Predictive value of [<Superscript>18</Superscript>F]-fluoride PET for monitoring bone remodeling in patients with orthopedic conditions treated with a Taylor spatial frame

Purpose

The Taylor Spatial Frame (TSF) is used to correct orthopedic conditions such as correction osteotomies in delayed fracture healing and pseudarthrosis. Long-term TSF-treatments are common and may lead to complications. Current conventional radiological methods are often unsatisfactory for therapy monitoring. Hence, an imaging technique capable of quantifying bone healing progression would be advantageous.

Methods

A cohort of 24 patients with different orthopedic conditions, pseudarthrosis (n?=?10), deformities subjected to correction osteotomy (n?=?9), and fracture (n?=?5) underwent dynamic [¹⁸F]-fluoride (Na¹⁸F) PET/CT at 8 weeks and 4 months, respectively, after application of a TSF. Parametric images, corresponding to the net transport rate of [¹⁸F]-fluoride from plasma to bone, K _i were calculated. The ratio of the maximum K _i at PET scan 2 and 1 (\( {\overline{K}}_{i, \max } \)) as well as the ratio of the maximum Standard Uptake Value at PET scan 2 and 1 (\( {\overline{SUV}}_{\max } \)) were calculated for each individual. Different treatment end-points were scored, and the overall treatment outcome score was compared with the osteoblastic activity progression as scored with \( {\overline{K}}_{i, \max } \) or \( {\overline{SUV}}_{\max } \).

Results

\( {\overline{K}}_{i, \max } \) and \( {\overline{SUV}}_{\max } \) were not correlated within each orthopedic group (p?>?0.1 for all groups), nor for the pooled population (p?=?0.12). The distribution of \( {\overline{K}}_{i, \max } \) was found significantly different among the different orthopedic groups (p?=?0.0046) -also for \( {\overline{SUV}}_{\max } \) (p?=?0.022). The positive and negative treatment predictive values for \( {\overline{K}}_{i, \max } \) were 66.7 % and 77.8 %, respectively. Corresponding values for \( {\overline{SUV}}_{\max } \) were 25 % and 33.3 %

Conclusions

The \( {\overline{K}}_{i, \max } \) obtained from dynamic [¹⁸F]-fluoride-PET imaging is a promising predictive factor to evaluate changes in bone healing in response to TSF treatment.

     

Evaluation of chronic inflammatory demyelinating polyneuropathy: 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (3D SHINKEI)

Objective

To evaluate the usefulness of 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) in patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

Methods

This institutional review board-approved retrospective study included 14 CIDP patients and nine normal subjects. The signal-to-noise ratio (SNR), contrast ratio (CR), and the size of the cervical ganglions and roots were measured by two raters.

Results

The SNRs of the ganglions and roots were larger in patients with CIDP (9.55?±?3.87 and 9.81?±?3.64) than in normal subjects (7.21?±?2.42 and 5.70?±?2.14, P?<?0.0001, respectively). The CRs of the ganglions and roots were larger in patients with CIDP (0.77?±?0.08 and 0.68?±?0.12) than in normal subjects (0.72?±?0.07 and 0.53?±?0.11, P?<?0.0001, respectively). The sizes of the ganglions and the roots were larger in patients with CIDP (6.44?±?1.61 mm and 4.89?±?1.94 mm) than in normal subjects (5.24?±?1.02 mm and 3.39?±?0.80 mm, P?<?0.0001, respectively).

Conclusions

Patients with CIDP could be distinguished from controls on 3D SHINKEI.

Key points

? 3D SHINKEI could visualize brachial plexus with high spatial resolution.? CIDP patients showed increased SNR, CR, and the size of brachial plexus.? 3D SHINKEI could discriminate CIDP patients from normal subjects.

