Evaluation of potential salivary acetaldehyde production from ethanol in oral cancer patients and healthy subjects.

BACKGROUND: Acetaldehyde has been implicated as a major factor in oral carcinogenesis associated with alcohol consumption. In this study, saliva samples from oral cancer patients and healthy individuals were incubated in vitro with ethanol in order to investigate factors which can influence salivary acetaldehyde production. MATERIALS AND METHODS: A total of 66 individuals (40 males and 26 females, mean age 52 years) participated in the study. Participants were classified into three groups: Group 1 (oral cancer patients [n = 20]); Group 2 (poor dental health status [n = 25]) and Group 3 (good dental health status [n=21]). Every patient chewed a 1g piece of paraffin chewing gum for 1 minute then saliva samples were collected from all individuals. After in vitro incubation of the samples with ethanol, the levels of salivary acetaldehyde production was measured by head space gas chromatography. Kruskal-Wallis and Mann-Whitney tests and Spearman's Correlations analysis were performed for statistical analyses. RESULTS: The salivary acetaldehyde production was significantly higher (p <0.0001) in both group 1 and group 2 when compared to group 3. However, there was no significant difference between group 1 and group 2. Poor dental health status, infrequent oral hygiene habits and dental visits, smoking and presence of a dental prosthesis were significant parameters for increased levels of salivary acetaldehyde production from alcohol. The evaluation of salivary acetaldehyde production after in vitro incubation with ethanol may be useful for early detection of oral cancer. CONCLUSION: According to the results of this study, the significantly higher levels of salivary acetaldehyde production in oral cancer patients and individuals with poor dental health status may suggest a possible link between increased salivary acetaldehyde production and oral cancer. Improved oral hygiene can effectively decrease the level of salivary acetaldehyde production in oral cavity. Hippokratia 2014; 18 (3): 269-274.

Soft tissue changes during distraction osteogenesis.

This study aimed to investigate soft tissue changes in distraction osteogenesis depending on various distraction and consolidation periods. Fifteen male rabbits were divided into three groups and evaluated for five parameters. An external custom-made device was placed on the right side of the mandible. The postoperative latent period was 4 days. The groups were distracted for different periods (6 days, 3mm; 11 days, 5.5mm, 16 days, 8mm). For histomorphometric analyses, specimens were retrieved from both study and control sides of the mandible and were examined with light microscopy. The number of muscle fibres and nuclei on the study side increase proportionally with the distraction period. Regeneration in the first group continued in its natural pattern; in the second group, there seemed to be degeneration rather than regeneration; and in the third group there seemed to be a balance between regeneration and degeneration processes. In conclusion, when a massive amount of bone is to be obtained, instead of distracting the bone at once, it is thought to give better results if the total amount of distraction is divided into several time periods.

Evaluation of hormonal change, biochemical parameters, and histopathological status of uterus in rats exposed to 50-Hz electromagnetic field.

This study investigates the effects of the electromagnetic field (EMF) resulting from the 170 kV high-voltage power lines on hormonal status, on progesterone and 17-beta estradiol levels, and on morphology of the uterus and ovaries associated with biochemical parameters of adult Wistar female rats. The rats were assigned to experimental (21) and control groups (7). The rats in the experimental group were housed in a wooden barn with 7.5 m vertical distance to the power line. Groups 1, 2, and 3 were exposed continuously (24 h) to electric-electromagnetic fields (ELF-EMFs) (48.21 +/- 1.58 mG) for 1, 2, and 3 months, respectively. The rats of group 4 served as the control and were placed in laboratory conditions (The average value of the ELF was 0.75 +/- 0.05 V/m. The value of the EMF was calculated to be 0.48 +/- 0.05 mG.). Significant (P < 0.05) decreases were determined among the groups in terms of reproductive organ weights (uterus and ovaries) and progesterone and estrogen levels in relation to the varying periods of the estrous cycle. Although marked reductions (P < 0.05) were observed among the groups in relation to plasma catalase activity, depending on exposure time, no significant differences were found in terms of glutathione and malondialdehyde levels. It is concluded that exposure to the ELF-EMFs for different time periods produced significant decreases in plasma catalase activities in the 3-month exposure groups but no effects on progesterone level, on 17-beta estradiol level, or on the morphology and weight of uterus and ovaries.

