Arthroscopic treatment for snapping scapula: a prospective case series

Purpose

Painful snapping scapula can be a disabling condition. The object of this prospective study was to assess the efficiency of arthroscopic bone resection of the medial superior corner of scapula, in patients suffering from continuously painful snapping scapula.

Methods

Twenty patients with painful snapping scapula underwent arthroscopic scapulothoracic bursectomi and resection of the hook formation at the medial superior margin of the scapular. Preoperatively, all patients reported temporary relief via a local anesthetic injection and had completed a 3-month rehabilitation program. The Western Ontario Rotator Cuff index (WORC) was used for the assessment of pain and function levels both pre- and postoperatively.

Results

Twenty patients (13 women and 7 men) were included. The mean follow-up was 2.9 years (range 2–5 years). The mean age was 40 years (range 19–68 years). The mean duration of symptoms was 4 years (range 4 months–20 years). Seven previously had arthroscopic operations in the affected shoulder with acromioplasty, with or without acromioclavicular joint resection. The median preoperative WORC score was 35.0 (range 18–74) and significantly increased to 86.4 (range 33–100) postoperatively. Out of 20 patients, 18 improved and 19 indicated that they would undergo the surgery again.

Conclusion

In this study, it was found that, among patients troubled by painful snapping scapula and without relief by exercise-based rehabilitation, arthroscopic resection of the medial superior hook formation in combination with partial bursectomy provides a serious gain in respect to the WORC score and is believed to be an effective treatment in most cases. One patient had a serious complication.     

Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study

Background

Cardiac surgery is a known risk factor for acute kidney injury (AKI) in children. However, cardiac surgery-associated AKI (CS-AKI) in neonates has not been well studied. The objectives of this study were: (1) to describe the epidemiology of CS-AKI in neonates utilizing the Acute Kidney Injury Network (AKIN) definition, (2) to identify risk factors for neonatal CS-AKI, and (3) to determine if neonatal CS-AKI is associated with increased morbidity and mortality.

Methods

This was a retrospective study involving 122 neonates (≤28 days) undergoing cardiac surgery from 2006 to 2009. Neonates with and without AKI were identified using serum creatinine (SCr) and urine output (UO) data.

Results

Cardiac surgery-AKI occurred in 76 (62 %) neonates, of whom 22 (29 %) were AKIN stage 1, 19 (25 %) were stage 2, and 35 (46 %) were stage 3. AKI mostly occurred early as 75 % of patients achieved their maximal AKIN stage within the first 48 h post-operatively. In the multivariate analysis, cardiopulmonary bypass duration of ≥120 min was independently associated with AKI [odds ratio (OR) 2.53, 95 % confidence interval (CI) 1.03–6.30]. Severe AKI (AKIN stage 3) was independently associated with mortality (OR 6.70, 95 % CI 1.08–41.50) and a longer stay in the pediatric intensive care unit (hazard ratio 9.09, 95 % CI 1.35–60.95). The majority of severe AKI cases (65 %) were identified with AKIN UO criteria alone without significant rises in SCr.

Conclusions

Cardiac surgery-AKI is common in neonates when the AKIN definition is utilized and is associated with higher morbidity and mortality, especially in those with more severe AKI.     

Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series

Introduction

Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery.

Method

We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36?years (23–68?years). The average hospital stay was 6?days (4–9?days).

Results

No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18?days (7–22?days).

Conclusion

We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.     

Dehydrated amniotic membrane allografts for the treatment of chronic wounds: a case series

A retrospective case series demonstrating the use of dehydrated human amniotic membrane (dHAM) allografts in the treatment of wounds of various aetiologies. Amniotic membrane was applied to a series of chronic wounds referred to a formal wound clinic for aggressive management, after prior, traditional treatment methods were found ineffective, over a period of 1 month. In each case, failure of traditional therapy was followed by placement of a dehydrated amniotic membrane allograft and the healing time course was documented with charted measurements. Wounds treated with the amniotic membrane allograft demonstrated improved healing, with a change in the healing trajectory from that previously noted. Dehydrated human amniotic membrane represents a potentially effective addition to existing wound care therapies, with further formal clinical studies indicated.     

成人心脏外科手术相关急性肾损伤的研究进展

心脏外科手术相关急性肾损伤(CSA-AKI)是临床危重症之一,致病因素和发病机制复杂,是临床医生面临的巨大挑战。目前预防及处理CSA-AKI尚存在很多争议。本文重点介绍CSA-AKI的研究进展。     

Gabapentin in the treatment of post-dural puncture headache: a case series

Gabapentin has been reported to be useful in the management of epilepsy, neuropathic pain and post-dural puncture headache. Seventeen obstetric cases are presented in which gabapentin was used either as a primary therapy for the management of severe headache following a diagnosed dural puncture or as an analgesic adjunct in patients with dural puncture headache unresponsive to epidural blood patch. In our patients, analgesic therapy was essential to enable care of their newborns as other management options had failed or were unavailable. In nine patients we observed an excellent result with reduction of headache severity within 24 hours. Gabapentin appears potentially beneficial in the management of patients with post-dural puncture headaches.     

Hyperbaric oxygen in the treatment of calciphylaxis: a case series.

BACKGROUND: Calciphylaxis, also referred to as calcific uraemic arteriolopathy, is a syndrome associated with end-stage renal disease (ESRD), and causes necrotic skin ulcers, often leading to a fatal outcome. Hyperbaric oxygen (HBO(2)) therapy has been used to enhance wound healing, but its role in the treatment of calciphylaxis is unclear. METHODS: We undertook a retrospective study of patients on renal replacement therapy with biopsy-proven calciphylaxis who were treated with HBO(2) between March 1997 and February 2000. RESULTS: Five patients were treated with HBO(2): three patients were on continuous ambulatory peritoneal dialysis (CAPD) and two were on chronic haemodialysis therapy. None of the patients had uncontrolled hyperparathyroidism and none underwent parathyroidectomy. The patients each received 25-35 treatments of HBO(2) at 2.5 atmospheres for 90 min per treatment. Two of these patients had complete resolution of extensive necrotic skin ulcers, with no adverse effects of HBO(2) therapy. Both had improvement in wound area transcutaneous oxygen pressure (P(tc)O(2)) with administration of 100% oxygen when measurements were taken at normobaric and hyperbaric pressures. In the other three patients receiving HBO(2), the skin lesions did not resolve. P(tc)O(2) was measured in two of these patients, neither of whom showed improvement with 100% oxygen administered at normobaric pressure. CONCLUSIONS: The data support a role for HBO(2) in the treatment of some patients with calciphylaxis, particularly as in the absence of uncontrolled secondary hyperparathyroidism there are few therapeutic options.