Modified subpectoral biceps tenodesis

Purpose

The proximal part of the long head of the biceps muscle has become a recognized cause of significant shoulder pain. Tenodesis of the long head of the biceps has been advocated as a treatment for pain resulting from biceps tendonopathy, biceps instability, and biceps tendon tears. All of these pathologies may be encountered during rotator cuff, SLAP or Bankart surgery, or in isolation. Several techniques have been described for this tenodesis, including various arthroscopic and subpectoral methods.

Methods

We present a modified bone bridge technique of Mazzocca et al., for subpectoral biceps tenodesis. In this technique we tenodese the tendon through two bone tunnels back over the muscle itself without implants.

Results

Application of this technique on 30 patients (ages 25–48 years) with short-term follow-up of 12–18 months showed statistically significant improvement (P value < 0.05) of the mean Constant and Oxford shoulder scores (pre-operative mean scores were 39.03 and 21.3, respectively, while postoperative mean scores were 76.43 and 44.8, respectively).

Conclusion

This technique has potential advantages as it allows the possibility of adjusting the tension of the biceps tendon before final suturing, in addition to quicker soft tissue healing.     

Does Physical Activity in Adolescence Have Site‐Specific and Sex‐Specific Benefits on Young Adult Bone Size,Content, and Estimated Strength?

The long‐term benefits of habitual physical activity during adolescence on adult bone structure and strength are poorly understood. We investigated whether physically active adolescents had greater bone size, density, content, and estimated bone strength in young adulthood when compared to their peers who were inactive during adolescence. Peripheral quantitative computed tomography (pQCT) was used to measure the tibia and radius of 122 (73 females) participants (age mean ± SD, 29.3 ± 2.3 years) of the Saskatchewan Pediatric Bone Mineral Accrual Study (PBMAS). Total bone area (ToA), cortical density (CoD), cortical area (CoA), cortical content (CoC), and estimated bone strength in torsion (SSI_p) and muscle area (MuA) were measured at the diaphyses (66% tibia and 65% radius). Total density (ToD), trabecular density (TrD), trabecular content (TrC), and estimated bone strength in compression (BSI_c) were measured at the distal ends (4%). Participants were grouped by their adolescent physical activity (PA) levels (inactive, average, and active) based on mean PA Z‐scores obtained from serial questionnaire assessments completed during adolescence. We compared adult bone outcomes across adolescent PA groups in each sex using analysis of covariance followed by post hoc pairwise comparisons with Bonferroni adjustments. When adjusted for adult height, MuA, and PA, adult males who were more physically active than their peers in adolescence had 13% greater adjusted torsional bone strength (SSI_p, p < 0.05) and 10% greater adjusted ToA (p < 0.05) at the tibia diaphysis. Females who were more active in adolescence had 10% larger adjusted CoA (p < 0.05), 12% greater adjusted CoC (p < 0.05) at the tibia diaphysis, and 3% greater adjusted TrC (p < 0.05) at the distal tibia when compared to their inactive peers. Benefits to tibia bone size, content, and strength in those who were more active during adolescence seemed to persist into young adulthood, with greater ToA and SSI_p in males, and greater CoA, CoC, and TrC in females. © 2014 American Society for Bone and Mineral Research.     

"Stem cell" origin of the hematopoietic defect in dyskeratosis congenita

We have used the long-term bone marrow culture (LTBMC) system to analyze hematopoiesis in three patients with dyskeratosis congenita (DC), two of whom had aplastic anemia, and the third had a normal blood count (apart from mild macrocytosis) and normal BM cellularity. Hematopoiesis was severely defective in all three patients, as measured by a low incidence of colony-forming cells and a low level of hematopoiesis in LTBMC. The function of the marrow stroma was normal in its ability to support the growth of hematopoietic progenitors from normal marrows seeded onto them in all three cases, but the generation of hematopoietic progenitors from patients marrow cells inoculated onto normal stromas was reduced, thus suggesting the defect to be of stem cell origin. The parents and unaffected brother of one of the families have also been studied in LTBMC and all showed normal hematopoietic and stromal cell function. From this study we speculate that there are some similarities between DC and the defect in the W/Wv mouse.     

Impact of elevated glycosylated hemoglobin on hospital outcome and 1 year survival of primary isolated coronary artery bypass grafting patients

Objective

It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting.

Robotic colorectal surgery: summary of the current evidence

Background

Several studies have confirmed that laparoscopic colorectal surgery results in improved early post-operative outcomes. Nevertheless, conventional laparoscopic approach and instruments have several limitations. Robotic approach could potentially address of many of these limitations.

Objectives

This review aims to present a summary of the current evidence on the role of robotic colorectal surgery.

Methods

A comprehensive search of electronic databases (Pubmed, Science Direct and Google scholar) using the key words “rectal surgery”, “laparoscopic”, “colonic” and “robotic.” Evidence from these data was critically analysed and summarised to produce this article.

Results

Robotic colorectal surgery is both safe and feasible. However, it has no clear advantages over standard laparoscopic colorectal surgery in terms of early postoperative outcomes or complications profile. It has shorter learning curve but increased operative time and cost. It could offer potential advantage in resection of rectal cancer as it has a lower conversion rates even in obese individuals, distal rectal tumours and patients who had preoperative chemoradiotherpy. There is also a trend towards better outcome in anastomotic leak rates, circumferential margin positivity and perseveration of autonomic function, but there was no clear statistical significance to support this from the currently available data.