Hepatic toxocariasis: US, CT and MRI findings.

Visceral larva migrans (VLM) most commonly occurs as a febrile disease of childhood particularly affecting children between 1 and 7 years of age. Pulmonary, dermatological, hepatic, lymphatic, cardiac, rheumatological and neurological manifestations may occur. VLM seems to be a rare disease in adults. We report the imaging findings of a woman with hepatic toxocariasis. Ultrasonography showed a solitary hepatic lesion measuring 4 x 3 cm, displaying a hypoechoic-heterogeneous pattern with ill-defined borders and distal acoustic enhancement, located in the right sub-diaphragmatic area. Two enlarged periportal lymph nodes and moderately dilated intrahepatic biliary ducts were also noted. The probability of toxocariasis was discussed, based on sonographic and biopsy findings, and the final diagnosis was confirmed by a specific ELISA test. In summary, a clinical picture of cholestasis initially resembling hepatitis or malignancy should be further evaluated by imaging techniques, and the ultrasound examiner should be familiar with the possible findings of hepatic toxocariasis, which consist of focal ill-defined hepatic lesions, hepato-splenomegaly, biliary dilatation, sludge and periportal lymph node enlargement.

The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey.

The aim of this cross-sectional study was to estimate the prevalence and risk factors of symptomatic knee and distal interphalangeal (DIP) joint osteoarthritis (OA) in the elderly (> or =50 years of age) urban population of Antalya, Turkey. According to the 1997 national census, Antalya's population was 508,840. By random cluster sampling, 655 individuals aged 50 years or more were interviewed face-to-face and subjected to structured interviews regarding knee pain, worsening pain on exertion, and the gelling phenomenon. They were also asked about performing namaz (a fundamental act of worship in Islam performed five times a day), smoking, type of residence, type of toilet, work style, and duration of walking per day. They were also questioned about swelling in DIP joints. In the case of suspicion of knee OA, the individuals were invited to the hospital for further evaluation by physical examination and direct roentgenogram. The diagnosis of knee OA was based on clinical or clinical and radiographic findings. The prevalence of symptomatic knee OA was determined as 14.8% in the population aged 50 years or over. Advanced age, female sex, namaz, and type of residence were found to be associated with knee OA. The rate of symptomatic knee OA was significantly lower in smokers and those walking more than 2 h per day. Female sex was also strongly associated with OA DIP joints. OA of DIP joints was found significantly associated with symptomatic knee OA. The latter is a major health problem in the elderly population, especially in about one fourth of women aged 50 years or over. These data suggest that advanced age, female sex, and type of residence are risk factors.

Use of cauda epididymis extract as immunocontraceptive.

The objective of this study was to evaluate use of a cauda epididymis extract (CEE) as an immunocontraceptive in rats. Twenty-two rats in puberty or 19 rats that gave birth once (primipara) were immunized with intraperitoneal (IP) injection of CEE. Rats in puberty received one or two injections of CEE containing 1.5 x 10(9) sperm/mL, while primipara rats received injections of CEE containing 3 x 10(6) sperm/mL up to three times. Animals were tested for the presence and concentration of anti-CEE antibody by enzyme-linked immunosorbent assay (ELISA) and monitored for pregnancy following natural insemination. Results revealed that 38 (92.6%) of the 41 rats were positive for anti-CEE antibodies, regardless of animal type or immunization procedure. However, there was no relation between pregnancy rates and concentration of anti-CEE antibody in rats immunized with CEE. These results indicate that immune response against CEE may not play a major role in contraception in rats.

Regional lidocaine infusion reduces postischemic spinal cord injury in rabbits.

