Pectoralis major rupture repair with Achilles tendon allograft in 22 bodybuilding athletes.

BACKGROUND: Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes. METHODS: In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up. RESULTS: All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1-182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P < 0.001). CONCLUSIONS: It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures. LEVEL OF EVIDENCE: Level IV.

Horizontal instability after acromioclavicular joint reduction using the two-hole technique is preferred over the loop technique: a single-blind randomized clinical trial.

BACKGROUND: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. METHODS: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. RESULTS: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. CONCLUSIONS: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

Can indirect magnetic resonance arthrography be a good alternative to magnetic resonance imaging in diagnosing glenoid labrum lesions?: a prospective study.

BACKGROUND: This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other. METHODS: This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form. RESULTS: Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were 77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%. CONCLUSIONS: Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.

Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey.

BACKGROUND: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. METHODS: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. RESULTS: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). CONCLUSIONS: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

Rotator cuff repair with or without proximal end detachment for long head of the biceps tendon tenodesis.

BACKGROUND: Rotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid. METHODS: This retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery. RESULTS: Groups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p<0.05) but were not significantly different between the two groups (p>0.05). No post-surgical complication was found in either group. CONCLUSIONS: There was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.

The impact of underlying diseases-related drugs on the chronic kidney disease-associated pruritus in hemodialysis patients.

Background: Uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP) is a frequent compromising symptom in end-stage renal disease. Despite the little attention paid to drugs used among hemodialysis (HD) patients, investigating medications used in this population of patients and examining the status of CKD-aP may lead to the identification of medications that improve or worsen the pruritus condition. We aimed to assess the role of underlying diseases-related drugs on CKD-aP in HD patients. Materials and Methods: We performed a case - control study on HD patients aged over 18 years old. The demographic data and clinical parameters including HD parameters, drug history, dermatologic assessments, and laboratory examination were assessed. Results: We compared 128 patients with CKD-aP as cases and 109 patients without CKD-aP as controls. Cases were on the longer course of dialysis (44.69 ± 43.24 months for cases vs. 38.87 ± 50.73 months for controls; P = 0.02). In multiple analyses of variables related to CKD-aP, backward LR logistic regression revealed that only atorvastatin (P = 0.036) was considered to be a predictive factor associated with CKD-aP. Thus, the use of atorvastatin reduced the index of CKD-aP (95% confidence interval: 0.256-0.954, odd's Ratio = 0.494). Conclusion: Atorvastatin was associated with decreased frequencies of CKD-aP among HD patients in our study. This knowledge may guide further clinical trials to evaluate atorvastatin's immunomodulatory and anti-inflammatory effects on the CKD-aP in HD populations.

Determination of the Association between Perceived Stigma and Delay in Help-Seeking Behavior of Women with Breast Cancer.

Background:One of the leading causes of death in patients with breast cancer is delays in help-seeking, which is influenced by various factors, including social factors such as cancer stigma. Objectives:This study aimed to determine the relationship between perceived stigma and delay in seeking help for women with breast cancer. Methods:In this cross-sectional study, 140 women with breast cancer referred to Besat Clinic in Rasht, Iran, were included. The data gathering tools included a demographic questionnaire, a cancer stigma questionnaire and a delay questionnaire completed through interviews with patients. Data analysis was performed using SPSS software V.21 and the descriptive and inferential statistics were performed using correlation coefficient, chi-square test, logistic regression, Mann-Whitney U-test, and Kruskal-Wallis test. Results:In this study, 72.1% of patients were aged between 39 and 57 years, with a mean age of 47.99±8.03 years; 34.3% and 16.4% of patients delayed seeking help between 30 and 90 days, and more than 90 days (with mean±SD of 75.35±165.19), respectively. Breast cancer stigma was present in 45% of patients. Delay in seeking help based on stigma was significant (P <0.001). Due to multiple logistic regression, the association between stigma and delayed relief was significant (P <0.01), so that in women suffering from breast cancer with stigma, the chance of delaying seeking help was 5.7 times (OR 5/706, Cl 95% 1.381-23.572) higher than women without stigma. Conclusion:Stigma may be a factor in delaying the screening of women with breast cancer. Therefore, it is recommended that the health care team considers stigma as one of the most important psychological aspects of breast cancer, which may have an impact on patients' delay in seeking help. It should also be considered in the process of diagnosis, treatment counseling, and patient follow-up.

