Autotransplantation of Pancreatic Fragments to the Portal Vein and Spleen of Totally Pancreatectomized Dogs: A Comparative Evaluation

Forty-nine dogs were made diabetic by total pancreatectomy. Fifteen untreated pancreatectomized animals survived a mean (+/-S.E.) of 7.0 +/- 1.1 days with a mean (+/-S.E.) plasma glucose level of 402 +/- 26 mg/100 ml before death. The pancreata of 32 dogs were distended with cold (4 degrees ) Hanks' solution, minced, digested with collagenase (600 U/ml tissue) for 15-25 minutes, and autotransplanted either into the splenic artery (three dogs), directly into the splenic pulp (21 dogs), or into the portal vein (ten dogs). Tissue infusion into the splenic artery resulted in infarction and persistent hyperglycemia. Direct implantation into the splenic pulp of tissue digested for 15, 20 and 25 minutes resulted in permanent normoglycemia (fasting plasma glucose < 150 mg/100 ml) in 7 of 8, 7 of 7, and 6 of 6 dogs respectively. Glucose tolerance test mean (+/-S.E.) K values (% decline of plasma glucose concentration/minute) in these groups two weeks after transplantation were 1.20 +/- 0.20%, 1.60 +/- 0.25 and 0.70 0.08% respectively, indicating that 20 minutes digestion was best for intrasplenic transplantation. Tissue prepared in the optimal manner (20 minutes digestion) and embolized into the liver resulted in normoglycemia in three of eight dogs, and a mean (+/-S.E.) K value of 0.77 +/- 0.10%. Both dogs receiving tissue dispersed for 25 minutes into the portal vein remained hyperglycemic. In the dogs subjected to intraportal transplantation, portal pressure rose from a mean (+/-S.E.) of 6.5 +/- 0.6 cm H(2)O before to 21.9 +/- 2.2 cm H(2)O immediately after tissue embolization, but declined to 6.5 +/- 1.0 cm H(2)O by ten weeks in animals becoming normoglycemic. We conclude that in dogs direct implantation of pancreatic tissue into the splenic pulp is superior to embolization into the portal vein or splenic artery because the splenic circulation is not compromized, portal hypertension is obviated, and glucose metabolism is best controlled as judged by glucose tolerance test K values.     

Effects of the Menstrual Cycle on Expiratory Resistance During Whole Body Exercise in Females

Our objective was to determine if the menstrual cycle affected expiratory resistance developed during progressive incremental exercise in females. Eleven females (age = 19.7 ± 1.1 yr., body mass = 58.9 ± 8.8 Kg, height = 1.65 ± 0.3 m) gave consent to participate in the study. Participants were studied during the follicular (day 7 ± 2 days following onset of menses) and luteal (day 21 ± 2 days following onset of menses) phases of their menstrual cycle. The expiratory resistance was significantly higher during the follicular phase at maximal workload versus the luteal phase (1.0 ± 0.06 cm H₂O/L/sec vs. 0.9 ± 0.07 cm H₂O/L/sec.: p¼ 0.05). No other differences were found in expiratory resistance, oxygen uptake or maximal heart rate during exercise. Results showed that the increase in expiratory resistance during the follicular phase of the menstrual cycle may be contributing to the changes in the pulmonary system of females as reported by other authors.

Key points

• During maximal exercise there was a significantly larger expiratory resistance during the follicular phase versus luteal phase of the female subjects menstrual cycle.
• Fluctuation in hormones (especially progesterone and/ or oestrogen) may contribute to changes in expiratory resistance.
• The increased expiratory resistance may be a contributing factor to the increased occurrence of expiratory flow limitation in female subjects.

Key words: airway resistance, female, menstrual cycle, exercise     

Novel PEGylated Basal Insulin LY2605541 Has a Preferential Hepatic Effect on Glucose Metabolism