Paraplegia secondary to spinal cord ischemia is a devastating complication in operations on the descending and thoracoabdominal aorta. We hypothesized that the tolerance of the spinal cord to an ischemic insult could be improved by means of regional administration of lidocaine. Thirty-one New Zealand white rabbits were anesthetized and spinal cord ischemia was induced by the placement of clamps both below the left renal vein and above the aortic bifurcation. The animals were divided into 5 groups. Aortic occlusion time was 20 minutes in Group 1 and 30 minutes in all other groups. Groups 1 and 2 functioned as controls. Lidocaine (Group 5) or normal saline solution (Group 3) was infused into the isolated aortic segment after cross-clamping. Group 4 animals received 20% mannitol regionally, before and after reperfusion. Postoperatively, rabbits were classified as either neurologically normal or injured (paralyzed or paretic). Among controls, 20 minutes of aortic occlusion did not produce any neurologic deficit (Group 1: 0/4 injured), while 30 minutes of occlusion resulted in more consistent injury (Group 2: 6/8 injured). Animals that received normal saline (Group 3) or mannitol (Group 4) regionally showed 80% neurologic injury (4/5). Animals treated with the regional lidocaine infusion (Group 5) showed much better neurologic outcomes (7/9 normal: 78%). This superiority of Group 5 over Groups 2, 3, and 4 was significant (P <0.02). We conclude that regional administration of lidocaine reduced neurologic injury secondary to spinal cord ischemia and reperfusion after aortic occlusion in the rabbit model.

Color Doppler imaging of the orbital vessels in Behçet's disease.

OBJECTIVE: To investigate blood flow velocity changes, pulsatility and resistivity index values of orbital vessels in Behçet's disease with or without ocular involvement (groups I and II) and healthy volunteers (group III). METHODS: Twenty-five eyes in the first group, 24 eyes in the second group and 24 eyes in the third group were examined by using color Doppler imaging. Peak systolic and end-diastolic blood flow velocity measurements, pulsatility and resistivity index values were measured in ophthalmic, central retinal, nasal and temporal ciliary arteries and the central retinal vein. RESULTS: The end-diastolic blood flow velocity measurements in all arteries were significantly higher in groups II and III than in group I, but resistivity and pulsatility indexes of all arteries were higher in group I than the other two groups. There was no significant difference in blood flow velocity of the central retinal vein in the three groups. CONCLUSION: Detection of increased vascular resistance of orbital vessels may predict the diagnosis of ocular involvement in Behçet's disease.

Cerebral perfusion through separate grafts for repair of acute aortic dissection with torn arch.

We have modified the technique of cerebral perfusion through anastomosed grafts for repair of acute arch dissections that require total arch replacement. We have performed this operation on a 71-year-old man with an acute type-A dissection and an arch tear between the orifices of the brachiocephalic arteries. We used 2 separate grafts for the brachiocephalic arteries and minimized brain ischemia by initiating antegrade selective cerebral perfusion after the 1st anastomosis. The patient had an excellent outcome. This method is simple and provides effective protection. Cerebral ischemic time can be kept under 30 minutes without need of a sophisticated pump setup or a multibranched graft. This affords extra time in case the surgeon encounters an unexpected lesion in the arch.

[Myocardial protection during coronary artery bypass surgery while off-pump]. / Pompasiz yapilan koroner arter cerrahisinde miyokardiyal koruma.

Myocardial protection during off-pump coronary artery bypass surgery (OPCAB) is a multifactorial problem and choice of graft sequence, maintenance of stable systemic hemodynamics are of central importance. New devices for atraumatic stabilization of the heart and visualization of coronary anastomoses allow grafting of all coronary arteries without cardiopulmonary bypass. Perfusion-assisted direct coronary artery bypass (PADCAB) techniques, in which coronary perfusion is independent of systemic arterial pressure, can eliminate unstable hemodynamic and improve myocardial protection during complex, multivessel OPCAB.

Results of immediate surgical treatment of all acute type A dissections.