     

Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial

Purpose

Purpose of the present study was to investigate the acute effects of a cold compression bandage on pain, swelling and skin-surface temperature after the first 24 h after arthroscopic surgery of the shoulder in a stationary setting and to compare it with cold therapy using only a cold pack. It was hypothesized that using the bandage is more effective in reducing pain and swelling after 24 h compared with using only a cold pack.

Methods

Fifty-two patients (53 ± 12.2 years) were randomly assigned to two groups after arthroscopic surgery. The first group wore a cold compression bandage, and the second group a conventional frozen cold pack. Pain, swelling and skin-surface temperature were measured 2, 8 and 24 h after surgery. Differences within and between groups were analysed.

Results

Both groups showed a significant reduction of the circumference of the arm 15 and 20 cm proximal of the lateral epicondyle 24 h after surgery (cold compression: p = 0.003; p < 0.001; cold: p < 0.001). Pain at rest was significantly reduced with cold compression bandage 24 h after surgery (p = 0.001). Skin temperature increased in both groups 24 h after surgery (bandage: p < 0.001; cold pack: p = 0.002). After 24 h, pain during activity was significantly decreased in the group wearing the bandage compared with the group using the cold pack (p = 0.026).

Conclusions

Based on the results of this study, no recommendation can be made with respect to the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Clinicians should question the need of expensive cold compression bandages in the short-term post-operative treatment after arthroscopic surgery of the shoulder.

Level of evidence

II.

     

Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology

Objective

To investigate the added value of secondary reports issued by radiologists subspecializing in gynaecologic imaging for determining deep myometrial invasion of endometrial cancer on MRI.

Methods

Initial (from referring institutions) and secondary (by subspecialized radiologists) interpretations of MRI of 55 patients with endometrial cancer were retrospectively reviewed. A radiologist blinded to clinicopathological information assessed both reports for the presence of deep myometrial invasion. Reference standard was based on hysterectomy specimens. Kappa coefficients (k) were used to measure their concordance. McNemar testing and receiver operating characteristic (ROC) analysis was used to compare sensitivities, specificities and areas under the curves (AUCs).

Results

Deep myometrial invasion was present in 25 (45.5 %) patients. Among 27.3 % (15/55; k?=?0.458) patients with discrepant results, secondary interpretations were correct in 10 (66.7 %) cases. Sensitivity was higher in secondary than in initial reports (76.0 % vs. 48.0 %, p?=?0.039) while no significant difference was seen in specificity (70.0 % vs. 76.7 %, p?=?0.668). At ROC analysis, there was a tendency for higher AUCs in secondary reports (0.785 vs 0.669, p?=?0.096).

Conclusion

Secondary readings of MRI by subspecialized gynaecologic oncologic radiologists may provide incremental value in determining deep myometrial invasion of endometrial cancer.

Key Points

? Deep myometrial invasion is an important prognostic factor in endometrial cancer.? Assessment of deep myometrial invasion is often discrepant between initial and secondary reports.? Secondary reports showed higher sensitivity and accuracy.? Secondary review of MRI may provide incremental value in endometrial cancer patients.

     

Aerobic capacities,anaerobic power,and anthropometric characteristics of elite female canoe polo players based on playing position

Purpose

To determine the aerobic capacities, anaerobic power, and anthropometric characteristics of elite female canoe polo players. A secondary purpose was to investigate positional differences between goalkeepers (GKs), flat 3 defenders (FDFs), and chase defenders (CHDFs).

Methods

Twenty-one elite female canoe polo players (age 26.8 ± 2.1 years; height 166.9 ± 5.2 cm; body mass 61.4 ± 7.1 kg; and percent body fat 21.0 ± 3.8%) volunteered. Anthropometric variables, peak oxygen uptake (\( \dot{V}{\text{O}}_{{2{\text{peak}}}} \)), ventilatory threshold (VT), anaerobic peak power output (PPO), and mean power output (MPO) were determined.

