Subscapularis function after total shoulder replacement: results with lesser tuberosity osteotomy

Until recently, little consideration was placed on the integrity of the subscapularis tendon after total shoulder arthroplasty. We have noted that several of our patients exhibited loss of internal rotation strength and subscapularis function after total shoulder arthroplasty utilizing an anatomic soft tissue repair of the subscapularis, both with and without bone tunnels. On the basis of those results, we began removing the subscapularis with a small piece of bone by a lesser tuberosity osteotomy in an attempt to achieve improved subscapularis function through bony healing at the repair site. A retrospective review of 28 patients (30 shoulders) was done of patients who had total shoulder arthroplasty performed between 2001 and 2003. The lesser tuberosity and attached subscapularis were repaired through bone tunnels in all cases. The mean follow-up was 1.1 years. Terminal internal rotation was evaluated by the belly-press examination. Subscapularis function was assessed by the patient's ability to tuck in a shirt behind the back, and 25 of 30 patients (83.3%) reported no difficulty. Belly-press examination results were normal in 18 of 30 patients (60%). Removal of the subscapularis through a lesser tuberosity osteotomy results in reliable restoration of internal rotation strength after total shoulder arthroplasty, as measured by the ability to perform a stomach press and to tuck in a shirt. In comparing these results with our earlier cohort of patients with similar demographics and postoperative rehabilitation that had soft tissue repair, improved results were seen in the group that underwent lesser tuberosity osteotomy.     

Inability to Induce Tolerance Through Direct Antigen Presentation

Both the direct and indirect antigen presentation pathways are important mechanisms for T cell-mediated allograft rejection. Studies using knockout mice and monoclonal antibodies have demonstrated that CD4+ T cells are both necessary and sufficient for the rejection of allogeneic tissues, including skin, heart, and islet. Furthermore, combined blockade of the CD28/B7 and CD154/CD40 costimulatory pathways induces tolerance in multiple CD4+ T-cell dependent allograft models. In this study, we addressed the T-cell requirement for costimulation in direct antigen presentation. We demonstrated that class II-specific alloreactive T-cell receptor transgenic T cells were sufficient to mediate allograft rejection independent of costimulatory blockade. Analysis of the costimulatory capacity of different antigen presenting cell (APC) populations demonstrated that APCs resident within the donor skin, Langerhans cells, are potent stimulators not requiring CD28- or CD154-dependent costimulation for direct major histocompatibility complex (MHC) antigen presentation. These results complement previous work examining the role of costimulation on CD8+ T cells, supporting a model in which the effectiveness of costimulatory blockade in the setting of transplantation may be selective for the indirect pathway of MHC alloantigen presentation.     

Type I interferons in the treatment of pancreatic cancer: mechanisms of action and role of related receptors

OBJECTIVE: We evaluated the role of type I interferons (IFNs) and IFN receptors in the regulation of cell growth in 3 human pancreatic adenocarcinoma cell lines (BxPC-3, MiaPaCa-2, and Panc-1). BACKGROUND: Chemotherapy and radiotherapy have a marginal role in the management of pancreatic adenocarcinoma. The addition of IFN-alpha showed promising results in early clinical trials. METHODS: Cell proliferation and apoptosis were evaluated by DNA measurement and DNA fragmentation, respectively. Type I IFN receptor (IFNAR-1 and IFNAR-2 subunits) was determined by quantitative RT-PCR and immunocytochemistry. Cell cycle distribution was evaluated by propidium iodide staining and flow-cytometric analysis. RESULTS: The incubation with IFN-beta for 6 days showed a potent inhibitory effect on the proliferation of BxPC-3 (IC(50), 14 IU/mL) and MiaPaCa-2 (IC(50), 64 IU/mL). The inhibitory effect of IFN-beta was stronger than IFN-alpha in all 3 cell lines and mainly modulated by the stimulation of apoptosis, although cell cycle arrest was induced as well. The expression of the type I IFN receptors was significantly higher in BxPC-3 (the most sensitive cell line to IFN) and mainly localized on the membrane, whereas in Panc-1 (the most resistant cell line) about 60% to 70% of cells were negative for IFNAR-2c with a mainly cytoplasmic staining for IFNAR-2c. CONCLUSION: The antitumor activity of IFN-beta is more potent than IFN-alpha in pancreatic cancer cell lines through the induction of apoptosis. Further studies should investigate in vivo whether the intensity and distribution of IFNAR-1 and IFNAR-2c may predict the response to therapy with IFN-alpha and IFN-beta in pancreatic cancer.     

Dorsal Dislocation of the Intermediate Cuneiform with Fracture of the Lisfranc Joint: A Case Report

Tarsal cuneiform dislocation in association with Lisfranc fracture-dislocation is a rare pedal injury. In this report, we describe the case of a patient who sustained a dorsal dislocation of the intermediate cuneiform in association with tarsometatarsal fracture-dislocation following traumatic axial loading and torsion of his foot. A satisfactory outcome was achieved by treating the injury by means of closed reduction and percutaneous Kirschner wire fixation. ACFAS Level of Clinical Evidence: 4.     

Qualitative comparison of sonic or laser energisation of 4% sodium hypochlorite on an Enterococcus faecalis biofilm grown in vitro

The effectiveness of sonic activation, laser activation and syringe irrigation of 4% sodium hypochlorite in removing an Enterococcus faecalis biofilm was compared. Biofilms were grown in extracted human single rooted teeth using a flow cell apparatus. After 4 weeks' growth, teeth were subjected to each treatment using 4% sodium hypochlorite and radicular dentinal surfaces of the root canals were analysed by scanning electron microscopy. Results showed that sonic activation and syringe irrigation with sodium hypochlorite showed reduced numbers of bacterial cells on the radicular dentine but were not effective in eliminating E. faecalis in the dentinal tubules. Laser activation of sodium hypochlorite resulted in clean dentine walls and undetectable levels of bacteria within dentinal tubules. Qualitatively, sonic or laser activation of 4% NaOCl resulted in greater bacterial reduction compared with syringe irrigation, with laser activation producing the greatest overall reduction.     

Guidelines for use access to compuuterized medical records

Computerization of the medical record allows the unique capability to provide differential access to various components of the record by users outsid of the immediate provider/patient health care setting Guidelines for designers, programmers, and users of computerizeid medical records have been defined in order to clarify which data elements or categories are appropriate for communication to various parties involved in utilizing patients information.