1.Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation
Fu-Ting HUANG ; Kai-Cheng LIN ; Chih-Yang LIN ; Wei-Ning CHANG
Clinics in Orthopedic Surgery 2021;13(3):366-375
Background:
Coracoacromial ligament transfer is the traditional procedure for treating chronic acromioclavicular separation, but it is significantly inferior to ligament reconstruction according to biomechanical and clinical studies. However, ligament reconstruction carries the risk of complications of graft loosening and peri-tunnel fractures. Currently, there is no ligament reconstruction procedure optimal for preventing such complications. The purpose of this study was to describe and retrospectively analyze the clinical and radiological outcomes of a “duo-figure-8” autogenic graft wrapping technique, which was used to concomitantly reconstruct the acromioclavicular and coracoclavicular ligaments.
Methods:
Preoperative, immediate postoperative, and final follow-up oputcomes were evaluated in 10 enrolled patients. Radiographic outcomes were indicated by the bilateral difference of the coracoclavicular distance (CCD) and overlapping length of the acromioclavicular joint (OLac). Quality of reduction was classified into 4 grades according to bilateral CCD difference into overreduction (< 0 mm), anatomic reduction (0–4 mm), partial loss of reduction (4–8 mm), and recurrent dislocation (> 8 mm). Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores.
Results:
The mean side-to-side differences for CCD were 11.9 mm (preoperative), −0.1 mm (immediate postoperative), and 3.4 mm (final follow-up); those for OLac were 9.4 mm (preoperative) and 2.7 mm (final follow-up). CCD and OLac outcomes significantly improved at final follow-up (p < 0.05). At the immediate postoperative stage, 6 and 4 patients had overreduction and anatomic reduction, respectively. At final follow-up, 7 and 3 patients had anatomic reduction and partial loss of reduction, respectively. The magnitude of improvement of ASES scores for patients with anatomic reduction and partial loss of reduction (p = 0.20) was 18.1 and 20.0, respectively. The magnitude of improvement of Constant scores in patients with anatomic reduction and partial loss of reduction (p = 0.25) was 19.9 and 22.3, respectively.
Conclusions
The technique yielded acceptable functional outcomes in patients with anatomic reduction or partial loss of reduction. The “duo-figure-8” wrapping method—a single autogenic tendon graft passing beneath the coracoid process with a tendonknot fixation over the distal clavicle and looping around the acromion intramedullary—did not increase the risk of peri-tunnel fractures over the clavicle, coracoid process, or acromion.
4.Concomitant Acromioclavicular and Coracoclavicular Ligament Reconstruction with a Duo-Figure-8 Autogenic Graft Wrapping Technique for Treating Chronic Acromioclavicular Separation
Fu-Ting HUANG ; Kai-Cheng LIN ; Chih-Yang LIN ; Wei-Ning CHANG
Clinics in Orthopedic Surgery 2021;13(3):366-375
Background:
Coracoacromial ligament transfer is the traditional procedure for treating chronic acromioclavicular separation, but it is significantly inferior to ligament reconstruction according to biomechanical and clinical studies. However, ligament reconstruction carries the risk of complications of graft loosening and peri-tunnel fractures. Currently, there is no ligament reconstruction procedure optimal for preventing such complications. The purpose of this study was to describe and retrospectively analyze the clinical and radiological outcomes of a “duo-figure-8” autogenic graft wrapping technique, which was used to concomitantly reconstruct the acromioclavicular and coracoclavicular ligaments.
Methods:
Preoperative, immediate postoperative, and final follow-up oputcomes were evaluated in 10 enrolled patients. Radiographic outcomes were indicated by the bilateral difference of the coracoclavicular distance (CCD) and overlapping length of the acromioclavicular joint (OLac). Quality of reduction was classified into 4 grades according to bilateral CCD difference into overreduction (< 0 mm), anatomic reduction (0–4 mm), partial loss of reduction (4–8 mm), and recurrent dislocation (> 8 mm). Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores.
Results:
The mean side-to-side differences for CCD were 11.9 mm (preoperative), −0.1 mm (immediate postoperative), and 3.4 mm (final follow-up); those for OLac were 9.4 mm (preoperative) and 2.7 mm (final follow-up). CCD and OLac outcomes significantly improved at final follow-up (p < 0.05). At the immediate postoperative stage, 6 and 4 patients had overreduction and anatomic reduction, respectively. At final follow-up, 7 and 3 patients had anatomic reduction and partial loss of reduction, respectively. The magnitude of improvement of ASES scores for patients with anatomic reduction and partial loss of reduction (p = 0.20) was 18.1 and 20.0, respectively. The magnitude of improvement of Constant scores in patients with anatomic reduction and partial loss of reduction (p = 0.25) was 19.9 and 22.3, respectively.