BACKGROUND: Surgery for acute type A aortic dissection is associated with a high mortality rate and incidence of postoperative complications. This study was designed to explore perioperative risk factors for death in patients with acute type A aortic dissection. METHODS AND RESULTS: One hundred twenty-four consecutive patients with acute type A aortic dissection between 1984 and 1998 were reviewed. All underwent operation with resection of the intimal tear and open distal anastomosis: 107 patients had surgery within 24 hours and 17 patients had surgery within 72 hours of symptom onset. Median age was 62 years (23 to 89); 89 were men. Forty-three patients had ascending aortic replacement only, 72 had hemiarch repair, in 2 the entire arch was replaced, and in 7 replacement included the proximal descending aorta. The aortic valve was replaced in 54 patients, resuspended in 52, and untouched in 18. Hospital mortality rate was 15.3% (19 of 124): of these, 3 patients died during surgery, 4 had fatal rupture of the distal aorta before discharge, and 2 died of malperfusion-related complications. Multivariate analysis revealed age >60, hemodynamic compromise, and absence of hypertension as preoperative indicators of hospital death (P:<0.05); the presence of new neurological symptoms was a significant preoperative risk factor in univariate analysis. Ominous intraoperative factors included contained hematoma and a comparatively low esophageal temperature but not cerebral ischemic time (mean 32 minutes). The site of the intimal tear did not influence outcome, but mortality rate was higher with more extensive resection: 43% with resection including the descending aorta died versus 14% with only ascending aorta or hemiarch replacement. Overall 5- and 10-year survival was 71% and 54%, respectively; among discharged patients (median follow-up 41 months) survival was 84% and 64% versus expected US survival of 92% and 79%. CONCLUSIONS: Immediate surgical treatment of all acute type A dissections with resection of the intimal tear and use of hypothermic circulatory arrest for distal anastomosis results in acceptable early mortality rates and excellent long-term survival.

Fascioliasis: US, CT, and MRI findings with new observations.

BACKGROUND: The purpose of this study is to describe the ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings in fascioliasis and to emphasize the impact of radiology in diagnosis. METHODS: Radiologic findings in 23 consecutive patients with fascioliasis were prospectively recorded. All patients had at least one US and CT examination, and 10 of them were studied by MRI. All diagnoses were confirmed by serologic methods. In the first three cases, initial diagnosis was reached by microscopic demonstration of the parasites' eggs in bile obtained by US-guided gallbladder aspiration. RESULTS: In the hepatic phase of fascioliasis, multiple, confluent, linear, tractlike, hypodense, nonenhancing hepatic lesions were detected by CT. On US, the parasites could be clearly identified in the gallbladder or common bile duct as floating and nonshadowing echogenic particles. MRI showed the lesions as hypo- or isointense on T1-weighted images and as hyperintense on T2-weighted images. CONCLUSIONS: CT findings in the hepatic phase and US findings in the biliary phase are characteristic of fascioliasis. Because clinical and laboratory findings of fascioliasis may easily be confused with several diseases, radiologists should be familiar with the specific radiologic findings of the disease to shorten the usual long-lasting diagnostic process.

Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children.

To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3-6 months after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96% alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5-15 min. Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean 15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared. Volumes of the 11 cysts in five patients who were followed for 6-21 months were markedly reduced (22%-64% of the initial volume) and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children.

Predictors of adverse outcome and transient neurological dysfunction after ascending aorta/hemiarch replacement.

BACKGROUND: This study was undertaken to determine predictors of adverse outcome and transient neurological dysfunction after replacement of the ascending aorta with an open distal anastomosis. METHODS: All 443 patients (300 male, median age 63) undergoing replacement of the ascending aorta with an open distal anastomosis between 1986 and 1998 were included in the analysis. The ascending aorta alone was replaced in 190 (42.9%); 253 (57.1%) also had proximal arch replacement. Median hypothermic circulatory arrest (HCA) time was 25 minutes (range 12 to 68). Either death or permanent neurological dysfunction were considered adverse outcome (AO). RESULTS: Adverse outcome occurred in 11.5% (51 of 443) of patients overall: in 7.4% of elective (20 of 269) or urgent (4 of 54) operations, but in 17% (19 of 113) of emergencies. Multivariate analysis of the group as a whole revealed that significant (p < 0.05) independent preoperative predictors of AO were age greater than 60 [odds ratio (OR) 2.2], hemodynamic instability (OR 2.7), and dissection (OR 1.9). For the 435 operative survivors, procedural variables predictive of AO were contained rupture (OR 2.8) and HCA time (OR 1.03/min). When only the 271 elective patients were analyzed separately, the need for a concomitant procedure (p = 0.009, OR 3.6) and HCA time (p = 0.002, OR 1.06/min) were the only predictors of AO in multivariate analysis. Transient neurological dysfunction (TND) occurred in 86 of 392 patients (22%). Significant predictors of TND for all patients without AO were age (OR 1.06/y), HCA time (OR 1.04/min), coronary artery disease (OR 2.2), hemodynamic instability (OR 3.4), and acute operation (OR 2.2). Survival of discharged patients was 93% at 1 year and 83% at 5 years. CONCLUSIONS: Early elective operation and shorter HCA time during ascending aorta/hemiarch surgery will reduce both AO and TND.