The impact of the novel basal insulin LY2605541 (LY) on hepatic and nonhepatic glucose uptake (non-HGU) was evaluated. Conscious dogs underwent euglycemic clamps with tracer and hepatic balance measurements. Clamp period infusions were peripheral venous regular insulin (0.1 nmol ⋅ kg⁻¹ ⋅ h⁻¹ [control], n = 6) or LY (bolus [nmol/kg], continuous [nmol ⋅ kg⁻¹ ⋅ h⁻¹]: 0.5, 0.5 [n = 6]; 0.375, 0.375 [n = 5]; 0.25, 0.25 [n = 4]), somatostatin, and glucose, as well as intraportal glucagon (basal). During the clamp, the dogs switched from net hepatic glucose output to uptake (rates reached 2.1 ± 1.2, 0.9 ± 2.1, 8.6 ± 2.3, and 6.0 ± 1.1 µmol ⋅ kg⁻¹ ⋅ min⁻¹ within 5 h in control, LY_0.25, LY_0.375, and LY_0.5, respectively). Non-HGU in LY increased less than in control; the ratio of change from basal in non-HGU to change in net hepatic glucose balance, calculated when glucose infusion rates (GIRs) were ~20 µmol ⋅ kg^-1 ⋅ min⁻¹ in all groups, was higher in control (1.17 ± 0.38) versus LY_0.25 (0.39 ± 0.33), LY_0.375 (−0.01 ± 0.13), and LY_0.5 (−0.09 ± 0.07). Likewise, the change from baseline in glucose R_d-to-R_a ratio was greatest in control (1.4 ± 0.3 vs. 0.6 ± 0.4, 0.5 ± 0.2, and 0.6 ± 0.2 in LY_0.25, LY_0.375, and LY_0.5, respectively). In contrast to exogenously administered human insulin, LY demonstrated preferential hepatic effects, similar to endogenously secreted insulin. Therefore, the analog might reduce complications associated with current insulin therapy.     

Intraportal splenic autotransplantation in rats: Feasibility and effectiveness

This experiment was designed to see whether or not normal host resistance to infection could be reestablished in splenectomized animals by intraportal autotransplantation of homogenized splenic tissue. Part I studied the feasibility of the technique. Within 1 hr of splenectomy, 16 adult Lewis rats received an intraportal injection of autogenous splenic tissue which had been passed through a 500-μm screen. Five rats died acutely from hemorrhage at the site of injection. The others tolerated the infusion well, both acutely and chronically. The animals developed only transient elevations in liver enzymes; chronic portal hypertension did not occur. Histologically, splenic tissue could be demonstrated within terminal portal venules. Part II assessed the effectiveness of intraportal splenic autotransplantation. Eight to twelve months after splenectomy, autotransplantation, or sham operation, 103 Sprague-Dawley rats were challenged with intravenous boluses of 10⁵ to 10⁸ pneumococci. Mortality was 91% for splenectomized animals, 88% for animals bearing autotransplants, and 59% for controls. Thus intraportal splenic autotransplantation is technically feasible in rats. The grafts are well tolerated by the liver, and splenic tissue is preserved in intimate contact with the blood stream. Even after 8 to 12 months, however, such autografts are not capable of providing normal protection against massive pneumococcemia.     

Changes of phasic and tonic smooth muscle function of jejunum in type 2 diabetic Goto-Kakizaki rats

AIM: To generate phasic and tonic stress-strain curves for evaluation of intestinal smooth muscle function in type 2 diabetic rats during active and passive conditions.METHODS: Seven diabetic Goto-Kakizaki (GK) male rats, 32-wk old (GK group), and 9 age-matched normal Wistar rats (Normal group) were included in the study. Jejunal segments were distended up to a pressure of 10 cm H₂O in an organ bath containing 37 °C Krebs solution with addition of carbachol (CA). The pressure and outer diameter changes were synchronously recorded. Passive conditions were obtained using calcium-free Krebs solution containing ethylene glycol tetraacetic acid and papaverine. Total phasic, tonic and passive circumferential stress and strain were computed from the diameter and pressure data with reference to the zero-stress state geometry. The active phasic and tonic stresses were defined as the total phasic and tonic stresses minus the passive stress.RESULTS: Diabetes increased jejunal mucosa and muscle layer thicknesses compared to the Normal group (mucosa, 755.8 ± 63.3 vs 633.1 ± 59.1 μm, P < 0.01; muscle, 106.3 ± 12.9 vs 85.2 ± 11.7 μm, P < 0.05). The pressure and stress thresholds were decreased in the GK group after CA application compared to distensions without CA application (pressure, 1.01 ± 0.07 vs 1.99 ± 0.19 cmH₂O, P < 0.01; stress, 0.11 ± 0.01 vs 0.24 ± 0.02 kPa, P < 0.01). CA application did not change the pressure and stress threshold in the Normal group (pressure, 2.13 ± 0.32 vs 2.34 ± 0.32 cm H₂O, P > 0.05; stress, 0.25 ± 0.03 vs 0.35 ± 0.06 kPa, P > 0.05). The amplitude of total phasic, total tonic, active phasic and active tonic circumferential stresses did not differ for the distensions without CA application between the GK group and the Normal group. However, the total phasic and total tonic stresses increased after CA application in the GK group compared those in the Normal group. When normalized to muscle layer thickness, the amplitude of active stresses before CA application was lowest in the GK group compared with the Normal group. No difference was found during CA application.CONCLUSION: The stress generated by intestinal muscle normalized to the muscle layer thickness was lowest in GK rats compared to normal rats whereas the response to CA stimulation was preserved.     