Results

\( \dot{V}{\text{O}}_{{ 2 {\text{peak}}}} \) was 40.88 ± 4.0 ml kg^?1 min^?1 or 2.50 ± 0.29 l min^?1, VT was 79.1 ± 8.6 \( \% \dot{V}O_{2peak} \), PPO was 348.7 ± 32.1 W, 5.66 ± 0.64 W kg^?1, and MPO was 266.5 ± 29.4 W, 4.37 ± 0.56 W kg^?1. CHDFs and FDFs had significantly (p < 0.05) greater relative \( \dot{V}{\text{O}}_{{2{\text{peak}}}} \) (19.5 and 15.0%, respectively) compared to GKs. GKs were significantly (p < 0.05) taller than CHDFs (6.3%) and FDFs (4.8%).

Conclusions

Elite female canoe polo players have well-developed oxidative and non-oxidative energy systems, as well as low percent body fat. Positional differences demonstrated that CHDFs and FDFs had significantly higher aerobic power compared to GKs; however, GKs were significantly taller. These results may assist the coach or sport scientist to construct and implement tailored training programs and may be beneficial for talent identification.

     

Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears

Purpose

The purpose of this study was to analyse patient and injury characteristics as well as arthroscopic findings in a prospective cohort of ACL-injured patients with or without an associated ramp lesion.

Methods

Two hundred and twenty-four patients undergoing a primary (n = 196) or revision (n = 28) ACL reconstruction were included. The presence of a ramp lesion was determined by a systematic arthroscopic inspection of the posteromedial compartment. Chi-square tests were used to compare the population of ACL-injured patients with and without a ramp lesion regarding sex, age, body mass index, previous ACL injuries, sport before injury, and injury characteristics. Significance was set at p < 0.05.

Results

Fifty-three out of 224 patients had a ramp lesion (24%). The presence of the latter was not related to any of the analysed patient characteristics. The prevalence of the lesion was higher in contact injuries (n = 19; 41%) compared with non-contact injures (n = 34; 19%; p < 0.001). It was higher in patients with complete ACL ruptures (n = 49; 27%) as opposed to partial ruptures (n = 1; 4%; p = 0.01). A patient was 2.98 [95% CI 1.49–5.98] times more likely to have a ramp lesion if the ACL injury was declared to have been caused by direct contact and 8.71 [95% CI 1.15–66.12] times more likely if the ACL tear was complete.

Conclusion

Ramp lesions may be anticipated in almost one out of four patients undergoing ACL reconstruction, especially if a patient sustained a contact injury and in the presence of a complete ACL tear.

Level of evidence

III.

     

Relationship between tibial spine size and the occurrence of osteochondritis dissecans: an argument in favour of the impingement theory

Purpose

Pathophysiology of osteochondritis dissecans (OCD) of the medial femoral condyle remains uncertain. Specifically, the relationship between the size of the anterior tibial spine (ATS) and the presence of OCD has not been explored. The purpose of this study was to evaluate the relationship between ATS size and the occurrence of OCD.

Methods

Seventy-nine children between 8 and 17 years of age were included in two groups: OCD (n = 37) and control (n = 42). The groups were matched in terms of age, gender, BMI and weight. Two independent observers performed an MRI analysis of the size of the tibial spine and intercondylar notch relative to the size of the respective epiphyses. For this study, the “S ratio” was calculated by dividing the height of the tibial spine by the height of the tibial epiphysis. The “N ratio” was calculated by dividing the height of the notch by the height of the femoral epiphysis. These two ratios for both groups were compared using Student’s t test.

Results

The mean value of the S ratio in the OCD group was 0.39 ± 0.06; the mean value of the S ratio in the control group was 0.32 ± 0.03 (P = 0.004). The mean value of the N ratio in the OCD group was 0.70 ± 0.08; the mean value of the N ratio in the control group was 0.70 ± 0.07 (n.s.).

Conclusion

This study’s findings confirm our hypothesis that patients with OCD have a more prominent tibial spine than in patients without OCD.

Level of evidence

IV.