Surgical techniques. Aortic arch and deep hypothermic circulatory arrest: real-life suspended animation.

Surgical reconstruction of the aortic arch is a complex procedure requiring careful preoperative analysis of the pathology and forethought toward surgical approach. Development of surgical techniques has brought dramatic improvement survival and reduction of neurological events associated with these procedures, yet significant morbidity is still encountered. New approaches to the patient with these pathologies include antegrade and retrograde perfusions to the brain. Continued research into physiology of hypothermic circulatory arrest offers the promise of pharmacological protection of the brain during aortic reconstruction and potentially development of therapeutic modalities to treat and limit ischemic brain damage.

Surgical treatment of the dilated ascending aorta: when and how?

BACKGROUND: The aorta is considered pathologically dilated if the diameters of the ascending aorta and the aortic root exceed the norms for a given age and body size. A 50% increase over the normal diameter is considered aneurysmal dilatation. Such dilatation of the ascending aorta frequently leads to significant aortic valvular insufficiency, even in the presence of an otherwise normal valve. The dilated or aneurysmal ascending aorta is at risk for spontaneous rupture or dissection. The magnitude of this risk is closely related to the size of the aorta and the underlying pathology of the aortic wall. The occurrence of rupture or dissection adversely alters natural history and survival even after successful emergency surgical treatment. METHODS: In recommending elective surgery for the dilated ascending aorta, the patient's age, the relative size of the aorta, the structure and function of the aortic valve, and the pathology of the aortic wall have to be considered. The indications for replacement of the ascending aorta in patients with Marfan's syndrome, acute dissection, intramural hematoma, and endocarditis with annular destruction are supported by solid clinical information. Surgical guidelines for intervening in degenerative dilatation of the ascending aorta, however, especially when its discovery is incidental to other cardiac operations, remain mostly empiric because of lack of natural history studies. The association of a bicuspid aortic valve with ascending aortic dilatation requires special attention. RESULTS: There are a number of current techniques for surgical restoration of the functional and anatomical integrity of the aortic root. The choice of procedure is influenced by careful consideration of multiple factors, such as the patient's age and anticipated survival time; underlying aortic pathology; anatomical considerations related to the aortic valve leaflets, annulus, sinuses, and the sino-tubular ridge; the condition of the distal aorta; the likelihood of future distal operation; the risk of anticoagulation; and, of course, the surgeon's experience with the technique. Currently, elective root replacement with an appropriately chosen technique should not carry an operative risk much higher than that of routine aortic valve replacement. Composite replacement of the aortic valve and the ascending aorta, as originally described by Bentall, DeBono and Edwards (classic Bentall), or modified by Kouchoukos (button Bentall), remains the most versatile and widely applied method. Since 1989, the button modification of the Bentall procedure has been used in 250 patients at Mount Sinai Medical Center, with a hospital mortality of 4% and excellent long-term survival. In this group, age was the only predictor of operative risk (age > 60 years, mortality 7.3% [9/124] compared with age < 60, mortality 0.8% [1/126], p = 0.02). CONCLUSIONS: This modification of the Bentall procedure has set a standard for evaluating the more recently introduced methods of aortic root repair.

Temporary neurological dysfunction after deep hypothermic circulatory arrest: a clinical marker of long-term functional deficit.