Some Properties Shared by Amino Acids and Entero-Oxyntin

The intestinal phase of gastric secretion has been thought to be due to the release of a hormone from the gut mucosa, and several properties have been attributed to this as-yet unidentified hormone. An amino acid solution, known to stimulate gastric secretion, was tested to see if it possesses several of these properties, i.e., inactivation by the liver, and the ability to augment the maximum responses to pentagastrin and histamine. In six dogs with Heidenhain pouches the gastric secretory responses to peripheral and portal intravenous administration of a solution of mixed L-amino acids were measured. The mean peak response of three such separate peripheral infusions in each dog was 370 µEq/30 minutes while the peak response to intraportal infusion was only 45 µEq/30 minutes (p < .05). In three dogs with Heidenhain pouches the intravenous administration of amino acids together with pentagastrin resulted in significant augmentation of the peak response to pentagastrin alone (p < .025). Similarly, administration of amino acids with histamine resulted in augmentation of the peak response to histamine alone (p < .05). Because amino acids mimic the actions of the “intestinal phase hormone” in these respects it is suggested that they may account, at least in part, for the intestinal phase of gastric secretion. In addition, amino acids absorbed during protein digestion may contribute to the gastric hypersecretion which is regularly seen with portosystemic shunts.     

The risks of total pancreatectomy and splenic islet autotransplantation

The intraportal site is the most common site for islet transplantation. Many other sites have been tried experimentally, including the spleen, which has successfully lead to insulin independence in a number of animal models. Nevertheless, there are no detailed reports of total pancreatectomy and splenic islet autotransplantation in humans. Five patients underwent total pancreatectomy and splenic islet autotransplantation for chronic pancreatitis. Four patients had a pylorus-preserving total pancreatectomy and one patient a duodenal-preserving pancreatectomy. In three cases islets were embolized into both the portal vein and spleen. Two patients received splenic islet transplants alone. Islets were transplanted by retrograde venous infusion via the short gastric veins (n = 3), splenic vein stump (n = 1), and the left gastroepiploic vein (n = 1). The total volumes of transplanted pancreatic digest in those receiving combined intraportal and splenic autografts (n = 3) were 15.8, 13.0, and 13.5 ml. The volumes in those receiving a splenic-alone autograft (n = 2) were 12.0 and 5 ml. The mean rise in portal pressure was 18 cm of water. Complications related to the splenic autograft included a wedge splenic infarct, an emergency splenectomy, and a portal vein thrombosis in one patient having a combined intraportal and splenic autograft. Two patients developed insulin independence. two patients were still insulin independent at 1-year follow-up, and all had normal HbA1c levels (mean 5.6, range 5.2-6.3). Splenic islet autotransplantation, after total pancreatectomy, does lead to insulin independence. However, in our experience the combined procedure has a high morbidity because of splenic infarction and venous thrombosis.     