     

Abnormal cervical lymph nodes in multiple sclerosis: a preliminary ultrasound study

Background

Cervical lymph nodes are the first drainage stations of the brain and therefore play a key role in neuroinflammatory disorders such as multiple sclerosis.

Objective

The aim of this study was to evaluate, by using ultrasound imaging, cervical lymph nodes in patients with multiple sclerosis and to ascertain if such patients have any clinical features to attest their role.

Methods

We enrolled 43 patients affected by relapsing–remitting multiple sclerosis (22 drug free and 21 under treatment with natalizumab or fingolimod), who underwent ultrasound examination. The morphology, diameters and volume of cervical lymph nodes were measured. We evaluated also a control group of 20 healthy volunteers.

Results

Between-group comparisons showed that the mean anteroposterior diameters in the cervical lymph nodes on both sides of the neck were significantly different (χ ² = 19.5, p < 0.001 for right; χ ² = 20.0, p < 0.001 for left). Post hoc contrasts showed that the mean anteroposterior diameters were greater both in drug-naive (mean ± SD 0.66 ± 0.20 cm; p < 0.001) and treated patients (0.55 ± 0.24 cm; p < 0.001) compared to healthy individuals (0.36 ± 0.19 cm). Moreover, significant difference (p < 0.001) was shown on comparing the mean volume of the cervical lymph nodes on both sides of the neck in the studied groups. No significant differences emerged between the drug-free and treated patients.

Conclusion

The abnormalities shown by ultrasound in cervical lymph nodes are related to deep ones and independent of the ongoing treatment, suggesting a relationship between lymphatic drainage and disease pathology.

     

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

Purpose

Retrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).

Materials and methods

From 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.

Results

We achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.

Conclusion

Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

     

Postprandial changes in secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP with a spatially selective inversion-recovery (IR) pulse

Purpose

To evaluate the influence of oral ingestion on the secretory flow dynamics of physiological pancreatic juice within the main pancreatic duct in healthy subjects by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively.

Materials and methods

Thirty-eight healthy subjects were investigated. MRCP with spatially-selective IR pulse was repeated every 15 s for 5 min to acquire a total of 20 images (cine-dynamic MRCP). A set of 20 MRCP images was repeatedly obtained before and after liquid oral ingestion every 7 min (including 2-min interval) for 40 min (a total of seven sets). Secretion grade of pancreatic juice on cine-dynamic MRCP was compared before and after oral ingestion using the nonparametric Wilcoxon signed-rank test.

Results

Median secretion grades of pancreatic juice at 5 min (score?=?2.15), 12 min (score?=?1.95) and 19 min (score?=?2.05) after ingestion were significantly higher than that before ingestion (score?=?1.40) (P?=?0.004, P?=?0.032, P?=?0.045, respectively). Secretion grade of pancreatic juice showed a maximum peak of 2.15 at 5 min after ingestion. Thereafter, the secretion grade of pancreatic juice tended to gradually decline.

Conclusion

Non-invasive cine-dynamic MRCP using spatially-selective IR pulse showed potential for evaluating postprandial changes in the secretory flow dynamics of pancreatic juice as a physiological reaction.

Key Points

? Secretion grade of pancreatic juice at cine-dynamic MRCP after ingestion was evaluated. ? Secretion grade was significantly increased within 19 min after liquid meal ingestion. ? Secretion grade showed maximum peak of 2.15 at 5 min after ingestion. ? Postprandial changes in pancreatic juice flow can be assessed by cine-dynamic MRCP.

     

No difference in prevalence of spine and hip pain in young Elite skiers

Purpose

To investigate the prevalence between back and hip pain in young Elite skiers.

Methods

Sample group (n = 102), consisted of young Elite skiers (n = 75) and age-matched non-athletes (n = 27), all completed a three-part back and hip pain questionnaire, Oswestry Disability Index and EuroQoL to evaluate general health, activity level, back and hip pain prevalence.