Bilateral total knee arthroplasty: Simultaneous versus staging in the same or in twice hospitalization.

BACKGROUND AND OBJECTIVE: Arthroplasty is the main treatment in patients with advanced knee osteoarthritis. In bilateral lesions, it is frequently performed in two simultaneous or separate surgical procedures. In this regard, the present study aimed to compare the results of knee arthroplasty in two joints simultaneously at two different times. METHOD: In general, all 40-70 years old patients in need of complete bilateral total knee arthroplasty (BTKA) were enrolled in this descriptive cross-sectional study during 2009-2016. They were included in three groups of BTKA as simultaneously (n = 272), staging in the same hospitalization (146), and staging in different hospitalizations (245). To assess the quantitative and qualitative function of the knees, patients' knees were evaluated before the surgery, and one month, three months, and two years after the surgery using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Finally, hospitalization time, anesthesia duration, and medical costs were compared between the three groups. RESULTS: Based on the results, knee function improved based on WOMAC and KSS scales in all groups after arthroplasty although no significant differences were observed between the three groups. Patients' satisfaction in simultaneous BTKA was significantly higher compared to the other two groups (P = 0.013). Eventually, complications demonstrated no significant differences between the three groups except for pulmonary and cerebral embolism which were more prevalent in old patients with a high body mass index in the simultaneous BTKA group (P = 0.035 and P = 0.043, respectively). CONCLUSION: Overall, simultaneous BTKA is a useful approach for reducing costs while increasing patients' function and satisfaction although it has certain complications such as embolism in older overweight patients.

Return to sports activity in the revision of anterior cruciate ligament reconstruction: A 2-6 Year follow-up study.

INTRODUCTION: and Objective: The risk of an anterior cruciate ligament (ACL) injury in young patients and those with sports activity is increasing. Regarding the need of athletes with ACL re-rupture to return to sports, ACL revision surgery has received great importance. This study was conducted to evaluate the outcome of ACL reconstruction revision surgery in athletes. METHOD: In general, 62 patients with primary surgery and 62 patients with revision ACL surgery were investigated in this study. The study subjects were matched in terms of age, gender, involved leg, injury mechanism, sports group, time of surgery, and the degree of cartilage injury and ankle meniscus rupture. The studied variables included age, gender, body mass index (BMI), sports group, infection, meniscus injuries, chondral lesion, time to return to sports, quality of return to sports, range of motion, Lachman's test, and knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee score, Lysholm, and Marx scores. They were obtained through the information in the patients' medical records and the questionnaire filled out by the participants and the examiner's physician through the follow-ups. Then, the collected data were imported into the SPSS software and underwent analysis. RESULTS: The mean follow-up of patients was 49 months (in the range of 2-6 years). None of the patients had a chronic infection. The mean time to return to sports was 29.2 ± 3.2 and 35.3 ± 4.3 weeks in the primary surgery and revision surgery groups, respectively. In addition, 34 (54.8%) and 25 (40.3%) patients of the primary surgery and the revision surgery groups returned to the same level before injury, respectively. On the latest follow-up, the results of the Lachman test showed no significant difference between the two groups (P = 0.222) whereas Lysholm, IKDC, MARX, and KOOS scores on the latest follow-up in primary surgery were significantly higher than those of revision surgery (P < 0.001). CONCLUSION: The rate of return to sports in revision surgery was 14.5% lower than that of primary surgery, and the average time of return to sports was six weeks. The rate of return to sports, similar to before the injury, was significantly lower in the revision group, females, the age group of over 25 years, and contact sports activity, and patients with a chondral lesion. All knee performance scores were also poorer in the revision surgery.

The correlation between perceived social support and childbirth experience in pregnant women.

