Total Patellar Skin Loss From Cryotherapy After Total Knee Arthroplasty

The use of cryotherapy after total knee arthroplasty is a very common therapeutic adjunct accepted as routine postoperative care. We present 2 cases of total patellar skin loss due to cryotherapy after total knee arthroplasty. Substantial soft tissue defects were created after the initial debridement of the necrotic tissue. Both patients were evaluated for frostbite, and the wounds were sharply debrided. Application of an advanced wound management technique involves the use of a collagen-glycosaminoglycan biodegradable bilayer matrix, silver impregnated antimicrobial dressing, and low-pressure vacuum device, followed by delayed split thickness skin grafting and low-pressure vacuum device. We find that this technique provided durable soft tissue coverage for necrotic wounds of the knee that do not involve the joint capsule.     

Spasticity,weakness, force variability,and sustained spontaneous motor unit discharges of resting spastic–paretic biceps brachii muscles in chronic stroke

Introduction: The purpose of our study was to examine relations among spasticity, weakness, force variability, and sustained spontaneous motor unit discharges in spastic–paretic biceps brachii muscles in chronic stroke. Methods: Ten chronic stroke subjects produced submaximal isometric elbow flexion force on impaired and non‐impaired sides. Intramuscular EMG (iEMG) was recorded from biceps and triceps brachii muscles. Results: We observed sustained spontaneous motor unit discharges in resting biceps on iEMG. Spontaneous discharges increased after voluntary activation only on the impaired side. The impaired side had greater matching errors and greater fluctuations in isometric force. Spontaneous discharges were not related functionally to spasticity, force variability, or weakness. However, greater strength on the impaired side correlated with less force variability. Conclusion: Weakness rather than spasticity is a main factor interfering with voluntary force control in paretic–spastic biceps brachii muscles in chronic stroke. Muscle Nerve, 2013     

Adverse Tumor Biology Associated with Mesenterico-Portal Vein Resection Influences Survival in Patients with Pancreatic Ductal Adenocarcinoma

Background

Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial.

Patients and Methods

Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD?VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed.

Results

Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD?VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD?VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD?VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival.

Conclusions

PD with VR has similar morbidity but worse OS compared with a PD?VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.     

Three-dimensional echocardiography of mitral Barlow's disease with infective endocarditis: Perforations or cleft-like indentations?

Barlow's disease is a complicated form of degenerative mitral valve (MV) disease. Infective endocarditis (IE) often occurs on the basis of primary heart diseases and may be combined with valve perforations. Cleft-like indentations (CLIs) were suggested by Ring et al. in 2013. They are located at the inter-scallop position and involve at least one-half of the valve. Herein, we report a case of Barlow's disease combined with IE and CLIs, which was confirmed intra-operatively and by histopathological examination. The CLIs were misdiagnosed by two-dimensional transthoracic echocardiography as perforations, but rightly interpreted by preoperative three-dimensional echocardiography. The possibility of CLIs should be considered in the evaluation of mitral regurgitation caused by myxomatous MV diseases.