全膝关节置换治疗血友病关节炎围手术期处理及短期疗效评价

 目的 探讨血友病关节炎全膝置换围手术期管理、凝血因子调控及早期临床疗效。方法 回顾性分析2009年3月至2014年3月采用全膝关节置换治疗8例（10膝）血友病膝关节炎患者资料,均为男性患者,年龄31~47岁,平均（38.3±5.0）岁;术前活化部分凝血活酶时间为（63.9±4.0） s,凝血因子活性为2.6%±0.9%;膝关节均有屈曲畸形,伸膝-12.0°±5.9°,屈膝-88.0°±11.4°。其中3例（3膝）合并外翻畸形,外翻角平均-3.0°±5.4°;2例（4膝）合并内翻畸形,内翻角平均-4.5°±6.0°。8例患者中,甲型6例,乙型2例,分别补充冻干人凝血八因子和凝血酶原复合物后手术。骨缺损根据AORI分型方法,T1、T2型采用骨水泥充填,T3包容型采用同种异体骨打压植骨、螺钉支撑内固定修复,T3节段型通过自体骨结构性植骨,并加用胫骨延长杆修复。采用美国特种外科医院（hospital for special surgery, HSS）膝关节评分评价膝关节功能。结果 8例患者均获得随访,随访时间9~26个月,平均14.3个月。末次随访时伸膝0°,屈膝98.5°±6.7°;HSS评分由术前（42.3±10.9）分提高到术后（88.3±4.6）分;X线片示植骨存活,假体、螺钉均未见松动、断裂。结论 全膝关节置换治疗血友病关节炎短期疗效满意,术前的预输试验有助于确定凝血因子的补充剂量。     

Successful solitary pancreas transplantation with portal-enteric drainage following unsuccessful islet cell transplantation

BACKGROUND: There are no data regarding the outcome of solitary pancreas transplantation (SPT) with portal venous drainage (PVD) following unsuccessful islet transplantation (ITx) after multiple islet injections into the portal vein. We herein describe the outcome of three SPTs with PVD performed after failed ITx. METHODS: Between October 2002 and December 2003, three SPTs with PVD were performed following unsuccessful ITx with multiple intraportal islet injections (mean 2.3 injections: range 2 to 3 injections) in two women and one man, aged 26, 49, and 60 years. Panel reactive antibody titer was 0% in all recipients. Immunosuppression was based on induction with either basiliximab (n = 2) or thymoglobulin (n = 1); maintenance therapy included steroids, mycophenolate mofetil, and tacrolimus. During the recipient operation, the absence of venous hypertension was established by direct measurement of portal pressure, before making the final decision to drain the pancreas into the portal vein. RESULTS: Portal pressures were 16 cm H2O, 14 cm H2O, and 13 cm H2O. Pancreas grafts were reperfused after a period of cold preservation of 638, 695, and 835 minutes, respectively. All grafts showed immediate endocrine function, maintaining their recipients insulin-independent for longest follow-ups of 8, 21, and 23 months, respectively. One recipient developed a nonocclusive venous thrombus that resolved with intravenous heparin infusion. CONCLUSIONS: Our experience showed that unsuccessful ITx with multiple intraportal injections does not necessarily preclude the possibility of subsequent successful SPT with PVD. Further experience is needed to define contraindications and possible complications of SPT with PVD following ITx.     

Idiopathic intracranial hypertension and bariatric surgery: a systematic review

BackgroundIdiopathic intracranial hypertension (IIH) is a rare condition typically affecting women with obesity who are of child-bearing age. Patients commonly present with headaches, visual disturbances, pulsatile tinnitus and papilledema. The association between IIH and obesity has been well established in the literature, suggesting that weight loss may contribute to improving IIH. For patients with severe obesity for whom conservative management is not successful, bariatric surgery is an effective modality for weight loss. We aimed to systematically review the literature to determine the efficacy of bariatric surgery in the treatment of IIHMethodsWe conducted a comprehensive search of MEDLINE, Embase, Scopus, the Cochrane Library and Web of Science (limited to studies in humans published in English between January 1946 and July 2015).ResultsTwelve primary studies (n = 39 patients) were included in the systematic review. All patients had a preoperative diagnosis of IIH. Preoperative body mass index (BMI) was 47.4 ± 3.6 kg/m²; BMI improved to 33.7 ± 2.1 kg/m² and 33.9 ± 11.6 kg/m² at 6 and 12 months postoperatively, respectively. Lumbar puncture opening pressures decreased from 34.4 ± 6.9 cm H₂O to 14.0 ± 3.6 cm H₂O after surgery. Common symptoms of IIH improved after bariatric surgery: headaches (100% preoperatively v. 10% postoperatively), visual complaints (62% v. 44%), tinnitus (56% v. 3%) and papilledema (62% v. 8%).ConclusionBariatric surgery appears to lead to considerable improvement in IIH. Idiopathic intracranial hypertension is not a well-publicized comorbidity of obesity, but its presence may be considered as an indication for bariatric surgery.     