OBJECTIVE: In recent years, the role of social support on different aspects of health especially pregnancy and childbirth has been emphasized. Social support facilitates individual access to necessary resources during stressful periods of life like pregnancy and childbirth. Present evidence of effects of social support on birth experience is inconsistent, Therefore, this study aimed to determine the correlation between perceived social support in pregnant women and their childbirth experience. DESIGN: Analytic-cross sectional survey. SETTING: Al-Zahra maternity hospital in Rasht, Iran. PARTICIPANTS: 185 pregnant women who were in latent phase of labor entered the study and finally, 89.18% (n = 165) completed the study. MEASUREMENTS: To measure perceived social support, the Multidimensional Scale of Perceived Social Support was used at latent phase of labor and to measure childbirth experience, the Childbirth Experience Questionnaire was used within 2 h after childbirth until the mother was discharged. RESULTS: Mean score of perceived social support by significant others (4.18 ± 0.79) was higher than other dimensions of social support. Total mean score of childbirth experience was 58.13 ± 10.72 (score range: 22-88). Logistic regression results showed that support by significant others (P = 0.042, OR = 1.56), gestational age (P = 0.003, OR = 1.56) and mode of delivery (P = 0.004, OR = 0.33) are predictor variables of childbirth experience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Perceived social support by significant others (spouse) during pregnancy has an important effect on woman`s childbirth experience. Therefore, providing training programs for family especially for spouse in order to increase maternal support during pregnancy is recommended, which can lead to a positive childbirth experience.

Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and post-stroke dementia: a hospital-based study from northern Iran.

Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with functional and cognitive outcomes of stroke and plays a key role in preventing neuronal death. This study aimed to answer the following question: does BDNF Val66Met polymorphism prognosticate survival status and risk of post-stroke dementia (PSD)? In a retrospective cohort study, 206 patients with ischemic stroke (IS) entered the study. They were consecutively being admitted to the neurology clinic in Poursina Hospital (northern Iran) from 2012 to 2014. The diagnosis of PSD was based on DSM-5 criteria. The current and the premorbid cognitive statuses of the patients were respectively assessed through the third edition of Addenbrooke's Cognitive Examination and the Informant Questionnaire on Cognitive Decline in the Elderly. BDNF Val66Met gene polymorphism was determined by PCR-RFLP. On average, 48 patients (23.3 %) developed PSD 6 months after IS. Log-rank test showed that the survival rate of at least one Val-allele carriers was significantly lower than that of Met/Met homozygotes (P = 0.0005), and the former developed PSD sooner than the latter (375, 492 days, respectively). Cox model showed that heterozygous carriers of Val/Met were at greater risk of PSD over time (HR 2.280, 95 % CI 1.566-4.106, P = 0.006). However, the risk ratio of patients with PSD among different BDNF genotypes decreased after adjusting demographic, clinical, and vascular risk factors, and was no longer statistically significant (AHR 2.434, 95 % CI 0.597-9.926, P = 0.215). Val-allele carriers or Val/Met genotypes were more quickly diagnosed as having dementia after IS. However, this genetic vulnerability became more destructive when it was added to demographic, clinical, and vascular risk factors.

Posterior lumbar interbody fusion and posterolateral fusion: Analogous procedures in decreasing the index of disability in patients with spondylolisthesis.

OBJECTIVE: The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups. METHODS: In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year. RESULTS: There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6(th) months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P < 0.0001). CONCLUSION: Both surgical fusion techniques (PLF and PLIF) were efficient to lessen the disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability.

Ultrasonographic evaluation of long-term results of nasal tip defatting in rhinoplasty cases.

OBJECTIVES/HYPOTHESIS: Nasal skin thickness has an important role in aesthetic results of rhinoplasty. The aim of this study was to evaluate the long-term results of tip and supratip skin defatting technique in rhinoplasty subjects using ultrasonography. STUDY DESIGN: Prospective, randomized, case-control study. METHODS: Among 111 rhinoplasty cases referred to a university hospital between February 2010 and September 2011, after physical examination and measuring the nasal tip and supratip skin thickness by ultrasonography, a total of 55 patients with thick and moderate skin were randomly allocated for rhinoplasty using one of the following methods: rhinoplasty with (case group) and without (control group) defatting tip and supratip skin. Ultrasonographic evaluation of the skins was repeated 1 and 12 months after surgery, and the data were analyzed by Wilcoxon and repeated measure tests using SPSS 17 software. RESULTS: Twenty-eight of 55 candidates (10 men, 45 women; mean age, 25.1 ± 7.6 years) underwent skin defatting during rhinoplasty; the other 27 patients did not undergo this procedure. Forty-four patients completed the study. Thickness of tip and supratip skin was not statistically different before surgery and during follow-up evaluations in defatting and nondefatting technique groups (P = .7). CONCLUSIONS: Defatting techniques have no effect on reducing tip and supratip skin thickness after rhinoplasty in moderate to thick skins.