A comparison of ice wrap and subacromial injection for postoperative pain and edema control following arthroscopic rotator cuff repair.

BACKGROUND: Postoperative pain and edema are the most common problems associated with arthroscopic rotator cuff repair. The purpose of the present study was to compare ice wrap and subacromial injection (SI) as treatments for early postop pain and edema control and to contrast them with a control group. MATERIALS AND METHODS: 59 patients treated with arthroscopic rotator cuff repair were randomized into three groups: 23 patients who received an ice wrap, 20 patients who received a SI, and a control group of 16 patients. RESULTS: Patient demographics, comorbidities, tear retraction, degree of fatty muscle degeneration, surgical procedures, and amount of irrigation fluid were similar for the three groups, which also showed similar results regarding postoperative pain and edema control as well as analgesic consumption. CONCLUSIONS: The present study failed to show any difference in effectiveness between the two most common pain management modalities, or between those modalities and the control group. LEVEL OF EVIDENCE: IV, prospective observational study.

Suture anchor fixation strength in the Latarjet procedure: a biomechanical study in cadavers.

BACKGROUND: The use of metallic screws for graft fixation during the Latarjet procedure is not devoid of complications. The purpose of the present cadaver study was to determine the initial strength of coracoid graft fixation using suture anchors and compare it to that of the traditional screw fixation of the graft using a fresh frozen human shoulder cadaver model. MATERIALS AND METHODS: Twelve unpaired fresh frozen cadaver shoulders were utilized. In the first group, suture anchor fixation of the graft was used, while 3.75-mm cannulated screws were used in the second group. The specimens were then cyclically loaded from 5 to 150 N at a speed of 0.05 mm/s for 100 cycles. After cyclic loading, each specimen was then loaded at a constant rate of 0.5 mm/s until 7 mm of displacement. Cyclic elongation, peak-to-peak displacement, stiffness and maximum load were measured. RESULTS: There were no significant differences between the traditional screw fixation and fixation using suture anchors in elongation, peak-to-peak displacement, stiffness and maximum load. CONCLUSIONS: In this study, traditional screw fixation and fixation using suture anchors did not significantly affect biomechanical performance in a classic Latarjet procedure.

A Review of Hemophagocytic Lymphohistiocytosis in Patients With HIV.

We provide an elaborate review of cases published between January 2005 and April 2021 on hemophagocytic lymphohistiocytosis (HLH) in HIV patients. Seventy articles describing 81 adult patients (age ≥19 years) were included. The median age was 40 years, and 78% were males. Only 65% were known to have HIV before presentation. CD4 count was ≥200 cells/mm3 in 23%, and HIV viral load was <200 copies/mL in 41%. The lack of meticulous reporting of ≥5 of 8 criteria for HLH diagnosis was evident in a third of cases. At least 1 infectious agent-other than HIV-was believed to trigger HLH in 78% of patients. The most common were Epstein-Barr virus (26%), human herpesvirus 8 (21%), and Histoplasma capsulatum (17%). Sixty percent survived. Among those, 93% received treatment for identified secondary trigger(s), while 51% received HLH-directed therapy. There was significant heterogeneity in the treatment regimens used for HLH.

Clinical Characteristics and Outcomes of Patients With SARS-CoV-2 Reinfection.

Objective: To examine the clinical characteristics, risk of hospitalization, and mortality of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection. Patients and Methods: We retrospectively reviewed all patients with SARS-CoV-2 reinfection at all Mayo Clinic sites between May 23, 2020, and June 30, 2021 (the period before the emergence of the Delta variant in the United States). The reinfection was defined as a positive SARS-CoV-2 test more than or equal to 90 days after initial infection or 45-89 days after with symptomatic second episode. Vaccination status was classified as fully vaccinated, first dose, and unvaccinated. Comparative analysis of baseline characteristics and comorbidities was performed by hospitalization and vaccination status. The survival analysis of the hospitalized patients was performed using Cox proportional hazard regression. Results: Among the 554 patients reinfected with SARS-CoV-2, 59 (10.6%) were pediatric, and 495 (89.4%) were adults. The median age was 13.9 years (interquartile range, 8.5-16.5 years) for the pediatric and 50.2 years (interquartile range, 28.4-65.6 years) for the adult population. Among the adult patients, the majority were unvaccinated (83.4%, n=413), and the duration to reinfection from initial infection was the longest in the fully vaccinated group (P<.001). Forty-two (75%) out of 56 patients were seropositive within 7 days of reinfection. In hospitalized adult patients, Charlson Comorbidity Index was an independent risk factor for mortality (adjusted hazard ratio, 0.35; 95% CI, 0.19-0.51). Conclusion: In this study, most adult patients with SARS-CoV-2 reinfection were unvaccinated. Furthermore, the duration to reinfection was longest in fully vaccinated individuals. Seropositivity was common among adult patients.

Cardiovascular device infections due to rapidly growing Mycobacteria: A review of cases at a tertiary care hospital.

