The relationship of superior labralanteroposterior (SLAP) lesions and pseudolaxity to shoulder injuries in the overhead athlete

Understanding the effect of superior labral lesions on the function of the shoulder is essential to successfullytreating the overhead athlete. Recognizing the pseudolaxity owing to superior labral anteroposterior (SLAP) lesions and the pathological "peel-back" sign is critical in evaluating the injured shoulder in general and repairing the SLAP lesion in particular. The mechanical characteristics of suture anchors are more favorable than tacks in resisting the pathological forces responsible for the peel-back mechanism. The higher success rate of arthroscopic suture anchor repair of SLAP lesions in comparison with open capsulolabral reconstruction suggests that SLAP lesions are the usual cause of the "dead arm" syndrome. In our experience, arthroscopic repair of SLAP lesions can return the overhead athlete to their preoperative level of function in the vast majority of cases (87% return to preoperative level for two or more seasons).     

Neonatal outcome when delivery follows a borderline immature lecithin to sphingomyelin ratio.

OBJECTIVE: Occasionally, clinicians are presented with a complicated preterm pregnancy where fetal pulmonary maturity testing might be used to help guide management decisions. However, should delivery be allowed if the lecithin to sphingomyelin ratio (L/S ratio) is not quite mature? The incidence of newborn complications after delivery with L/S ratio values of 1.8 and 1.9 is unknown. The purpose of this study was to evaluate the neonatal morbidity and mortality in patients that delivered with these borderline immature results. STUDY DESIGN: All patients who underwent fetal pulmonary maturity testing were prospectively recorded in log books. An L/S ratio of > or = 2.0 was considered mature. Patients with an L/S ratio of 1.8 or 1.9 were considered "borderline immature." These borderline immature cases were evaluated for the gestational age at amniocentesis, the gestational age at delivery, and neonatal outcome. RESULTS: During the 9-year study period, L/S ratio testing was performed on 2038 patients. Of these, 162 preterm patients (7.9%) had an L/S ratio of 1.8 or 1.9 A total of 63 of these 162 patients delivered < 72 hours after the amniocentesis and met study criteria. The pregnancies ranged from 27 to 36 weeks' gestation. There was a 13% incidence (95% confidence interval (CI) of 4% to 30%) of major neonatal morbidity and a 3% incidence (95% CI of 0% to 17%) of neonatal mortality in the 30 pregnancies with an L/S ratio of 1.8. The incidence of major neonatal morbidity was only 3% (95% CI of 0% to 15%) in the 33 patients with an L/S ratio of 1.9, with no cases of mortality (95% CI of 0% to 9%). CONCLUSION: Based on 95% CIs, the data of this study reveal that the maximum risk for major morbidity is < or = 15%, with a mortality risk of < 10% in a preterm newborn delivered with a 1.9 L/S ratio value. The maximum risk is 30% for major morbidity and 17% for mortality in preterm newborns delivered with a 1.8 L/S ratio. This information may help in the decision-making process of whether to deliver or to observe when faced with a borderline immature L/S ratio result in a complicated preterm pregnancy.     

Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure

BACKGROUND: We sought to determine whether evolving techniques of aortic arch reconstruction used during the Norwood procedure decreased the incidence of postoperative aortic arch obstruction. METHODS: Our technique for aortic arch reconstruction in patients undergoing the Norwood procedure has evolved from using an allograft patch (classic group, n = 26) to primary connection of the pulmonary artery and arch (autologous group, n = 20). More recently, we have used a novel technique involving coarctation excision, an extended end-to-end anastomosis on the back of the arch, and a counterincision on the anterior descending aorta to sew in an allograft patch for total arch reconstruction (interdigitating group, n = 33). Cardiac catheterizations performed before stage II palliation were reviewed for aortic diameters at multiple levels in 79 infants (median age, 4.2 months). Aortic arch obstruction was defined as a ratio between the diameters of the arch anastomosis and the descending aorta (coarctation index) of less than 0.7. RESULTS: Overall, 15 (19%) children had aortic arch obstruction. All 15 required aortic intervention (balloon angioplasty, n = 12; surgical patch angioplasty, n = 2; both, n = 1). Aortic arch obstruction rates for the classic, autologous, and interdigitating groups were 46% (n = 12), 15% (n = 3), and 0%, respectively ( P > .001). CONCLUSION: Reconstruction of the aortic arch with excision of ductal and coarctation tissue is associated with lower aortic arch obstruction rates in patients undergoing the Norwood procedure. Arch reconstruction with a novel interdigitating technique decreases the incidence of aortic arch obstruction.