primary bone and 5 metastatic tumors. In 14 cases Area Sl was involved and in 3 cases both Areas S1 and S2. All 17 cases were by making a dorsal arc‐ or “∩‐” shaped incision to expose the tumor, protecting the surrounding soft tissues with a copper grid, and then heated the tumors locally with 2450 MHz microwave to 50°C for 20 min, after which all or some of the necrotic tumor tissue was removed, preserving the support role of the scapula. Results: The operation time was 60–180 min (mean 120 min) and blood loss was 300–1000 mL (mean 460 mL). No serious intraoperative or postoperative complications occurred in any patient. The patients were followed up for 3 months to 10 years (mean 4.2 years). Three patients with Ewing's sarcoma in the scapula had pulmonary, cerebral and systemic multiple metastases and died 8～24 months after surgery. Three patients with malignant fibrous histiocytoma died of pulmonary and systemic multiple metastases 10～22 months after surgery; one patient had recurrence 6 months after surgery and survived with tumor. Five patients with metastatic tumor in the scapula died of non‐scapular metastatic tumor 6～14 months after surgery. The other five patients with primary malignant bone tumors had no recurrence or metastasis during follow‐up. Three cases had restricted extension of the shoulder joint with unrestricted protraction and retroflexion after surgery. Conclusion: In situ microwave inactivation features simple surgery, reliable effects and patient acceptability, making it an ideal surgical method for malignant tumors in the scapula.     

Surgical assessment of the proximal thoracic curve in adolescent idiopathic scoliosis

Existing predictive signs as available in current literature may miss potential proximal thoracic (PT) curve deterioration and shoulder imbalance, following selective main thoracic (MT) curve correction in adolescent idiopathic scoliosis (AIS). The present study is an attempt to evaluate and complement these signs, through a retrospective study of 56 AIS patients who underwent correction and fusion from 1986 till 2003 with follow-up 4–16 years. Forty-nine had fusion of MT curve, 7 of MT and PT. Cotrel–Dubousset instrumentation in 45, Luque in 12. Preoperative data: MT 50° (40°–80°), PT 25° (0°–50°), shoulder elevation from −4 cm (right) to 2 cm (left), clavicle angle from −14° to 5°, PT bending correction from 0 to 100% and T1 tilt from −15° to 14°. We introduced the first rib index (FRI), i.e., the difference between the diameter of right and left first rib arch as a percentage of the sum of both diameters, averaging from −22.7 to 14.3%. (Minus signs refer to or predict right, while positive left shoulder elevation.) Evaluation included all predictive parameters as related principally to postoperative left shoulder elevation ≥1 cm, patient satisfaction and surgeon fulfillment. Postoperative correction MT curve 53% (23–83%) and PT 35% (0–100%). One progressive paraplegic started 40 min following normal wake-up test. Immediate decompression, full recovery. Three cases with wound infection recovered after late removal of instrumentation. Loss of correction ≥10° in five. Fifteen had postoperative persisting left shoulder elevation ≥1 cm. Seven of these expressed dissatisfaction. Statistically FRI proved valuable predictive factor always in combination with previously described signs. We concluded that a postoperative left shoulder elevation ≥2 cm is a potential cause of dissatisfaction and may be prevented with thorough validation of all predictive signs, principally the FRI. Part of this paper was presented at the 62nd annual meeting of the Hellenique Orthop. Society (October 2006) and received the 1st award for best clinical paper.     

Clinical and radiological outcome after mini-open Latarjet technique with fixation of coracoid with Arthrex wedge mini-plate

BackgroundTechnical faults leading to coracoid fractures during screw insertion and coracoid graft osteolysis are concerns with standard screw fixation techniques in Latarjet procedure. The purpose of this study is to share our experience using Arthrex wedge profile plate with mini-open technique for graft fixation, that ensures better load distribution between coracoid graft and glenoid.MethodsWe did retrospective analysis of 24 patients with recurrent anterior shoulder instability after failed arthroscopic Bankart's repair. Arthroscopic examination of affected shoulder was done in lateral position before making patient supine for open Latarjet. A low profile wedge plate (Arthrex) with two screws was used for the procedure. CT analysis was performed post-operatively at 6 months to see graft union and results were evaluated using the Rowe and Walch Duplay score.ResultsMean follow-up time was 26 months. Postoperatively, mean forward elevation was 170.6 + 4.6° (loss of average 5.9°) and mean external rotation was 42.5 + 5.3° (loss of average 3.1°). All patients returned to their previous occupation. None reported to be having any recurrent subluxation. Functional assessment done using Rowe score and Walch Duplay score showed statistically significant improvement (p value 0.034). There were no implant-related complications and no case of coracoid graft osteolysis.ConclusionsMini-open Latarjet with graft fixation with Arthrex mini-plate provides satisfactory outcome in patients who require reoperation due to dramatic bone loss and failed soft tissue reconstruction. The modified incision improves exposure enabling plate fixation and the secure fixation accelerates rehabilitation.     

Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: A case report

Free muscular, osteomuscular, and fasciocutaneous flaps are widely used for midfoot reconstruction. The latissimus dorsi (LD) flap is rich in muscle mass, but the weight‐bearing ability of the reconstruction with its combination with a scapula or rib has not been evaluated. Here, we report a case of reconstruction of the right midfoot with the trauma‐related osteomyelitis using a free chimeric scapula and LD muscle flap in a 59‐year‐old woman with diabetes mellitus. After radical debridement and sequestrectomy, a 7 × 3 cm² wound with a 5 × 3 cm² bony defect was reconstructed with the chimeric scapula and LD muscle flap. The postoperative course was uneventful. The bony union was achieved 6 months after surgery. In 14 months follow‐up, no clinical complications including a new ulcer or stress fracture were noted. At the end of follow‐up, the gait analysis showed an unbalanced stress distribution on the right foot and a valgus gait. We suggest that this chimeric scapula and LD muscle flap may be an alternative option for midfoot reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.     

Subperiosteal resection of mid-clavicle in Sprengel��s deformity correction

We report the results of fifteen cases of Sprengel’s deformity treated surgically by initial subperiosteal resection of the middle third of the clavicle in conjunction with surgical release of all attachments of the scapula to the spine, excision of any omovertebral bone and resection of prominent supraspinous process of scapula. The patients included ten female and three male patients (age range at the time of operation, 3.3–10 years; mean: 6.11 years). The deformity involved the left shoulder in eight patients, the right shoulder in three and two were bilateral. All patients were followed for an average of 5.9 years (range 4–11 years). Preoperatively, the arc of total abduction (glenohumeral and scapulothoracic) ranged from 80 to 140°, and the average was 110°. The shoulders were level, and the range of motion was dramatically improved with an average range of abduction of 166.5° (range 140–180°). The age of the patients and the presence of an omovertebral bone did not influence the results. All patients and their parents expressed satisfaction with the operative results. We feel that our procedure is a simple one, which helps to improve the degree of correction, avoid neurovascular complications and has the advantage of complete regeneration of the clavicle. The technique provides an easy, safe method of repositioning the scapula at its normal level.     

Combined treatment of 8 MHz radiofrequency hyperthermia and irradiation in a patient with mediastinal metastases of renal cancer

A combined therapy of irradiation and 8 MHz radiofrequency hyperthermia using the Thermotron-RF Model 8 was performed on a patient with mediastinal metastasis of renal cancer. The patient was a 74-year-old male, who received left transperitoneal nephrectomy for left renal tumor in December, 1982. Histology report indicated clear cell carcinoma of the kidney. He noticed puffy face and dyspnea in April, 1984. A CT scan showed a mediastinal tumor 57 X 43 X 120 mm in size and right pleural effusion. Aspiration biopsies revealed metastatic adenocarcinoma of the mediastinal lymph nodes. The combined therapy of irradiation and 8 MHz radiofrequency hyperthermia was started in July, 1984. He was irradiated with daily 2.0 Gy, 5 times a week and was heated twice a week within one hour after each irradiation, totally 50 Gy of irradiation and 14 sessions of hyperthermia. After the treatment, 69% tumor regression and disappearance of pleural effusion were obtained. The combined therapy with 28.8 Gy of irradiation and 7 sessions of hyperthermia was added for the regrowth of the tumor in February, 1985. A 30% of tumor regression was achieved, however, there was no improvement of the dyspnea or pleural effusion. He died on April 8, 1985.     