Conclusions
The technique yielded acceptable functional outcomes in patients with anatomic reduction or partial loss of reduction. The “duo-figure-8” wrapping method—a single autogenic tendon graft passing beneath the coracoid process with a tendonknot fixation over the distal clavicle and looping around the acromion intramedullary—did not increase the risk of peri-tunnel fractures over the clavicle, coracoid process, or acromion.
5.Clinical diagnosis rather than aquaporin-4 immunoglobulin status predicts the cognitive performance in central demyelinating disease
Min-Chien Tu ; Wen-Neng Chang ; Chun-Chung Lui ; Nai-Ching Chen ; Chi-Wei Huang ; Chen-Chang Lee ; Ching Chen ; Chiung-Chih Chang
Neurology Asia 2012;17(4):331-340
Background:Reports on the aquaporin-4 immunoglobulin G (AQP4-IgG) status for cognitive performance
and neuroimaging correlations are limited in neuromyelitis optica (NMO) and multiple sclerosis (MS)
literature. Methods: Cognitive results of 19 MS and 15 NMO patients were compared with 47 agematched
controls. Apparent diffusion coeffi cient (ADC) values were used to delineate gray matter
and white matter damages and correlate with neuropsychological results. Results: Verbal memory test
showed signifi cant differences between MS and NMO in the late registration, early and delay recall
(p<0.05), while their retention rates were even. In MS, ADC values were signifi cantly elevated in the
dorsolateral prefrontal and occipital gray matter which was in contrast with NMO group that showed
elevation in the dorsolateral prefrontal gray matter and parieto-occcipital white matter. AQP4-IgG
status exerted a limited effect on ADC values and neuropsychological results.
Conclusions: Verbal memory test might be helpful in differentiating NMO and MS. ADC values
can be used as a surrogate marker for tissue injury in NMO and MS since they were in line with the
cognition scores. Anatomical regions with elevated ADC values were different in NMO and MS.
6.Psilocybin for End-of-Life Anxiety Symptoms: A Systematic Review and Meta-Analysis
Chia-Ling YU ; Fu-Chi YANG ; Szu-Nian YANG ; Ping-Tao TSENG ; Brendon STUBBS ; Ta-Chuan YEH ; Chih-Wei HSU ; Dian-Jeng LI ; Chih-Sung LIANG
Psychiatry Investigation 2021;18(10):958-967
Objective:
To systematically examine the effectiveness and tolerability of psilocybin for treating end-of-life anxiety symptoms.
Methods:
The Medline, Embase, CENTRAL, and PsycINFO databases were searched up to November 25, 2020. We enrolled clinical trials investigating psilocybin for treating end-of-life anxiety symptoms. Meta-analysis was conducted using random-effects model.
Results:
Overall, five studies were included, revealing that psilocybin was superior to the placebo in treating state anxiety at 1 day (Hedges’ g, -0.70; 95% confidence interval, -1.01 to -0.39) and 2 weeks (-1.03; -1.47 to -0.60) after treatment. Psilocybin was more effective than placebo in treating trait anxiety at 1 day (-0.71; -1.15 to -0.26), 2 weeks (-1.08; -1.80 to -0.36), and 6 months (-0.84; -1.37 to -0.30) after treatment. Psilocybin was associated with transient elevation in systolic (19.00; 13.58–24.41 mm Hg) and diastolic (8.66; 5.18–12.15 mm Hg) blood pressure compared with placebo. The differences between psilocybin and placebo groups with regard to allcause discontinuation, serious adverse events, and heart rates were nonsignificant.
Conclusion
Psilocybin-assisted therapy could ameliorate end-of-life anxiety symptoms without serious adverse events. Because of the small sample sizes of the included studies and high heterogeneity on long-term outcomes, future randomized controlled trials with large sample sizes are needed.
7.Prognostic value of auto-antibodies to extractable nuclear antigens in neuromyelitis optica
Min-Chien Tu ; Nai-Ching Chen ; Chun-Chung Lui ; Wen-Neng Chang ; Chi-Wei Huang ; Sz-Fan Chen ; Chiung-Chih Chang
Neurology Asia 2014;19(3):287-293
Background: Compared with the Western population, central demyelinating disorders are relatively
rare while the data on the prognostic value of autoantibodies together with clinical characteristics and
cognitive dysfunction has rarely been explored in neuromyelitis optica (NMO) and multiple sclerosis
(MS). Methods: Nineteen patients with MS and 14 with NMO underwent clinical profiling and cognitive
assessment. According to serology tests, they are divided into four subgroups for further analysis.
Results: There was higher frequency of aquaporin-4 immunoglobulin G. sero-positivity (64.3% vs.
