ABSTRACT
Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)
Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 4477 years) and mean follow up was 7 years (range of 59 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Outcome Assessment, Health Care , Arthroscopes , Rotator Cuff/surgery , Rotator Cuff Injuries , Range of Motion, Articular , Shoulder Injuries , Ultrasonography , Traumatology , OrthopedicsABSTRACT
Background and purposeThe purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty.Materials and methodsSixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity.ResultsMean age was 57.2 years (range, 4477 years) and mean follow up was 7 years (range of 59 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears.ConclusionsIn the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.(AU)
Antecedentes y objetivoAnalizar la cicatrización mediante ecografía y el seguimiento funcional a mediano plazo de pacientes con roturas parciales bursales del manguito rotador (RPBMR) con reparación in situ sin acromioplastia.Materiales y métodosSe evaluaron 62 pacientes. Se realizó la medición del rango de movimiento y la puntuación en el score American Shoulder and Elbow Surgeons (ASES). El dolor se registró usando una escala visual análoga (EVA). Se valoró ecográficamente la reparación con un mínimo de seguimiento de 5 años.ResultadosLa edad promedio fue de 57,2 años (rango de 44 a 77 años) y el seguimiento promedio, de 7 años (rango de 5 a 9 años). Todos los parámetros del rango de movimiento activo mejoraron significativamente (p<0,0001). El puntaje de ASES mejoró de 46,5 a 90,2 y los puntajes EVA mejoraron de 6,5 a 1,73 (p<0,0001). Un total de 56 pacientes (90%) realizaron control ecográfico al final del seguimiento; 51 presentaron integridad del tendón (91%) en la ecografía. Cinco pacientes presentaron re-roturas (9%); 3 tuvieron una re-rotura completa del tendón (5%) y 2 una re-rotura parcial (4%). No hubieron diferencias funcionales o del rango de movilidad significativas entre aquellos pacientes con el tendón intacto y los que presentaron re- roturas.ConclusionesA mediano plazo, la reparación in situ artroscópica de RPBMR demostró excelentes resultados funcionales en la mayoría de los pacientes con baja tasa de complicaciones. Estos mantienen un alto índice de cicatrización en el tiempo.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Outcome Assessment, Health Care , Arthroscopes , Rotator Cuff/surgery , Rotator Cuff Injuries , Range of Motion, Articular , Shoulder Injuries , Ultrasonography , Orthopedics , TraumatologyABSTRACT
BACKGROUND AND PURPOSE: The purpose of this study was to analyze midterm functional outcomes and tendon integrity in patients treated with in situ arthroscopic repair of Partial Bursal Rotator Cuff Tears (PBRCTs) without acromioplasty. MATERIALS AND METHODS: Sixty two patients were included. Clinical assessment consisted of glenohumeral range of motion measurement and the American Shoulder and Elbow Surgeons (ASES) score. Pain was rated by using a visual analog scale (VAS). A postoperative ultrasound image control was performed at a minimum 5 years follow up to assess tendon integrity. RESULTS: Mean age was 57.2 years (range, 44-77 years) and mean follow up was 7 years (range of 5-9 years). Significant improvements in range of motion, functional outcomes and pain were observed postoperatively (P<.0001). The ASES score improved from 46.5 to 90.2; and the VAS improved from 6.5 to 1.73 (P<.0001). Fifty six patients (90%) performed ultrasound evaluation at the end of follow up. Fifty-one patients (91%) presented tendon integrity on ultrasound. Five patients presented re-tears (9%). Three patients (5%) had a complete tendon re-tear and two patients (4%) had a partial re-tear. No difference in range of motion or functional outcomes were found between patients with intact tendon and those who had re-tears. CONCLUSIONS: In the midterm follow up, arthroscopic in situ repair PBRCTs without acromioplasty showed excellent functional outcomes and high healing rates in most patients with low complication rates.
ABSTRACT
Recent animal and human studies highlight the uncertainty about the onset of an aversive event as a crucial factor for the involvement of the centromedial amygdala (CM) and bed nucleus of the stria terminalis (BNST) activity. However, studies investigating temporally predictable or unpredictable threat anticipation and confrontation processes are rare. Furthermore, the few existing fMRI studies analyzing temporally predictable and unpredictable threat processes used small sample sizes or limited fMRI paradigms. Therefore, we measured functional brain activity in 109 predominantly female healthy participants during a temporally predictable-unpredictable threat paradigm, which aimed to solve limited aspects of recent studies. Results showed higher BNST activity compared to the CM during the cue indicating that the upcoming confrontation is aversive relative to the cue indicating an upcoming neutral confrontation. Both the CM and BNST showed higher activity during the confrontation with unpredictable and aversive stimuli, but the reaction to aversive confrontation relative to neutral confrontation was stronger in the CM compared to the BNST. Additional modulation analyses by NPSR1 rs324981 genotype revealed higher BNST activity relative to the CM in unpredictable anticipation relative to predictable anticipation in T-carriers compared to AA carriers. Our results indicate that during the confrontation with aversive or neutral stimuli, temporal unpredictability modulates CM and BNST activity. Further, there is a differential activity concerning threat processing, as BNST is more involved when focussing on fear-related anticipation processes and CM is more involved when focussing on threat confrontation.