The influence of three-dimensional scapular kinematics on arm elevation angle in healthy subjects

BackgroundWe often clinically observe individual differences in arm elevation angles, but the motion producing these differences remains unclear, partly because of the difficulty of accurately measuring scapular motion. The aim of this study was to determine whether the scapular or glenohumeral (GH) motion has more influence on differences in the arm elevation angles by capturing not only the humerus and scapula but also the trunk using two- (2D) and three-dimensional (3D) shape-matching registration techniques.MethodsFifteen healthy subjects (13 male and 2 female; mean age: 27.7 years) were instructed to elevate their arms in the sagittal, scapular, and coronal planes. They were divided into high and low groups based on the average of arm elevation angle measured by a goniometer. The 3D scapular, thoracohumeral, and glenohumeral motions were evaluated using 2D/3D single-plane registration. To compare 3D motions between groups, we performed a two-way repeated measures analysis of variance.ResultsEight subjects were assigned to the high group, while seven subjects were assigned to the low groups based on an average elevation angle of 172°. The low group demonstrated a significant larger scapular protraction during elevation in all planes (P = 0.0002 for flexion; P = 0.0047 for scaption; P = 0.0314 for abduction), and smaller posterior tilting only during flexion (P = 0.0157). No significant differences occurred in scapular upward rotations or the glenohumeral positions and rotations.ConclusionsThis study revealed that insufficient scapular retraction and posterior tilting results in lower arm elevation angles, suggesting that improving the flexibility and activation of muscles surrounding the scapula may be important to achieve complete arm elevation.     

Pseudo-winging of scapula due to benign lesions of ventral surface of scapula – Two unusual causes

Winging of the scapula due to benign lesion of ventral surface of scapula is one of the rare cause and difficult to diagnose in first place. We present two unusual cases of pseudo winging of scapula due to benign lesions of scapula. First case was of 23 year old male with solitary osteochondroma of ventral surface of scapula. Second was 38 year old female with hemangioma involving subscapular muscles. Both the patients presented to us with dull aching pain over right scapular and shoulder region of 6 months duration with gradually increasing pseudo-winging of scapula. On examination there was mild tenderness over superomedial border of scapula with scapular snapping⁵ or ''clunk'' on hyper abduction of shoulder. Further radiographic evaluation of right scapular region revealed solitary osteochondroma of ventral surface of right scapula in first case whereas MRI revealed hemangioma of subscapular muscles in second case. Hemangioma was initially treated by weekly injecting sclerosing agent (Inj. Polidocanol) locally for 4 weeks. Both lesions were later treated by excision and subsequent follow up revealed disappearance of pain and winging of scapula.

Conclusion

Winging of the scapula due to solitary osteochondroma and subscapular hemangioma of the scapula may present with an initial diagnostic difficulty but appropriate knowledge of literature and diagnostic acumen can give excellent results.     

A three-dimensional scapular motion analysis in patients with arthroscopic anterior capsulolabral repair of the shoulder: The effect of scapular stabilization taping

BackgroundThe aim of this study was to investigate the scapular kinematics during dynamic humeral movements in patients with arthroscopic anterior capsulolabral repair of the shoulder along with the potential biomechanical corrective effects of scapular stabilization taping.MethodsTwenty patients with unilateral traumatic anterior shoulder instability and arthroscopic anterior capsulolabral repair participated in the study. Dynamic shoulder kinematics were assessed during the scapular plane shoulder elevation for both the operated and non operated shoulders and also under two conditions: no-taping and taping. Statistical analysis to compare sides and conditions was performed with analysis of variance models.ResultsThe scapula was more internally rotated position in operated shoulders than in non operated shoulders. Furthermore, the scapula was less internally rotated and more downwardly rotated at 120° of elevation in the taping condition.ConclusionsOperated shoulders demonstrated kinematics alterations when compared to non operated shoulders underwent arthroscopic anterior capsulolabral repair. Additionally, changes in the scapular orientation with the taping was very small but followed a pattern, which would be suggested to be an orientation that potentially produce more scapular stability and to increase stress on the inferior glenohumeral ligament.     