Results

No significant differences were shown for lifetime prevalence of back pain in the skiers (50%) compared with controls (44%) (n.s.). Duration of back pain for the skiers showed (30%) > 1 year, whilst (46%) > 5 years. A significant difference was shown with increased Visual Analogue Scale back pain levels for skiers 5.3 (SD 3.1) compared with controls 2.4 (SD 1.9, p = 0.025). No significant differences were shown for lifetime prevalence of hip pain in skiers (21%) compared with controls (8%) (n.s.).

Conclusion

Young Elite skiers are shown not to have increased lifetime prevalence for back and hip pain compared with a non-athletic control group.

Level of evidence

II.

     

Late recanalisation beyond 24 hours is associated with worse outcome: an observational study

Objectives

We evaluated the rate of late recanalisation beyond 24 h after intravenous thrombolysis (IVT) and its relationship with haemorrhagic transformation and outcome.

Methods

We reviewed prospectively collected clinical and imaging data from acute ischaemic stroke patients with distal internal carotid artery or proximal middle cerebral artery occlusion who underwent angiography on admission, 24 h and 1 week after IVT. Patients were trichotomised according to vascular status: timely recanalisation (<24 h), late recanalisation (24 h-7 days), and no recanalisation.

Results

Non-invasive angiography revealed timely recanalisation in 52 (50.0 %) patients, late recanalisation in 25 (24.0 %) patients, and no recanalisation in 27 (26.0 %) patients. Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation (odds ratio 6.674; 95 % CI: 1.197 to 37.209; p?=?0.030). In patients without timely recanalisation, shift analysis indicated that late recanalisation led to a worse modified Rankin Scale score (odds ratio 6.787; 95 % CI: 2.094 to 21.978; p?=?0.001).

Conclusions

About half of all patients without recanalisation by 24 h after IVT may develop late recanalisation within 1 week, along with higher mRS scores by 3 months. Pre-existing atrial fibrillation is an independent predictor for late recanalisation.

Key Points

? About half of patients may develop late recanalisation within 1 week. ? Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation. ? Late recanalisation led to a higher mRS score than no recanalisation.

     

Early post-procedural patients compliance and VAS after UAE through transradial versus transfemoral approach: preliminary results

Purpose

The aim of our study is to verify VAS and patient compliance in the immediate post-procedural time, in patients undergoing UAE through radial approach versus femoral procedure.

Methods

Between January and September 2017, 30 consecutive patients (age range 28–47, average 32 years) were enrolled for the study. UAE was performed by two interventional radiologists with more than 10 years of experience and more than 100 cases of UAE done. Patients were divided into two groups: transfemoral approach (group a, n?=?15 patients) and transradial approach (group b, n?=?15 patients). After procedure, patients were questioned about the compliance using the questionnaire at 24 h and VAS rating at 6, 12, 18 and 24 h.

Results

The average of VAS in group b was lower than in group a in each evaluation at 6 h (p?<?0.20), 12 h (p?<?0.07), 18 h (p?<?0.02) and 24 h (p?<?0.22) on the basis of Mann–Whitney U test, however, without a clear scientific evidence. Also the compliance score at 24 h had better results in the group b (average 14.0, range 13.0–16.0) in comparison with group a (average 18.0, range 17.0–21.4) (p?<?0.001).

Conclusion

Transradial approach improves the compliance and VAS of patients undergone to UAE.

     

Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography?

Objective

To evaluate the diagnostic accuracy of positron emission mammography (PEM) for identifying malignant lesions in patients with suspicious microcalcifications detected on mammography.

Methods

A prospective, single-centre study that evaluated 40 patients with suspicious calcifications at mammography and indication for percutaneous or surgical biopsy, with mean age of 56.4 years (range: 28-81 years). Patients who agreed to participate in the study underwent PEM with 18F-fluorodeoxyglucose before the final histological evaluation. PEM findings were compared with mammography and histological findings.