Factors Relating to Coagulation,Fibrinolysis and Hepatic Damage After Liver Resection

A survey of the blood of twenty-two patients who had undergone hepatic resection was performed. Serum levels of α-2 plasmin inhibitor-plasmin complex initially decreased from 1.58 ± 0.31 μg/ml on the preoperative day (PREOP), to 0.92 ± 0.14 μ/ml on the first postoperative day (POD 1), and then increased to 3.13 ± 0.92 μg/ml on the seventh postoperative day (POD 7) (mean ± SE)). Thrombin-anti-thrombin III complex (14.2 ± 4.3 ng/ml on PREOP and 26.0 ± 4.1 ng/ml on POD 7 (mean ± SE)) and D-dimer (335 ± 96 ng/ml on PREOP and 1859 ± 258 ng/ml on POD 7 (mean ± SE)) increased in the early postoperative stage. The level of 6-keto-prostaglandin F1α increased after the operations (from 13.2 ± 1.8 pg/ml on PREOP to 37.8 ± 12.8 pg/ml on POD 7 (mean ± SE)). The level of thromboxane B-2 decreased at first, and then gradually increased and returned to its preoperative level on POD 7 (144.7 ± 43.8 pg/ml on PREOP, 57.6 ± 27.5 pg/ml on POD1 and 152.5 ± 58.4 pg/ml on POD 7 (mean ± SE)). Superoxide dismutase activity increased at first, and then gradually decreased, postoperatively (2.8 ± 0.5 NU/ml on PREOP, 4.8 ± 0.8 NU/ml on POD1 and 2.6 ± 0.3 NU/ml on POD 7 (mean ± SE)). That is, biodefensive reactions which protect patients against the shift to disseminated intravascular coagulation (DIC) were inferred with by the increase in antiplatelet aggregation, despite the activation of coagulation and fibrinolytic mechanisms after hepatic resection.     

Relationship between transpulmonary artery distance and pulmonary arterial pressure in patients with chronic bronchitis

Measurements were made of the distance between the bifurcation of the right and left main pulmonary arteries (the transpulmonary artery distance) on plain chest radiographs in healthy subjects, patients with chronic bronchitis, and patients with polycythaemia rubra vera. The following figures for transpulmonary artery distance were obtained—healthy subjects: range 7·0-10·5 cm., mean 8·76 cm., S.D. 0·81 cm.; patients with chronic bronchitis: range 7·3-12·4 cm., mean 10·26 cm., S.D. 1·08 cm.; patients with polycythaemia rubra vera: range 8·3-10·7 cm., mean 9·20 cm., S.D. 0·57 cm. The transpulmonary artery distance was related to height but not to age or sex in the healthy subjects. It did not appear to be influenced by variations in the central blood volume. There was a linear relation between transpulmonary artery distance and mean pulmonary arterial pressure in patients with chronic bronchitis. In 21 of 29 patients whose transpulmonary artery distance was greater than 9·5 cm., the mean pulmonary arterial pressure exceeded 30 mm. Hg. In only one of the 13 patients whose transpulmonary artery distance was less than 9·5 cm. did the mean pulmonary arterial pressure exceed 30 mm. Hg. These results suggest that the measurement of transpulmonary artery distance may be useful in following the progression of pulmonary hypertension and detecting its presence in epidemiological and other studies.     

Usefulness of monitoring intrapleural pressure with digital chest drainage system for the management of air leakage after lung resection

Open in a separate window OBJECTIVESThe objective of this study was to determine the variation in intrapleural pressure (IPP) with and without air leakage using a digital chest drainage system (DCS) for each pressure setting.METHODSIn this retrospective single-centre study, we analysed 49,553 h of air leakage after anatomical lung resection in 714 patients between 2018 and 2020. The transition of mean IPP and mean air leak flow was monitored using DCS, and the association between mean IPP and mean air leak flow was examined. The relationship between the transition of mean IPP and air leakage according to the varying suction pressures on DCS was also investigated.RESULTSOverall, 272 patients (38.1%) showed air leakage after surgery. The mean IPP in patients without air leakage was −12.0 ± 2.9 cmH₂O and maintained at about −12 cmH₂O constantly, while the mean IPP in patients with air leakage was −8.3 ± 1.9 cmH₂O, which changed to −12 cmH₂O instantly if air leakage disappeared (P < 0.001). Among patients with air leakage, the mean IPP changed more distinctly in patients with mild suction management than in those with conventional suction management (−5.0 ± 2.6 to −11.5 ± 4.2 and −8.8 ± 1.3 to −12.1 ± 2.5 cmH₂O, respectively; P < 0.001).CONCLUSIONSThe change in IPP on a DCS is useful for detecting air leakage. Furthermore, management with a mild suction setting on DCS makes it easy to recognize the disappearance of postoperative air leakage.     