10.5%; p=0.003) and antinuclear antibodies (ANA) and/or antibodies to extractable nuclear antigens
(anti-ENA) in NMO compared to MS (42.9% vs. 5.2%; p=0.026). The presence of anti-ENA represented
a unique clinical phenotype, with longer segment of myelitis (p=0.049), female preponderance, and an
inverse correlation between age-of-onset and annual relapse rate (ρ= -0.88, p=0.021). Among patients
with anti-ENA positivity, comprehensive serology panels revealed Sjögren’s syndrome A antibodies
as the most common (83%), in contrast to limited clinical documentation of Sjögren’s syndrome
(16%). There was no significant difference in cognitive assessment by anti-ENA status. MS and NMO
represent two different serologic entities.
Conclusions: Anti-ENA may have prognostic value for its linkage to a unique clinical phenotype,
which has longer initial segment of myelitis, female preponderance, and higher annual relapse rate
on earlier age-of-onset, but has limited clinical impact on cognition. Further studies are warranted
to investigate whether anti-ENA represents an epiphenomenon of myelitis or simply a systemic
inflammatory state.
8.Unplanned emergency department visits within 90 days of hip hemiarthroplasty for osteoporotic femoral neck fractures: Reasons, risks, and mortalities
Yang-Yi WANG ; Yi-Chuan CHOU ; Yuan-Hsin TSAI ; Chih-Wei CHANG ; Yi-Chen CHEN ; Ta-Wei TAI
Osteoporosis and Sarcopenia 2024;10(2):66-71
Objectives:
Bipolar hemiarthroplasty is commonly performed to treat displaced femoral neck fractures in osteo porotic patients. This study aimed to assess the occurrence and outcomes of unplanned return visits to the emergency department (ED) within 90 days following bipolar hemiarthroplasty for displaced femoral neck fractures.
Methods:
The clinical data of 1322 consecutive patients who underwent bipolar hemiarthroplasty for osteoporotic femoral neck fractures at a tertiary medical center were analyzed. Data from the patients’ electronic medical records, including demographic information, comorbidities, and operative details, were collected. The risk factors and mortality rates were analyzed.
Results:
Within 90 days after surgery, 19.9% of patients returned to the ED. Surgery-related reasons accounted for 20.2% of the patient’s returns. Older age, a high Charlson comorbidity index score, chronic kidney disease, and a history of cancer were identified as significant risk factors for unplanned ED visits. Patients with uncemented implants had a significantly greater risk of returning to the ED due to periprosthetic fractures than did those with cemented implants (P = 0.04). Patients who returned to the ED within 90 days had an almost fivefold greater 1-year mortality rate (15.2% vs 3.1%, P < 0.001) and a greater overall mortality rate (26.2% vs 10.5%, P < 0.001).
Conclusions
This study highlights the importance of identifying risk factors for unplanned ED visits after bipolar hemiarthroplasty, which may contribute to a better prognosis. Consideration should be given to the use of cemented implants for hemiarthroplasty, as uncemented implants are associated with a greater risk of peri prosthetic fractures.
9.Coronary Stent Infection Presented as Recurrent Stent Thrombosis.
Chih Hung LAI ; Yung Kai LIN ; Wen Lieng LEE ; Wei Chun CHANG
Yonsei Medical Journal 2017;58(2):458-461
Percutaneous transluminal coronary angioplasty with metal stent placement has become a well-developed treatment modality for coronary stenotic lesions. Although infection involving implanted stents is rare, it can, however, occur with high morbidity and mortality. We describe herein a case of an inserted coronary stent that was infected and complicated with recurrent stent thrombosis, pseudoaneurysm formation and severe sepsis. Despite repeated intervention and bypass surgery, the patient died from severe sepsis.
Aneurysm, False
;
Angioplasty, Balloon, Coronary
;
Humans
;
Mortality
;
Myocardial Infarction
;
Sepsis
;
Stents*
;
Thrombosis*
10.Intestinal Stricture in Crohn's Disease.
Chen Wang CHANG ; Jau Min WONG ; Chien Chih TUNG ; I Lun SHIH ; Horng Yuan WANG ; Shu Chen WEI
Intestinal Research 2015;13(1):19-26
Crohn's disease (CD) is a disease with chronic inflammation of unknown etiology involving any part of the gastrointestinal tract. The incidence and prevalence of CD are increasing recently in Asia. Half of the CD patients will have intestinal complications, such as strictures or fistulas, within 20 years after diagnosis. Twenty-five percentage of CD patients have had at least one small bowel stricture and 10% have had at least one colonic stricture and lead to significant complications. Most of these patients will require at least one surgery during their lifetime. Early diagnosis and evaluation with adequate managements for the patients can prevent disability and mortality of these patient. Here, we reviewed the current incidence of CD with stricture, the etiology of stricture, and how to diagnose and manage the stricture.
Asia
;
Colon
;
Constriction, Pathologic*
;
Crohn Disease*
;
Diagnosis
;
Disease Management
;
Early Diagnosis
;
Fistula
;
Gastrointestinal Tract
;
Humans
;
Incidence
;
Inflammation
;
Intestines
;
Mortality
;
Prevalence