Minimal-incision total shoulder arthroplasty: a cadaveric study

Traditional exposure for total shoulder arthroplasty (TSA) is a deltopectoral incision of approximately 17 cm. Recent literature suggests that minimally invasive surgery for knee and hip arthroplasties may be successful in reducing perioperative morbidity and improving patient satisfaction. In the study reported here, we evaluated a minimal-incision approach to TSA. Using 10 fresh-frozen cadaveric shoulders, we performed TSAs through a 6-cm incision originating at the center of the coracoid process and extending distally along the deltopectoral interval. Soft-tissue releases, humeral osteotomy, and glenoid resurfacing were performed in all 10 cadaver shoulders using standard TSA retractors and guides. No skin or soft-tissue complications were observed. We conclude that it is technically possible to perform TSA through an appropriately placed minimal (6-cm) incision.     

Potential options to optimize therapy of gastroesophageal reflux disease with proton pump inhibitors

Proton pump inhibitors (PPIs) are antisecretory agents that are widely used in the short- and long-term management of gastroesophageal reflux disease (GERD) to relieve symptoms, heal esophagitis, and prevent complications, such as strictures and Barrett's esophagus. The total healthcare costs of GERD are high, especially for maintenance treatment. Therefore, the choice of cost-effective therapeutic options is an ineluctable challenge for public health authorities, third-party payers, and patients. In some European Union countries, a recent trend of public health authorities is to promote the choice of less expensive PPIs, regardless of their antisecretory potency--this in spite of the evidence that newer PPIs provide superior symptom relief and esophageal erosion healing compared to earlier drugs. Several large clinical trials have demonstrated the superiority of esomeprazole over other PPIs at standard doses for both initial and continuous maintenance therapy in patients with moderate/severe erosive esophagitis. The non-erosive GERD poses a major challenge as this condition appears more frequently to be less responsive to PPIs. The use of PPIs with the strongest antisecretory properties might reveal to be more adequate and cost-effective, particularly for this indication.     

Smoking during pregnancy: a risk factor for peripheral neuropathy?

Studies dealing with the outcomes of developmental carbon monoxide (CO) exposure on myelination in rat offspring are reviewed. Prenatal CO exposure from gestational day 0 to gestational day 20 impairs myelin deposition around peripheral axons resulting in a significant hypomyelination in juvenile and adult rats. Myelin protein patterns analyzed by SDS-polyacrylamide gel electrophoresis and lipid patterns analyzed by the HPTLC method are not altered in both peripheral and central nervous systems of CO-exposed offspring. Interestingly, when sphingomyelin is extracted and purified, the derivatization by OPA reagent and analysis by reversed-phase HPLC reveal a significant increase in sphingosine levels in peripheral nervous system but not in central nervous system of CO-exposed rats. The above morphological and biochemical alterations are not accompanied by motor disabilities.     

Prevalence of Erectile Dysfunction in Systolic Heart Failure Patients in a Developing Country: Tbilisi,Georgia, Eastern Europe

IntroductionIn the past decade, there has been an increasing amount of published information regarding erectile dysfunction (ED) and heart failure (HF) in economically advanced, westernized populations. However, there is a paucity of data regarding ED and HF in developing countries. The country of Georgia is categorized as a lower-middle-income country (LMIC) with an emerging and developing economy.AimTo examine the prevalence of ED in patients with HF from a developing and LMIC and assess the association with depression.MethodsWe conducted an observational, cross-sectional study that included male patients 18 years of age or older with an ejection fraction ≤40% by echocardiogram in a heart failure disease management program in Tbilisi, Georgia. The Sexual Health Inventory for Men (SHIM) survey was used to categorize men according to degree of ED. Baseline clinical characteristics known to be associated with ED, such as New York Heart Association functional classification, were also documented.Main Outcome MeasuresThe SHIM survey and the nine-question Patient Health Questionnaire.ResultsThe prevalence of ED was found to be 61.7%. Patients with ED were generally older, had more peripheral vascular disease, and had greater levels of depression than those without ED.ConclusionsThere is a high prevalence of ED in patients with HF living in Tbilisi, Georgia. In comparison to previously published data on HF populations, our Georgian population showed lesser degrees of ED. More research is needed to better explain the causality for lower prevalence of ED, but explanations may include lower degrees of diabetes and aspects of treatment such as beta-blocker medication. Health care providers in LMICs should screen all of their male HF patients for ED and provide appropriate therapy. Hebert K, Anand J, Trahan P, Delgado M, Greene J, Julian E, Cuomo J, Gogichaishvili I, Nozadze N, Dias A, and Arcement L. Prevalence of erectile dysfunction in systolic heart failure patients in a developing country: Tbilisi, Georgia, Eastern Europe.