Despite advances in surgical techniques, 20% to 90% of rotator cuff (RTC) repairs fail. They tend to fail at the suture-tendon junction due to tension at the repair and gap formation prior to healing. This study evaluated the gap formation and ultimate tensile failure loads of a RTC repair with a decellularized human dermal allograft. Augmentation of a RTC repair with an extracellular matrix graft decreased gap formation and increased load to failure in a human RTC repair model. [ Orthopedics. 2014; 37(9):608–614.]
Groin pain is often related to hip pathology. As a result, groin pain is a clinical complaint encountered by orthopaedic surgeons. Approximately one in four persons will develop symptomatic hip arthritis before age 85 years. Groin injuries account for approximately 1 in 20 athletic injuries, and groin pain accounts for 1 in 10 patient visits to sports medicine centers. Many athletes with chronic groin pain have multiple coexisting pathologies spanning several disciplines. In treating these patients, the orthopaedic surgeon must consider both musculoskeletal groin disorders and nonorthopaedic conditions that can present as groin pain. A comprehensive history and physical examination can guide the evaluation of groin pain.
Groin pain is often related to hip pathology. As a result, groin pain is a clinical complaint encountered by orthopaedic surgeons. Approximately one in four persons will develop symptomatic hip arthritis before age 85 years. Groin injuries account for approximately 1 in 20 athletic injuries, and groin pain accounts for 1 in 10 patient visits to sports medicine centers. Many athletes with chronic groin pain have multiple coexisting pathologies spanning several disciplines. In treating these patients, the orthopaedic surgeon must consider both musculoskeletal groin disorders and nonorthopaedic conditions that can present as groin pain. A comprehensive history and physical examination can guide the evaluation of groin pain.
Total dislocation of the talonavicular joint is rare. Detection of a major tarsal bone extrusion is simple. However, its management and treatment are not. We present a case of a total extrusion of the talus and navicular of an open dislocation and the reconstruction options that subsequently followed. In spite of a well-perfused foot, our patient decided to undergo a below the knee amputation after an infection.
Selexipag, a selective prostacyclin receptor agonist, is approved for treating pulmonary arterial hypertension in WHO Group 1 adult patients. Compared to parenteral prostacyclin formulations, selexipag offers a significant improvement in patient’s and caregiver’s quality of life because of its oral formulation, frequency of administration, and mechanism of action. Although experience in the pediatric population is limited and selexipag is not FDA-approved for use in the pediatric pulmonary hypertension population, many US pediatric centers are expanding the use of this therapy to this younger population. We report our institution's experience in the use of selexipag to treat pulmonary hypertension in children under 10 years of age, between 10 and 30 kg. Seven patients were initiated on selexipag therapy including de novo initiation and transition from intravenous treprostinil to oral selexipag. All patients were on stable background therapy with phosphodiesterase-5 inhibitor and endothelin receptor antagonist therapies at baseline. All patients reached their planned goal selexipag dose during admission without the need for changes to the titration schedule and without hemodynamic deterioration. In our experience, oral selexipag is safe and well-tolerated in young pediatric patients with pulmonary hypertension. Based on our favorable experience, we developed an institution-specific selexipag process algorithm for continued successful use in the pediatric population.
De Quervain tenosynovitis is a disorder of the tendons of the first dorsal compartment of the wrist that causes pain and functional disability, which may be refractory to conservative treatments. We present a case of ultrasound‐guided percutaneous needle tenotomy and platelet‐rich plasma injection for the successful treatment of de Quervain tenosynovitis.
Epitheliomesenchymal biphasic tumors of the stomach include carcinosarcomas and gastroblastomas. Carcinosarcomas are composed of high-grade, malignant epithelial and mesenchymal cells, occur in older patients, and have poor prognosis. Gastroblastomas are composed of mildly atypical spindle and epithelial cells, occur in children and young adults, and are primarily considered low-grade with good prognosis (one documented case with metastasis). A 57-year-old woman with …
Severe neurologic complications occur in 14-25% of allogeneic stem cell transplants (alloSCT), with metabolic encephalopathy and infections accounting for the majority of cases. Autopsy studies reveal neuropathological changes in 70-90% in post alloSCT patients. Multifocal necrotizing leukencephalopathy (MNL) is a rare pathologic entity predominantly affecting the brainstem. The etiology is unknown; however, it has been described in immunosuppressed patients including those with leukemia who have received intrathecal chemotherapy or CNS radiation. CASE: A 54 year old man with relapsed poor risk acute myeloid leukemia underwent a second myeloablative alloSCT from an unrelated donor after attaining a second complete remission. He was conditioned with fludarabine, busulfan and antithymocyte globulin; tacrolimus and methotrexate were graft versus host disease (GVHD) prophylaxis. Neutrophils engrafted on day +16. Patient had no history of CNS disease and had never received any intrathecal chemotherapy or radiotherapy. Immediate post-transplant course was complicated by CMV viremia treated with foscarnet as well as grade 1 GVHD of the gastrointestinal tract treated with budesonide. He developed acute onset of tinnitus and vertigo at day +44. MRI of brain showed T2 hyperintensity involving the medulla and pons, suggestive of a demyelinating process. He was switched from tacrolimus to sirolimus for concern of reversible posterior leukoencephalopathy. Cerebrospinal fluid revealed an elevated total protein (84 [15-45 mg/dl]) but cytology and infectious parameters (HSV1/2 , VZV, HHV6, JC virus, CMV, EBV and toxoplasma gondii) were negative. High dose methylprednisolone was started. Rapidly progressive neurological deterioration occurred, manifested as dysarthria, dysphagia, myoclonus and dyspnea requiring ventilatory support. Repeat imaging showed progression of T2/FLAIR hyperintensity into the midbrain and extending to involve the entire medulla down into the superior cervical spine. Patient died on day +62 due to respiratory failure. CNS histology at autopsy showed MNL with associated midbrain, pons, medulla and spinal cord axonal damage, but no evidence of encephalitis, meningitis, fungal, or parasitic infection. As previously reported, our case of MNL predominantly affected the brainstem. An extensive diagnostic evaluation did not reveal an underlying infectious etiology. Furthermore, this occurred in the absence of CNS radiation or intrathecal therapy for the leukemia. It is noteworthy that our patient developed MNL after a second myeloablative alloSCT, raising the possibility that the MNL in this case resulted from cumulative chemotoxicity. Further study into the etiology of MNL is warranted.