A comparison of endocrine and exocrine function after pancreatic fragment autotransplantation into splenic pulp, portal vein, and hepatic parenchyma.

Three sites were evaluated for potential pancreatic fragment autotransplantation. Both endocrine and exocrine functions were evaluated following autotransplantation into splenic pulp, portal vein, or hepatic parenchyma in 44 pancreatectomized dogs. Cholecystic bile amylase concentrations in the hepatic parenchyma group surviving more than 2 months were elevated significantly, and choledochal bile amylase concentrations increased markedly following pancreozymin-secretin injection. In contrast, bile amylase concentrations in dogs with intrasplenic or intraportal implants were low and did not respond to PS injection. Histologically pancreatic autografts in hepatic parenchyma revealed marked proliferation of exocrine tissue with abundant zymogen granules and reconstruction of the acinar lobules with a few islets. These acinar cells in the hepatic parenchyma were ultrastructurally normal. Transplant endocrine function, estimated by K values, was significantly better after splenic pulp and portal vein than after a hepatic parenchyma implantation, but no group improved during 1-year follow-up. Glucose-stimulated initial insulin responses were abnormally low in all recipients. Islet B cells lacked mature insulin granules, such as seen in normal resting B cells. This ultrastructural finding implies a persistent demand on the B cells and may explain the spontaneous recurrence of hyperglycemia and the diminished initial insulin response to a glucose load. This study indicates that euglycemic recipients of pancreatic fragment autotransplantation remain unstable and prediabetic.     

Effect of lignocaine, sodium cromoglycate, and ipratropium bromide in exercise-induced asthma

Eight patients with exercise-induced asthma participated in a single-blind trial comparing the protective effects of inhaled lignocaine (estimated dose 48 mg), sodium cromoglycate (estimated dose 12 mg), and ipratropium bromide (estimated dose 120 μg). Saline was used as control. Effects were assessed from the mean maximal percentage fall in forced expiratory volume in one second (FEV₁) and maximal mid-expiratory flow rates (MMFR) after they had run on a treadmill for eight minutes. There was no significant change in baseline FEV₁ or MMFR before each agent was given. Saline, lignocaine, and sodium cromoglycate did not alter the mean baseline FEV₁ or MMFR significantly. Ipratropium caused bronchodilatation with an increase of 16·3% in the mean FEV₁ (p<0·001) and of 43·4% in the mean MMFR (p<0·05). After exercise the maximal percentage falls in FEV₁ (means and SEM) after saline, lignocaine, sodium cromoglycate, and ipratropium bromide were 38·1% (5·0), 34·5% (6·1), 11·3% (3·7), and 19·3% (7·4) respectively. Similarly, the mean maximal falls in MMFR after saline, lignocaine, sodium cromoglycate, and ipratropium bromide were 54·4% (5·2), 52·9% (7·7), 23·6% (6·6), and 32·1% (10·5) respectively. The inhibitory effects of sodium cromoglycate and ipratropium bromide were significant whereas lignocaine failed to produce an effect. These results suggest that mediator release is an important factor in exercise-induced asthma and that in some patients the effects of the mediators may be on the postsynaptic muscarinic receptors. Local anaesthesia of sensory vagal receptors, on the other hand, does not prevent exercise asthma and these receptors do not appear to have any important role in exercise-induced bronchoconstriction.     

Scapular neck length and implications for reverse total shoulder arthroplasty: An anatomic study of 442 cadaveric specimens

Purpose:

Reverse total shoulder arthroplasty (RTSA) may be used to treat a variety of pathologic shoulder conditions, but complications such as scapular notching continue raise concerns. Variable anatomy surrounding the glenoid may have implications for future RTSA design, but at present the anatomy of the scapular neck in the human population has not been clearly defined.

Materials and Methods:

442 human scapulae from the Hamann-Todd Osteological Collection were measured for scapular neck length (SNL) and scapular neck angle (SNA). SNL was defined as the distance from the most lateral portion of the infraglenoid tubercle to the most inferolateral portion of the glenoid fossa. The SNA was measured according to Gerber et al. previously. The mean, standard deviation and ranges for SNL and SNA were calculated and compared based on sex and race, and interobserver variability was calculated.