BACKGROUND: With increasing clinical experience, it has become clear that two distinct forms of neurological injury occur after operations on the thoracic aorta that require temporary exclusion of the cerebral circulation. Traditionally, evaluation of neurological outcome was limited to reporting the incidence of postoperative stroke related to ischemic infarcts due to particulate embolization. More recently, the symptom complex defined as "temporary neurological dysfunction" (TND) was recognized as a functional manifestation of subtle and presumably transient brain injury, but whether this early postoperative syndrome is associated with long-term deficits of cognitive and intellectual functions has not been established. METHODS: With Institution Review Board approval, 105 patients undergoing elective thoracic aortic surgery were entered into a protocol involving neuropsychological evaluation with a battery of tests preoperatively, and 1 and 6 weeks postoperatively. Patients who could not be tested adequately or had documented strokes were eliminated from final analysis. Seventy-one patients completed the neuropsychological evaluation, which consisted of eight tests consolidated into five domains: attention, cognitive speed, memory, executive function, and fine motor function. Independent observers also determined whether temporary dysfunction was present, and graded its severity based on a fixed but subjective clinical scale, ranging from simple disorientation and lethargy or confusion (grade 1-2) to prolonged extreme agitation or psychotic behavior requiring treatment with psychotropic drugs (grade 3-5). Data were normalized to baseline values, and were analyzed using analysis of variance, analysis of covariance (ANCOVA), and chi2 as necessary. RESULTS: A previous analysis had shown that patients who could not be tested or had poor scores 1 week postoperatively were more likely to perform poorly at 6 weeks (odds ratio 5.27, p < 0.01). In the current study, in order to determine the clinical relevance of TND, patients were analyzed retrospectively according to their performance in neuropsychological testing: patients with no change or a decline of less than 50% in tests of memory, motor function, and attention 1 week postoperatively (group 1, n = 49) were compared with those with a negative change exceeding 50% in the same functions at 1 week (group 2, n = 22). The overall incidence of TND was 28.1% (20/71). The incidence of TND in group 2 (14/22, 63%) was significantly higher than in group 1 (6/49, 12%; p = 0.0006). Similarly, the severity of TND (as assessed by clinical score > 2) was also significantly higher in group 2 (11/14) compared with group 1 (0/6; p = 0.006.) CONCLUSIONS: The incidence and severity of clinically apparent temporary neurological dysfunction correlates significantly with poor performance on neuropsychological tests 1 week postoperatively. Such poor performance predicts continued deficits in memory and motor function at 6 weeks. Thus, TND may not be a benign self-limited condition as previously supposed, but rather a clinical marker for insidious but significant neurological injury associated with measurable long-term deficits in cerebral function. A concerted effort to reduce the incidence of this complication is therefore necessary.

Sonographically detected subacromial/subdeltoid bursal effusion and biceps tendon sheath fluid: reliable signs of rotator cuff tear?

PURPOSE: Our purpose was to determine the association between sonographically detected subacromial/subdeltoid (SA/SD) bursal and biceps tendon sheath effusions and arthrographically proven rotator cuff tears. METHODS: Shoulder sonography reports and sonograms of 105 shoulders in 102 patients who also underwent arthrography were retrospectively reviewed for the presence of fluid within the biceps tendon sheath and SA/SD bursa. Reports and sonograms for 151 asymptomatic shoulders were also reviewed. RESULTS: Biceps tendon sheath effusion and/or bursal fluid were detected in 50 (48%) of 105 shoulders. Fifty-one patients had rotator cuff tears; 28 of them had effusions at 1 or both sites. The sensitivity, specificity, and positive predictive value (PPV) of biceps tendon sheath effusions for diagnosing rotator cuff tear were 35%, 74%, and 56%, respectively. For SA/SD bursal effusions, the sensitivity, specificity, and PPV were 8%, 94%, and 57%, respectively. For combined biceps tendon sheath and bursal effusions, the sensitivity, specificity, and PPV were 12%, 91%, and 54%, respectively. There was no statistically significant association between rotator cuff tears and effusions in the biceps tendon sheath, SA/SD bursa, or both. Among the 151 asymptomatic shoulders, 12 (7.9%) had biceps tendon sheath fluid, 5 (3.3%) had SA/SD bursal effusion, and 2 (1.3%) had both biceps tendon sheath and bursal effusions. CONCLUSIONS: The sonographic detection of intraarticular fluid, SA/SD bursal fluid, or both has a low sensitivity and PPV in the diagnosis of rotator cuff tears. Isolated intra-articular and/or SA/SD bursal effusions are not reliable signs of rotator cuff tear.