Cardiovascular device infection due to rapidly growing mycobacteria (RGM) is rarely encountered in clinical practice. Due to the increasing number of indications and use of cardiovascular devices in an aging population, optimized management of these infections is of great importance. We report seven cases of RGM cardiovascular device infection. Three patients had left-ventricular assist device (LVAD) infections; two patients had cardiovascular implantable device (CIED) infections; and one had an aortic vascular stent infection. Specific cardiac valvular infection was not detected among any of the patients. All patients had a high number of comorbidities which limited some patients from receiving optimal combination antimicrobial therapy. The prognosis of cardiovascular device infections with RGM is guarded with only four patients still alive; however, the treatment approach for each patient varied considerably and often based on concurrent medical conditions, overall adjustments to goals of care, and specific patient preferences. Further analysis of cardiovascular device infections with RGM is warranted to establish a more systematic approach in successful management.

Bloodstream infections with rapidly growing nontuberculous mycobacteria.

BACKGROUND: Bloodstream infections (BSI) with rapidly growing mycobacteria (RGM) resulted in recent nosocomial outbreaks predominantly in immunocompromised patients. A little is known about the clinical implications of RGM BSI with different species. METHODS: We conducted a multicenter retrospective cohort study of patients with RGM BSI from November 2011 to December 2020. Demographic data, clinical presentation, laboratory and radiographic findings and microbiological characteristics were used to tabulate descriptive statistics. We performed a comparative analysis of patients with BSI due to Mycobacterium abscessus complex (MABC) vs. other RGM. RESULTS: We identified 32 patients with positive blood cultures for RGM, 4/32 (12.5%) were considered to have unclear significance. The most common source for RGM BSI was intravascular catheters (14/28, 50%). Compared to other sources, patients with catheter-related bloodstream infection (CRBSI) received a shorter course of antimicrobial therapy (median [IQR]: one month [0.37-2.25] vs. six months [2-12]), (P = 0.01). The most common species isolated were MABC (12/28, 42.9%), followed by Mycobacterium fortuitum group (6/28, 21.4%) and Mycobacterium chelonae (6/28, 21.4%). Compared to other RGM, MABC BSI was more likely to be secondary to skin and soft tissue infection, associated with longer hospital stay (P = 0.04) and higher death rates despite a higher number of antimicrobial agents used for empirical and directed therapy per patient. CONCLUSION: MABC BSI is associated with an overall more resistant profile, longer hospital stay, and higher death rate despite a more aggressive therapy approach.

Cosmetic bilateral leg lengthening using intramedullary nail experience of 9 cases.

BACKGROUND: Distraction osteogenesis to correct deformity and limb-length discrepancy was defined by Ilizarov. Traditional distraction osteogenesis was made with circular external fixators or monolateral fixators commonly for deformity, and external fixators was related with pin site infections and pain due to soft-tissue transfixation. Nowadays, bone lengthening method is used with different intramedullary nail systems for cosmetic purposes. METHODS: From 2011 until 2018, a total of 9 patients (6 males and 3 females:16 femoral, 2 tibial), with constitutional short stature, to whom the intramedullary nail lengthening technique for cosmetic purposes had been applied, were retrospectively reviewed. The mean age was 28.3 while the mean height before the lengthening was 151 cm. RESULT: The mean lengthening gained in all patients were 8.7 cm. The mean follow-up period was 22 ± 11 months while the healing index with normal bone healing was 46.8 ± 16 months/cm. Complications that we noted were; insufficient bone regeneration (n = 2), quadriceps contracture (n = 1), proximal locking screw runaway (n = 1). CONCLUSION: Bone lengthening for aesthetic purposes with different nail systems can be very safe and beneficial to the patients improving their social capabilities and self-confidence. Yet, patients should be well informed about the complications and risks of the lengthening surgery.

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions.

BACKGROUND: Femoral and sciatic nerves could be damaged during various stages of the periacetabular osteotomy. Changing the position of the hip could be the most effective way of preventing nerve injuries. The purpose of the present study was to investigate the distances of the nerves to various bony landmarks with different hip positions in computerized pelvic scanograms of healthy adults. MATERIALS AND METHODS: Fifteen healthy male adults (30 hips) (age 30 ± 6) were included. Scans were performed at three different hip positions measured by goniometer (neutral "N," flexion (30-45°) + abduction (30-45°) + external rotation (20°) "F" and neutral+ abduction (30-45°) + external rotation (20°) (Nabext) at three different levels (sourcil "1," the middle of the femoral head "2," and lower border of triradiate cartilage "3." RESULTS: At the sourcil level, the femoral nerve was found to be the furthest distance from the anterior acetabulum in the neutral position compared to flexion or neutral plus abduction, external rotation (p < 0.001). For the sciatic nerve, at level 2, hip flexion resulted in a greater distance than in the neutral position (p = 0.001). For level 3, hip flexion caused a decrease in the distance of the sciatic nerve to the acetabulum compared to both neutral positions (N or Nabex) (p = 0.001). CONCLUSIONS: During a pubic cut of the osteotomy, the femoral nerve moves closer to the anterior acetabulum wall with hip flexion or abduction plus external rotation. During an ischial cut, the sciatic nerve gets closer to the ischium with hip flexion while it moves away from the bone during retroacetabular cut. Level-III Study.

