Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

Purpose

To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears.

Materials and methods

Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery.

Results

Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively.

Conclusions

In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears.     

Transverse bronchoplasty of the membranous wall after resection of an endobronchial hamartoma

Lung hamartomas are rare benign tumors of the bronchi. Their management consists of bronchoscopic excision or removal through a thoracotomy and bronchotomy whenever there is a large tumor totally obstructing the bronchial lumen. As a lung-sparing procedure is usually the aim, various bronchoplastic techniques have been described, providing a functional lumen of the repaired bronchus. We describe a simple technique that can be safely undertaken to preserve a satisfactory diameter of the bronchus or trachea and prevent a stenosis at the site of repair.     

Prevention,diagnostic evaluation,management and prognostic implications of liver disease in critically ill patients with COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.     

Congenital left main coronary artery to coronary sinus fistula

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.     

Posterior capsule rupture and vitreous loss during phacoemulsification with or without the use of an anterior chamber maintainer

PURPOSE: To compare the incidence of posterior capsule rupture and vitreous loss during phacoemulsification with and without the use of an anterior chamber maintainer (ACM) SETTING: Aristotle University Eye Clinic, Thessaloniki, Greece. METHODS: The surgical records of patients who had phacoemulsification by experienced surgeons over a 2-year period were reviewed. The cases were divided into 2 groups: surgery performed without the use of an ACM (no-ACM group) and surgery performed with the use of an ACM (ACM group). RESULTS: The no-ACM group comprised 231 cases and the ACM group, 312 cases. Posterior capsule rupture occurred in 19 cases (8.22%) and 22 cases (7.05%), respectively. Of the patients with posterior capsule rupture, 6 (31.57%) in the no-ACM group and 16 (72.72%) in the ACM group had vitreous loss and required an anterior vitrectomy; the difference between the 2 groups was statistically significant (P =.03). CONCLUSIONS: The use of an ACM in phacoemulsification provided a consistently deep anterior chamber and approximately the same rate of complications as with a standard technique in the hands of experienced surgeons. However, when posterior capsule rupture occurred, the incidence of vitreous loss was significantly higher in eyes with an ACM.     

Evaluation of two vitallium blade-form implants retrieved after 13 to 21 years of function: a clinical report

This article describes the clinical, radiographic, and histologic evaluation of 2 immediately loaded Vitallium blade-form implants retrieved from the posterior maxilla of 2 patients after 21 and 13 years of function. Neither implant demonstrated mobility or signs of pathosis, and both appeared to have integrated well with surrounding bone. The hydroxyapatite coating of the second implant, which was retrieved after 13 years of function, showed no dissolution. These observations suggest that immediately loaded dental implants have the potential to achieve and maintain osseointegration and that hydroxyapatite coatings can resist degradation over long-term service.     

Perfluorocarbon liquid utilization in primary vitrectomy repair of retinal detachment with multiple breaks

PURPOSE: To evaluate the efficacy of pars plana vitrectomy in conjunction with intraoperative perfluoro-n-octane (PFO) use as initial treatment of retinal detachment (RD) with multiple breaks located at various distances from the ora serrata. METHODS: Twenty-two consecutive eyes (15 phakic, 2 aphakic, and 5 pseudophakic) presenting with RD with multiple breaks and tears underwent primary pars plana vitrectomy, PFO retinal reattachment, transcleral cryopexy or endolaser treatment of breaks, PFO/air exchange, and final injection of 18% perfluoropropane (C3F8). Scleral buckles were not used. The mean follow-up period was 29 months. RESULTS: Temporary PFO utilization attached the posterior retina and facilitated the safe removal of vitreous at its base and around the retinal tears. Intraoperative complications included new breaks (3 eyes), enlargement of breaks (2 eyes), and a small bubble of subretinal PFO (1 eye). Postoperatively, the retina remained attached during follow-up in 19 eyes. Cataract developed or progressed in 13 phakic eyes. CONCLUSIONS: Pars plana vitrectomy in conjunction with intraoperative PFO utilization is effective as initial treatment of RDs with multiple breaks. The main limitation of this technique is the postoperative progressive cataract formation in phakic eyes.