Results:

The mean SNL was 1.06 cm ± 0.33 cm (0.37-2.43 cm). Males demonstrated a larger SNL (1.08 cm ± 0.33 cm) than females (1.01 cm ± 0.32 cm) (P < 0.12), and Caucasians (1.09 cm ± 0.33 cm) demonstrated a significantly larger SNL than African-Americans (1.00 cm ± 0.32) (P < 0.01). The mean SNA was 106.7° ± 11.0° (76.9-139.4°). No significant correlation was found between SNL and SNA (Pearson Correlation Coefficient = 0.018) (P < 0.702).

Conclusion:

Scapular neck length and SNA vary widely within the population but there appears to be a tendency towards increased SNL in males and Caucasians.

Clinical Relevance:

The anatomy of the scapular neck may have significant implications for RTSA design, surgical planning, and reduction of associated complications.     

Using retroperitoneal laparoscopic ureterolithotomy in the treatment of impacted upper ureteric calculi

BackgroundThe ideal treatment for upper ureteric calculi is still debatable, particularly for patients with large, impacted ureteric calculi. Retroperitoneal laparoscopic ureterolithotomy (RLU) may be a worthwhile alternative to open surgery. In this study, we retrospectively evaluated our clinical experience associated with RLU performed for impacted upper ureteric calculi (>1.5 cm) help urologists in clinical practice and provide a reference for clinical work.MethodsA total of 64 cases (38 males; 26 females) with impacted upper ureteric calculi between April 2018 and January 2020 were analyzed retrospectively. The basic information of the included research subjects are as follows: The mean age was 50.8±25.4 years. The largest stone diameter was 1.8±0.3 cm. The mean stone retention time was 42±11 days. The mean degree of hydronephrosis was 2.8±1.2 cm.ResultsThe mean operative time was 85.4±18.3 minutes. The mean hospital duration was 7.5±1.8 days. The stone-free rate was 98.4%. Two patients required additional intervention. Post-operative fever developed in 3 patients. The decrease in hemoglobin levels was 7.8±3.6 g/L. The increase in procalcitonin (PCT) level was 3.7±1.8 ng/mL. No major complications, for example, sepsis, bleeding, bowel injury, or cardiopulmonary morbidities, were reported.ConclusionsRLU should be regarded as an excellent first line treatment modality for impacted upper ureteric calculi (>1.5 cm) owing to the high success rate, low complication rate, and the short length of operative time and hospital duration.     

Anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior lesions: A cadaveric study and preliminary report

ObjectiveThis study aims to investigate the anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior (SLAP) lesions in a human cadaveric model.MethodsIn this anatomic study, bilateral shoulder girdles of 12 adult formalin embalmed cadavers were used. All cadavers were male, and the mean age was 63.4±7.3 years. The portal entry point was determined as midway between the anterior and posterior borders of the acromion, approximately 1 cm lateral from the edge of the acromion. After a guidewire was placed in the glenoid cavity at the 12 o’clock position where the SLAP lesion typically occurs, a switching stick was inserted there. Each glenoid was then drilled with a 2.4 mm drill through an arthroscopic cannula. Subsequently, anatomical dissection was executed to assess the relationship of the transmuscular portal with the suprascapular nerve, axillary nerve, supraspinatus tendon, acromion, and biceps tendon. Lastly, the shortest distance between the aforementioned structures with the drill was measured by a sensitive caliper to determine whether there was a penetration of the structures. Differences between the right and left sides were analyzed.ResultsThe mean distance between the portal and the axillary nerve was 55.5 mm±6.0 mm, and the mean length of the suprascapular nerve was 61.2 mm±7.0 mm. The mean distance between the portal and the supraspinatus tendon was 2.8 mm±1.5 mm. No penetration of the axillary nerve, suprascapular nerve, and supraspinatus tendon was observed in any cadaver. No differences were detected for measured anatomical parameters between the right and left sides (p>0.05).ConclusionFindings from this cadaveric study revealed that the transmuscular portal may allow for a reliable anchor placement without any nerve or tendon penetration during arthroscopic SLAP repair.Level of EvidenceLevel V     

Deformed Complex Vertebral Osteotomy Technique for Management of Severe Congenital Spinal Angular Kyphotic Deformity