Bare area on the trochanter and its correlations to gluteal tendon insertion dimensions.

Gluteus medius and minimus tears have recently been reported to be very common and the main etiology of lateral sided hip pain. The purpose of this study was to determine whether there is any correlation between the dimensions of the tendon insertions and bare areas (BA) and various bony landmarks. Twenty-seven hemipelvises from adult male hips were included. The bony landmarks [anterior tip (Ta), posterior tip of trochanter, vastus tubercle (VT) and center of BA] were marked. The longitudinal lengths and widths (maximum) of posterosuperior (PS), lateral facets (LF), minimus insertion (Min) and BA and the distance between posterior (Tp) and Ta and between anterior/posterior tips and the VT or center of BA were measured using a digital caliper. A correlation analysis was performed between variables. There was a correlation between LFlength and Minlength (r = 0.4, P = 0.01) and between Ta-BA and PS + LF (r = 0.5, P = 0.003) or Minlength (r = 0.4, P = 0.016). LFwidth was negatively correlated with BAwidth (r = -0.4, P = 0.002). Tp-BA was negatively correlated with BAwidth (r = -0.4, P = 0.01). LFwidth was correlated with Tp-BA, and this nearly reached statistical significance (r = 0.3, P = 0.05). BA can be used intraoperatively as landmarks to estimate the width of the LF and also to determine the length of the longitudinal insertion of the gluteus medius and minimus tendons.

Pomalidomide and dexamethasone in myelomatous pleural effusion.

Myelomatous pleural effusion (MPE) is an uncommon clinical entity and occurs in less than 1% of all patients with multiple myeloma. MPE indicates a progression of disease, therefore is associated with a poor prognosis and estimated median survival of <3 months. Treatment of MPE is challenging, and the data regarding the role of novel agents lack in the literature. Herein, we report a relapsed IgA myeloma case of a patient presenting with MPE, who was treated with pomalidomide with a very good partial response.

A Primary Adrenal Epithelioid Angiomyolipoma (PEComa) in a Patient with Tuberous Sclerosis Complex: Report of a Case and Review of the Literature.

Epithelioid angiomyolipomas (EAMLs) are mesenchymal tumors that are part of the family of the perivascular epithelioid cell neoplasms (PEComas). These tumors portray a potential aggressive behavior with metastatic lesions found in around 30% of reported cases. EAMLs might present sporadically or in association with the tuberous sclerosis complex (TSC). They typically involve the kidneys, liver, and lungs. It is extremely rare for these tumors to arise from other organs. The present report describes an unusual case of an adult patient with a history of TSC who developed EAML of the adrenal gland. Moreover, he presented with metastatic disease to the liver, a feature rarely described. The diagnosis of EAMLs can be challenging as they are hard to distinguish from other adrenal or renal tumors without a thorough histopathologic and immunohistochemical evaluation. Due to the potential aggressive behavior of these malignancies, timely diagnosis is extremely important and has significant therapeutic and prognostic implications.

Seminoma metastasized to the prostate: A case report and literature review.

The testicular seminomas are germ-cell tumors which account for approximately 50% of all testicular tumors. Most primary testicular germ cell tumors metastasize through a lymphatic system in a predictable pattern with the retroperitoneal lymph nodes being the most common initial metastatic site. Hematological metastasis to the distant organs is less common, and except for pulmonary metastasis, changes the classification from good to intermediate prognosis. Metastasis of testicular seminoma to the prostate is an extremely rare entity with only five reported cases in the literature. In this report, we present a 63-year-old male with recurrent testicular seminoma presenting in prostate.

Concomitant use of blinatumomab and donor lymphocyte infusion for mixed-phenotype acute leukemia: a case report with literature review.

Blinatumomab and donor lymphocyte infusion (DLI) combination is a promising cancer therapy, whereby blinatumomab might achieve an initial reduction in leukemic-cell burden using T cells, and after tumor clearance, DLI can potentially stimulate the donor immune system to achieve longer lasting remission. Here, we present a 51-year-old female with mixed phenotype acute leukemia who had a hematologic relapse 3 months after she received total body irradiation-based myeloablative allogeneic hematopoietic stem cell transplantation from an unrelated human leukocyte antigen matched (10/10) donor and achieved complete remission with minimal residual disease negativity by multi-parameter flow cytometry using the combination of blinatumomab and DLI. To the best of our knowledge, this is the first report to describe the use of blinatumomab and DLI combination therapy in the treatment of B/myeloid mixed phenotype acute leukemia.