Conclusion

The use of robotic approach seems to be capable of addressing most of the shortcomings of the standard laparoscopic surgery. The technique has proved its safety profile in both colonic and rectal surgery. However, the cost involved may restrict its use to patients with challenging rectal cancer and in specialist centres.     

A qualitative study of stakeholder views and experiences of minor ailment services in the United Kingdom

BackgroundAn international strategy designed to promote access to primary care is the utilisation of community pharmacy to deliver structured minor ailment services (MASs). An understanding of key implementation features of MASs will support effective service delivery and implementation, promote MAS viability, sustainability and overall improvement.AimThe aim of this study is to explore the views and experiences of a range of stakeholders concerning the implementation of MASs in the United Kingdom.MethodsA qualitative approach was used to obtain data. Participants were recruited using purposeful and snowball sampling. Stakeholders from five different regions were included. Using the digital recordings of the interviews, thematic content analysis was undertaken.ResultsThirty-three participants agreed to be interviewed. Twenty-nine semi-structured interviews were conducted. Thematic content analysis yielded three major themes, including (1) benefits of MASs, (2) structural challenges associated with MAS design and (3) other implementation factors associated with MAS delivery. Stakeholders recognised the positive impact of the service to improve patient access and care, promote efficiencies, and promote the professional role of the pharmacist. Nevertheless barriers do exist to service delivery and implementation. Stakeholders identified the need to potentially increase the population groups served by MASs, increase the conditions treated and widen their formulary lists. Similarly, marketing strategies needed to be improved to enhance consumer awareness. Stakeholders presented mixed views about whether pharmacists needed to complete clinical training and the need to increase pharmacist's remuneration. In addition the level of healthcare collaboration needed to improve.ConclusionSeveral concepts emerged from the investigation to facilitate service delivery. Barriers to service implementation had a variable impact on implementation. Service delivery should function to meet all stakeholder needs and can be achieved through stakeholder collaboration. However, improved marketing to promote consumer awareness together with better collaborative processes can potentially improve MAS implementation.     

Validation of the RHL30 digital gene expression assay as a prognostic biomarker for relapsed Hodgkin lymphoma

Despite continuing improvements in the management of classical Hodgkin lymphoma (cHL), relapse remains associated with a risk of lymphoma-related mortality. The biological composition of relapse tumour biopsies shows interpatient variability, which can be leveraged to design prognostic biomarkers. Here, we validated the RHL30 assay, a previously reported gene expression model in an independent cohort of 41 patients with relapsed cHL. Patients classified as high-risk by the RHL30 assay had inferior failure-free survival (FFS) after autologous stem cell transplantation (2-year FFS 41% vs. 92%, P = 0·035). The RHL30 model is a robust biomarker that risk-stratifies patients considered for autologous stem cell transplantation.     

Strategies in the management of post-burn breast deformities

Background

Burn injuries to the chest area may end up with severe breast deformity and asymmetry. They are frequently complex and unique to each case, affecting parenchymal development, breast implantation on chest wall, nipple areola complex position, infra-mammary fold definition, and skin envelope. Furthermore, contractures affecting adjacent territories may occur and add to the deformity. Surgical correction should address all the deformity components. Thus, a structured reconstructive plan that recruits different mammaplasty techniques and deals with adjacent territories is needed. This work presents different strategies used in treating severe post-burn breast deformities. Elaborate analyses of the deformities, surgical techniques, and outcomes are presented and a structured reconstructive plan is proposed.

Methods

Sixteen deformed breasts in 11 patients (mean age, 22 years) were managed. The techniques used included a variety of mastopexy techniques, prosthesis-based endoscopic breast reconstruction, and autologous breast augmentation with fat grafting or local flaps in some hypoplastic cases. Ancillary procedures to the neck, axilla, and abdomen were carried out to release the breast when tethered by their contractures.

Results

Considerable improvement and reasonable symmetry were achieved in most cases. All patients were satisfied with the results, tolerated the need for multiple procedures, and accepted residual minor asymmetries.

Conclusions

A post-burn breast deformity has a complex nature that may be addressed on multiple stages with different techniques of mastopexy, augmentation, and reconstruction. Ancillary procedures to a contracted adjacent territory may be needed to release the breast if tethered. Adopting a structured reconstructive plan may help obtain reproducible constant results. Level of Evidence: Level IV, therapeutic study.     

Relationship of regular physical activity with neuroelectric indices of interference processing in young adults

The relationship of physical activity with interference processing was examined using behavioral and neuroelectrical measures in young adults divided into more active and less active groups. The participants completed Stroop (i.e., color-naming) and reverse Stroop (i.e., word-meaning) tasks that differed in the level of difficulty while event-related potentials were assessed. In the low interference Stroop task, participants were asked to respond to the ink color of the word, while the meaning was either congruent or incongruent with the color. In the high interference reverse Stroop task, participants had to indicate the meaning of colored words while ignoring the color of the font. The results indicated that young adults in the more active group exhibited a shorter response time (RT) and a lower intra-individual variability of RT than did those in the less active group. These behavioral differences were associated with larger P2 and P3 and smaller N450 amplitudes in the Stroop task and with larger P2 and N2 and smaller N450 amplitudes in the reverse Stroop task. No differences were observed in the contingent negative variation (CNV) between the groups. These findings suggest that, for young adults, regular physical activity is positively associated with a better neural efficiency in resource allocation for tasks that require the ability to inhibit cognitive interference and provide evidence for the potential neural mechanisms underlying the improved Stroop performance.