Results

Most calcifications (n?=?34; 85.0 %) were classified as BIRADS 4. On histology, there were 25 (62.5 %) benign and 15 (37.5 %) malignant lesions, including 11 (27.5 %) ductal carcinoma in situ (DCIS) and 4 (10 %) invasive carcinomas. On subjective analysis, PEM was positive in 15 cases (37.5 %) and most of these cases (n?=?14; 93.3 %) were confirmed as malignant on histology. There was one false-positive result, which corresponded to a fibroadenoma, and one false negative, which corresponded to an intermediate-grade DCIS. PEM had a sensitivity of 93.3 %, specificity of 96.0 % and accuracy of 95 %.

Conclusion

PEM was able to identify all invasive carcinomas and high-grade DCIS (nuclear grade 3) in the presented sample, suggesting that this method may be useful for further evaluation of patients with suspected microcalcifications.

Key Points

? Many patients with suspicious microcalcifications at mammography have benign results at biopsy. ? PEM may help to identify invasive carcinomas and high-grade DCIS. ? Management of patients with suspicious calcifications can be improved.

     

Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to <Emphasis Type="Italic">N</Emphasis>-Butyl Cyanoacrylate

Purpose

To identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).

Materials and Methods

Institutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.

Results

Technical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.

Conclusion

Uterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.

Level of Evidence

Level 4, Case Control Study

     

Significant influence of rotational limb alignment parameters on patellar kinematics: an in vitro study

Purpose

Component malrotation has a major impact on patellar kinematics in total knee arthroplasty. The influence of natural rotational limb alignment on patellar kinematics is unclear so far. Based on recent clinical investigations, we hypothesized that rotational limb alignment significantly influences patellar kinematics.

Methods

Patellar kinematics of ten cadaveric knees was measured using computer navigation during passive motion. Data were correlated with different rotational limb alignment parameters of preoperative CT scans.

Results

Femoral antetorsion showed a significant influence on patellar rotation, while tibial tubercle–posterior cruciate ligament distance additionally displayed a significant influence on patellar mediolateral shift (p < 0.05). Femoral posterior condylar angle was sensitive to patellar epicondylar distance, rotation and tilt (p < 0.05). Patellar rotation was influenced by five out of eight rotational limb alignment parameters (p < 0.05).

Conclusions

Rotational limb alignment should be paid more attention in terms of clinical evaluation of patellar tracking and future biomechanical and clinical investigations.

     

Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients

Purpose

The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair.

Methods

Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated.

Results

The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p < 0.001). A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores (p ? 0.001).

Conclusion

Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life.

Level of evidence

IV.

     

Retrospective review of thoracic neural damage during lung ablation – what the interventional radiologist needs to know about neural thoracic anatomy

Background and Purpose

Radiofrequency ablation (RFA) is associated with low neural morbidity compared with surgery, which commonly causes debilitating long-term pain. The purpose was to review the thoracic neural anatomy relevant to percutaneous RFA and to retrospectively review symptomatic nerve injury after lung RFA at our institution.

Materials and Methods

We retrospectively examined all symptomatic nerve injuries occurring after computed tomography (CT)-guided RFA treatment of lung tumors for 462 patients/509 procedures/708 lesions treated at our large tertiary referral centre during 10 years.

Results

Eight patients experienced neurological complications after heating during the RFA procedure. These complications occurred in the phrenic (n = 1), brachial (n = 3), left recurrent (n = 1), and intercostal nerves (n = 2) and the stellate ganglion (n = 1). Three were grade 2, four grade 3 and one grade 4 injuries (CTCAE v3).

Conclusion

Although rare, neurological complications can occur after RFA, and they can occasionally be severe. To prevent these complications, it is important for the interventional radiologist to be aware of the anatomy of nervous structures and to attempt to identify nerves on CT scans during the RFA procedure. Creating a pneumothorax can be useful to avoid nerve damage and related clinical complications.