[Final results after operative treatment of shoulder joint infections]. / Endergebnis nach operativer Behandlung von Schultergelenksinfekten.

PURPOSE: In a consecutive case series the results of operative treatment of patients with shoulder joint infections following rotator cuff surgery, endoscopic subacromial decompression or subacromial injection were studied. PATIENTS AND METHODS: Between 1990 and 2001 26 patients developed a postoperative infection. 24 patients were available for a mean follow-up of 4.3 (1-12) years. The mean age of the study group was 59.8 (28-84) years. Patients were divided into three groups. Group I consisted of 9 patients with infection after rotator cuff repair, group II consisted of 4 patients with infection after endoscopic subacromial decompression and there were 11 patients in group III with an infection that developed following subacromial injection. Patient evaluation was done according to the Constant and ASES Scores, the SF-36 and a visual analogue scale (VAS) for postoperative pain and satisfaction. RESULTS: The mean postoperative Constant Score was 68.6 pts (SD 25.1) in group I, 84.6 pts (SD 10.4) in group II and 75.6 pts (SD 25.1) in group III. The mean ASES-Score was 65.6 pts (SD 30.0) in group I, 69.8 pts (23.6) in group II and 78.5 pts (SD 25.7) in group III. The SF-36 showed for the summarized physical scale 37.3 pts (SD 12.6) in the first, 39.8 pts (SD 5.8) in the second and 37.7 pts (SD 12.4) in the third group and for the summarized psychometric scale 40.4 pts (SD 2.7) in the first, 44.3 pts. (SD 10.8) in the second and 45.7 pts. (SD 10.1) in the third group. For the VAS for pain, group I had 4.3, group II 4.0 and group III 2.5 pts Patient satisfaction showed similar results with 6.4 pts in the first, 6.5 pts in the second and 6.8 pts in the third group. CONCLUSION: Considering the functional results of operative revision, infection of the shoulder joint following rotator cuff surgery, endoscopic subacromial decompression or subacromial injection is a rare but severe complication.

Molecular determinants of diltiazem block in domains IIIS6 and IVS6 of L-type Ca(2+) channels.

The benzothiazepine diltiazem blocks ionic current through L-type Ca(2+) channels, as do the dihydropyridines (DHPs) and phenylalkylamines (PAs), but it has unique properties that distinguish it from these other drug classes. Wild-type L-type channels containing alpha(1CII) subunits, wild-type P/Q-type channels containing alpha(1A) subunits, and mutants of both channel types were transiently expressed in tsA-201 cells with beta(1B) and alpha(2)delta subunits. Whole-cell, voltage-clamp recordings showed that diltiazem blocks L-type Ca(2+) channels approximately 5-fold more potently than it does P/Q-type channels. Diltiazem blocked a mutant P/Q-type channel containing nine amino acid changes that made it highly sensitive to DHPs, with the same potency as L-type channels. Thus, amino acids specific to the L-type channel that confer DHP sensitivity in an alpha(1A) background also increase sensitivity to diltiazem. Analysis of single amino acid mutations in domains IIIS6 and IVS6 of alpha(1CII) subunits confirmed the role of these L-type-specific amino acid residues in diltiazem block, and also indicated that Y1152 of alpha(1CII), an amino acid critical to both DHP and PA block, does not play a role in diltiazem block. Furthermore, T1039 and Y1043 in domain IIIS5, which are both critical for DHP block, are not involved in block by diltiazem. Conversely, three amino acid residues (I1150, M1160, and I1460) contribute to diltiazem block but have not been shown to affect DHP or PA block. Thus, binding of diltiazem to L-type Ca(2+) channels requires residues that overlap those that are critical for DHP and PA block as well as residues unique to diltiazem.