Pectoralis major rupture in body builders: a case series including anabolic steroid use.

BACKGROUND: Rupture of the pectoralis major (PM) muscle is a rare injury, with increasing incidence over the last decades, mainly due to participation in weightlifting and contact sports. Surgical management of PM injuries has been related with superior functional outcome, faster return to activities, better cosmesis and higher level of patients' satisfaction. The aim of the study is to present our experience in the management of this rare clinical entity and to correlate the use of anabolic steroids in the occurrence of the injury and the impact of type of injury, method of reconstruction and anabolic steroids on the post-operative outcome. CASES: We present a series of six male bodybuilding athletes who sustained PM rupture during weightlifting. We recorded the location & type of injury, the history and type of anabolic steroids use, the method of repair and the post-operative outcome. TREATMENT AND OUTCOMES: The mean follow-up period was 16 (12-24) months. All patients treated surgically had excellent results according to Bak criteria and returned to full activity within 5.4 (5-7) months following surgical reconstruction. No post-operative complications were recorded, despite the continued use of anabolic steroids, however one patient died from myocardial infarction within a year of surgical treatment. CONCLUSIONS: PM rupture is an injury with increasing incidence within bodybuilding athletes probably not related to the dominance of the limb. Fixation of the tendon with suture anchors results in excellent clinical outcome and patient's satisfaction postoperatively regardless the chronicity of the repair. Our observations in these cases suggest that anabolic steroids use may contribute to the injury due to an excessive upward adjustment of the athlete's goals in lifting weights and moreover the continuation of administration even in the recovery period does not seem to have a negative effect either on the time or on the level of adequate functional recovery postoperatively.

Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome.

Introduction Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.

Upper extremity emergencies during SARS-COV-2 pandemic: Turnout trends.

INTRODUCTION: During the SARS-COV-2 pandemic and consequent government measures to prevent the overwhelming of public hospitals, emergency department (ED) orthopaedic turnout was significantly altered. This study compared the turnout of patients with upper extremity (UE) and hand & wrist (H&W) emergencies during the SARS-COV-2 pandemic, with the same period of 2019, in the public and private sector. MATERIAL-METHODS: Data from a two-month period [March 23, 2020 (application of severe restrictions of civilian circulation) to May 18, 2020 (two weeks after lockdown cessation)] were collected from a public-university hospital and a private hospital and were compared with data from the same "normal" period in 2019. RESULTS: During the pandemic, the number of patients with orthopaedic, UE, and H&W problems was significantly reduced by 57.09%, 49.77%, 49.92% respectively (p<0.001) compared to 2019. However, the ratios of UE/total orthopaedic emergencies and of H&W/total orthopaedic emergencies increased significantly during the pandemic from 37.17% to 43.32% and from 25.07% to 29.15% (p=0.006 and p<0.001) respectively, compared to 2019. In the private sector, the turnout  was increased for patients with UE problems (8.82%, p=0.67) and H&W problems (24.39%, p=0.3), while in the public sector the turnout was significantly decreased for UE (49.77%, p<0.001) and H&W problems (49.92%, p<0.001) in 2020 compared to 2019. DISCUSSION: The extent of lockdown was unprecedented in recent years. The reduction of orthopaedic, UE and H&W emergencies during lockdown can be attributed to the fear of contracting the virus in the hospitals and even more in hospitals serving as COVID-19 reference centers. Despite the decrease -in absolute numbers- of patients, the increased percentages of UE to total orthopaedic and of H&W to total orthopaedic emergencies in 2020 in both hospitals, reflect the new hobbies' uptake and the increase of domestic accidents during the lockdown, despite overall activity decrease, and underline the necessity of presence of hand surgeons in the EDs. This is one of the very few population-based studies worldwide to show trends in incidence of different injuries of the UE at a regional level during the pandemic, and its results could affect future health care policies.

The administration of estrogens, combined with anti-androgens, has beneficial effects on the hormonal features and asymmetric dimethyl-arginine levels, in women with the polycystic ovary syndrome.

The present study was designed in order to: (a) compare ET-1 and ADMA levels, between women with PCOS (n=106) and healthy controls (n=30); (b) determine the effects of treatment with estrogens and anti-androgens on the hormonal features of PCOS, insulin resistance, ET-1 and ADMA levels. Women with PCOS were randomized in five therapeutic protocols: (I) 17beta-estradiol+cyproterone acetate 50mg; (II) conjugated estrogen+CA 50 mg; (III) ethinyl estradiole+CA 2mg; (IV) EE+CA 52 mg; (V) EE+desogestrel. In all women, gonadotropin, PRL, androgen, SHBG, insulin, glucose, ET-1 and ADMA levels were determined; in women with PCOS, testosterone, SHBG, ET-1 and ADMA levels were measured again after 3, 6, 12 months of treatment and insulin and glucose levels after 12 months. ET-1 and ADMA concentrations were higher in women with PCOS, and they were positively correlated with each other. ADMA levels were decreased and IR was increased with treatment. Treatment with synthetic estrogens (EE) resulted in a more pronounced increase in SHBG and a more pronounced decrease in FAI, compared to natural estrogens. Conclusively, PCOS is associated with endothelial dysfunction, which is ameliorated by the administration of estrogens and anti-androgens, independent of IR.