Subject(s)
Amygdala/physiology , Anticipation, Psychological/physiology , Brain Mapping , Fear/physiology , Septal Nuclei/physiology , Adult , Female , Humans , Magnetic Resonance Imaging , Male , Receptors, G-Protein-Coupled/genetics , Time Factors , Young AdultABSTRACT
OBJECTIVE: To analyze a series of patients with bone tumours reconstructed with modular prostheses and to evaluate: 1) Survival of the implant. 2) Causes of failure. 3) Complication rates. 4) Limb salvage overall survival. 5) Functional results and full weight bearing. MATERIALS AND METHODS: A retrospective study from longitudinally maintained oncology databases was undertaken. All patients with bone tumours reconstructed with endoprosthesis were analysed. A toal of 106patients matched the inclusion criteria. They were divided into groups: group 1, primary bone tumours; group 2, bone metastasis; group 3, osteoarticular allograft reconstruction revisions. The type of failures were classified according to Henderson et al. (2014) and functional results assessed by the Musculoskeletal Tumor Society (MSTS). Demographic analysis, survival and the differences between groups were recorded. RESULT: The mean follow-up of the patients was 68 months. Mean age was 43 years. Overall implant survival was 86.4% at 2 years (95% CI: 79-94) and 73% at 5 years (95% CI: 60-80). Nineteen patients (18%) developed a prosthetic failure. The limb salvage overall survival was 96% at 5 years (95% CI: 91-99). The mean functional results according to the MSTS was 24 and mean time to full weight bearing was 2.3 weeks. CONCLUSIONS: Limb conservation surgery and endosprosthetic reconstruction is a valid option for patients with bone tumours with failure rates similar to other reconstruction methods.
Subject(s)
Bone Neoplasms/surgery , Femoral Neoplasms/surgery , Prosthesis Failure , Adolescent , Adult , Aged , Aged, 80 and over , Bone Neoplasms/mortality , Bone Neoplasms/secondary , Female , Femoral Neoplasms/mortality , Femoral Neoplasms/secondary , Follow-Up Studies , Humans , Humerus , Kaplan-Meier Estimate , Limb Salvage , Male , Middle Aged , Organ Sparing Treatments , Plastic Surgery Procedures , Reoperation/statistics & numerical data , Retrospective Studies , Tibia , Treatment Outcome , Weight-Bearing , Young AdultABSTRACT
BACKGROUND: Altered amygdala activation to fear-related stimuli has been proposed to be a potential neural correlate of heightened threat sensitivity in anxiety- and stress-related disorders. However, the role of stimulus awareness and disorder specificity remains widely unclear. Here we investigated amygdala responses to conscious and unconscious fearful faces in patients suffering from panic disorder (PD), generalized anxiety disorder (GAD), or post-traumatic stress disorder (PTSD) and in a large sample of healthy controls (HC). METHODS: During event-related functional magnetic resonance imaging participants (n = 120; 20 PD, 20 GAD, 20 PTSD, 60 HC) were confronted with briefly presented fearful faces, neutral faces, and non-faces in a backward masking paradigm. The design allowed for the analysis of trial-by-trial face detection performance and amygdala responses to fearful v. neutral faces. RESULTS: All participants exhibited increased amygdala activation to fearful v. neutral faces during conscious trials. Specifically during unconscious face processing, the PTSD, compared with all other groups, showed higher right basolateral (BLA) amygdala activity to fearful v. neutral faces. CONCLUSIONS: The present study shows that BLA amygdala hyperactivity during unconscious, but not conscious, processing of fearful faces differentiates PTSD from the investigated disorders. This finding suggests an automatic and specific neural hyper-responsivity to general fear cues in PTSD and supports the idea of categorical differences between PTSD and other anxiety-related disorders.
Subject(s)
Amygdala/physiopathology , Anxiety Disorders/physiopathology , Fear/physiology , Stress Disorders, Post-Traumatic/physiopathology , Adolescent , Adult , Case-Control Studies , Cues , Facial Expression , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Panic Disorder/physiopathology , Reaction Time , Regression Analysis , Young AdultABSTRACT
BACKGROUND: There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed. METHOD: The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes. RESULTS: Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses. CONCLUSIONS: The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.
Subject(s)
Amygdala/physiopathology , Brain/physiopathology , Dental Anxiety/physiopathology , Fear/physiology , Panic Disorder/physiopathology , Phobia, Social/physiopathology , Stress Disorders, Post-Traumatic/physiopathology , Adult , Amygdala/diagnostic imaging , Brain/diagnostic imaging , Dental Anxiety/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Male , Panic Disorder/diagnostic imaging , Phobia, Social/diagnostic imaging , Stress Disorders, Post-Traumatic/diagnostic imaging , Visual Perception/physiology , Young AdultABSTRACT
The midcingulate cortex (MCC; often somewhat imprecisely referred to as dorsal or cognitive part of the anterior cingulate cortex or dACC) is a core region contributing to cognitive control. Neuroanatomical deviations in the midcingulate region have been observed in a variety of mental disorders. Even in healthy subjects a high degree of morphological variability is seen, for example concerning the degree of anterior midcingulate fissurization. To investigate the relationship between anterior midcingulate morphology and function, individuals with a leftward midcingulate folding asymmetry (LEFT) were compared to individuals showing a lower degree of fissurization or a rightward asymmetric folding (REST). Data from two experiments, a masked Stroop paradigm and a combined go/no-go and stop-signal task, are reported. With the masked Stroop task, LEFT subjects revealed a better processing of incongruent Stroop stimuli when compared to REST subjects. This was reflected in both augmented N400 responses as well as significantly higher accuracy scores. In addition, similar effects were found with event-related potentials from the combined go/no-go and stop-signal task. Here, the N200 but not the P300, which have been associated with conflict-related and evaluative processing stages, respectively, was found to be significantly increased with LEFT subjects. The results of this study foster an association of midcingulate fissurization with differences in behavior and neurophysiological functioning related to cognitive control.