Analysis of polyethylene wear of reverse shoulder components: A validated technique and initial clinical results

One of the most prevalent phenomena associated with reverse total shoulder arthroplasty (rTSA) is scapular notching. Current methods examine only the damage to the scapula and no methods are available for quantifying the total wear volume of the polyethylene humeral bearing. Quantifying the polyethylene material loss may provide insight into the mechanism for scapular notching and into the particle dose delivered to the patient. A coordinate measurement machine (CMM) and custom computer algorithms were employed to quantify the volumetric wear of polyethylene humeral bearings. This technique was validated using two never‐implanted polyethylene humeral liners with a controlled amount of wear in clinically relevant locations. The technique was determined to be accurate to within 10% of the known value and within 5 mm³ of the gravimetrically determined values. Following validation, ten retrieved polyethylene humeral liners were analyzed to determine a baseline for future clinical tests. Four of the ten polyethylene humeral liners showed visible and measureable wear volumes ranging from 40 to 90 mm³ total with a maximum wear rate as high as 470 mm³/year in one short duration and significantly damaged humeral liner. This validated technique has the potential to relate patient outcomes such as scapular notching grades to polyethylene release into the body. While the total wear volumes are less than reported in literature for cases of osteolysis in knee and hip patients, dosages are well within the osteolytic thresholds that have been suggested, indicating that osteolysis may be a clinical concern in the shoulder. This work provides the basis for future studies that relate volumetric wear to patient outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:980–987, 2017.

     

Epstein-Barr virus-related primary central nervous system lymphoma after cadaveric renal transplantation improved by treatment with high-dose methotrexate followed by irradiation

A 57-year-old man was admitted to hospital because of motor aphasia on 16 September 2000. He had an approximate 2-year history of haemodialysis treatment, since April 1997, and had received a cadaveric renal transplantation in July 1999. Computed tomography and magnetic resonance imaging (MRI) revealed a mass with ringed enhancement in the left temporal-parietal lobe. Primary central nervous system (CNS) lymphoma (diffuse large B cell type) was diagnosed based on an open brain tumour biopsy. Epstein-Barr virus early RNA (EBER) in situ hybridization showed positive signals in the nuclei of the CNS lymphoma cells. A dose reduction of immunosuppressant and three series of high-dose methotrexate (MTX) therapy with leucovorine rescue followed by irradiation (whole brain irradiation, 30 Gy; partial brain tumour irradiation, 20 Gy) were carried out for his primary CNS lymphoma. The patient is currently in good condition (September 2004) with no enlargement of the lymphoma, as examined by MRI every 3 months, and preserved renal function.     

Statistical shape modeling-based reconstruction eliminates the need for full scapular computed tomography scan data in preoperative total shoulder arthroplasty planning

BackgroundPreoperative total shoulder arthroplasty (TSA) planning tools use a three-dimensional (3D) model of the full scapula based on computed tomography (CT) images with a scan length covering the complete scapula with a given radiation exposure for patients. The aim of this study is to investigate whether full scapular models can be reconstructed from partial CT data.MethodsIn this retrospective cohort study, bone models representing 5 scan lengths with decreasing levels of scapular coverage (level 1-5) were created. All the models were reconstructed with a validated statistical shape model (SSM) allowing automatic 3D measurements of glenoid version, inclination, scapular offset, and center point position. Radiation exposure between 2 patient groups (group 1 = corresponding to L1, group 2 = complete scapula) was compared.ResultsIn terms of inclination and version, we found a mean absolute difference between the complete model and the different partial scan models of 0.5° (SD 0.4°). The maximum difference was 3° for inclination and 2° for version. For scapular offset and center point position, the mean difference was 0 mm (max 1 mm). The mean radiation exposure was 4 mSv (SD 2 mSv) for group 1 and 13 mSv (SD 6 mSv) for group 2 (P = .009).ConclusionAn SSM-based reconstruction technique can accurately reconstruct complete scapular bone models based on partial CT scan data. Incorporation of an SSM-based reconstruction technique in software tools for preoperative TSA planning would lead to decreased radiation exposure (9 mSv) for patients without influencing its accuracy.     

Thymic small cell carcinoma associated with pulmonary squamous cell carcinoma

A 63-year-old man presented with dyspnea on effort. Chest computed tomography showed an anterior mediastinal mass and a lung mass in the right lower lobe. Thallium scintigraphy revealed accumulation in the mediastinal mass. Therefore, under diagnosis of invasive thymoma or thymic carcinoma associated with suspected lung cancer, exploratory right thoracotomy was undertaken through a median sternotomy with video-assisted thoracoscopic support. The lung mass was intraoperatively diagnosed as squamous cell carcinoma. Right lower lobectomy and total thymectomy were then carried out without additional incision. Thymic small cell carcinoma was diagnosed; therefore the patient received 50 Gy of irradiation to the mediastinum. Ten months after surgery the patient is alive without recurrence.