ObjectivesTo (i) introduce the deformed complex vertebral osteotomy (DCVO) technique for the treatment of severe congenital angular spinal kyphosis; (ii) evaluate the sagittal correction efficacy of the DCVO technique; and (iii) discuss the advantages and limitations of the DCVO technique.MethodsMultiple malformed vertebrae were considered a malformed complex, and large‐range and angle wedge osteotomy was performed within the complex using the DCVO technique. Patients with local kyphosis greater than 80° who were treated with DCVO and did not have tumors, infections, or a history of surgery were included. A retrospective case study was performed in these patients with severe angular kyphosis who underwent the DCVO technique from 2008 to 2016. Demographic data, the operating time, and the volume of intraoperative blood loss were collected. Spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], and sacral slope [SS]), local and global sagittal parameters (deformity angle, thoracic kyphosis [TK], and lumbar lordosis [LL]), visual analog scale (VAS) score, and Oswestry disability index (ODI) score were recorded pre‐ and postoperatively. Paired t‐tests (α = 0.05) were used for all data (to compare the mean preoperative value with the mean postoperative and most recent follow‐up values). P < 0.05 was considered statistically significant.ResultsTwenty‐nine patients with a mean age of 34 years (range, 15–55) were included in the final analysis. Seventeen patients were male, and 12 were female. The mean follow‐up was 44 months (range, 26–62). The mean operating time was 299 min (range, 260–320 min). The mean blood loss was 2110 mL (range, 1500–2900 mL). Three patients had T₇–T₈ deformities (3/29, 10.3%), six had T₈–T₉ deformities (6/29, 20.7%), six had T₉–T₁₀ deformities (6/29, 20.7%), 10 had T₁₀–T₁₁ deformities (10/29, 34.5%), three had T₁₁–T₁₂ deformities (3/29, 10.3%), and one had T₉–T₁₁ deformities (1/29, 3.4%). The mean local deformity angle significantly improved from 94.9° ± 10.8° to 24.0° ± 2.3° through the DCVO technique, with no significant loss at the follow‐up. Moreover, the global sagittal parameters and spinopelvic parameters exhibited ideal magnitudes of improvement; TK decreased from 86.1° ± 12.1° to 28.7° ± 2.5°, LL improved from 94.5° ± 4.1° to 46.1° ± 3.0°, and PI minus LL improved from −60.9° ± 6.5° to −13.7° ± 2.6°. Both the VAS and ODI scores significantly improved at the last follow‐up. CSF fistula and neural injury did not occur during the perioperative period. At the last follow‐up, fixation failure was not observed.ConclusionThe DCVO technique provides an alternative and effective method for the treatment of congenital severe angular spinal kyphotic deformities and may decrease the occurrence of perioperative complications.     

Left Atrial and Left Ventricular Diastolic Function After the Maze Procedure for Atrial Fibrillation in Mitral Valve Disease: Degenerative Versus Rheumatic

The present study was aimed to compare the left atrial and left ventricular diastolic functions amongst the rheumatic and degenerative mitral valve disease patients in atrial fibrillation who reverted to normal sinus rhythm following Cox-maze procedure. We prospectively investigated the left atrial and left ventricular function with Doppler echocardiography, by dividing into the rheumatic (N = 105) and the degenerative group (N = 47). Over the follow-up period (mean: 4.4 ± 1.2 years in the rheumatic group, 4.8 ± 1.3 years in the degenerative group), the rheumatic group showed statistically significant decrease in A'' velocity and E'' velocity, on contrary to degenerative group (A'' velocity: mean decrease of 0.43 ± 0.13 cm/s in the rheumatic group, mean increase of 0.57 ± 0.11 cm/s in the degenerative group, p = 0.029, E'' velocity: mean decrease of 0.23 ± 0.17 cm/s in the rheumatic group, mean increase of 0.21 ± 0.15 cm/s in the degenerative group, p = 0.031). In addition, the rheumatic group showed statistically significant increase in E/E'' ratio than the degenerative group (mean increase of 4.49 ± 1.98 in the rheumatic group, mean increase of 1.74 ± 1.52 in the degenerative group, p = 0.047). Despite successful sinus rhythm restoration, the progressive loss of LA function as well as LV diastolic function is more prominent in the rheumatic group than the degenerative group. Therefore, differentiated strategies for postoperative surveillance are needed according to the pathology of mitral valve disease.