BACKGROUND: Isolated infraspinatus tear is very rare and clinical features are not as well known, therefore the purpose of this study was to evaluate clinical characteristics and outcomes of isolated infraspinatus tear that authors experienced. METHODS: Authors reviewed 288 cases of full-thickness rotator cuff tear involving infraspinatus between 2010 and 2015, and retrospectively analyzed six cases of isolated infraspinatus tear. Perioperative clinical characteristics, postoperative functional outcomes of 6 months were investigated. Functional evaluation included visual analogue scale (VAS), range of motions, American Shoulder and Elbow Surgeons (ASES) score, and Constant score. RESULTS: Calcific tendinitis was accompanied in 4 cases (66.7%). Three of them received steroid injection or aspiration or extracorporeal shockwave therapy. Mean preoperative pain VAS was 7.1 (range, 5–9), and mean postoperative pain VAS at 6 months later was 1.6 (range, 0–5). Preoperative muscle strength by isokinetic muscle performance test showed 52% deficit of abduction and 37.6% deficit of external rotation. All 6 patients had arthroscopic repair of the infraspinatus tendon. All the patients at the 6 months follow-up exhibited clinical improvement in the Constant score (67.8 [range, 45–77] to 89.3 [range, 81–100], p=0.029), and ASES score (52.3 [range, 30–77] to 90.0 [range, 80–100], p=0.002). There was no healing failure on imaging. CONCLUSIONS: Isolated infraspinatus tendon tear was frequently accompanied by calcific tendinitis, but pathophysiologic relationship should need more study. To rule out neurogenic etiology, magnetic resonance imaging and electromyography would be helpful. Arthroscopic infraspinatus tendon repair and supraspinatus debridement showed relatively good result in painful shoulder.
Debridement ; Elbow ; Electromyography ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Muscle Strength ; Pain, Postoperative ; Retrospective Studies ; Rotator Cuff ; Rupture* ; Shoulder ; Surgeons ; Tears ; Tendinopathy ; Tendons

The corresponding author's name and E-mail address have been corrected. This article was corrected online. The authors would like to apologize for any inconvenience cause.

No abstract available.
Multiple Organ Failure* ; Sepsis*

No abstract available.
Multiple Organ Failure* ; Sepsis*

The corresponding author's name and E-mail address have been corrected. This article was corrected online. The authors would like to apologize for any inconvenience cause.
Electronic Mail ; Rupture

An irreparable rotator cuff tear refers to a situation where the tear in the rotator cuff is large, and there is significant fatty degeneration and atrophy, making it impossible to suture the torn ends back to the humeral head. Various treatment options, including tendon transfer procedures, can be considered in such cases. Tendon transfer may be chosen for younger and active patients, and the selection should consider the advantages and disadvantages, the characteristics of different tendon transfer techniques and the condition of the rotator cuff.The lack of established standard treatment guidelines highlights the need for, further research and clinical experience. Future studies will be needed to establish the effectiveness and safety of treatments, and efforts should be made to improve treatment methods and ensure appropriate patient selection.

BACKGROUND: Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. METHODS: Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. RESULTS: The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. CONCLUSIONS: A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.
Adult ; Aged ; Arthroscopy/*adverse effects/*methods ; Carboxymethylcellulose Sodium ; Drug Carriers ; Female ; Humans ; Hyaluronic Acid/adverse effects/*therapeutic use ; Male ; Middle Aged ; Pain ; Prospective Studies ; Range of Motion, Articular ; Recovery of Function ; Rotator Cuff/injuries/*surgery ; Shoulder Joint/physiology ; Tissue Adhesions/*prevention & control ; Treatment Outcome ; Viscosupplements/adverse effects/*therapeutic use

PURPOSE: Juvenile xanthogranuloma usually affects the anterior uvea before the age of 1 year, and it may less frequently involve the corneoscleral limbus. We report a case of juvenile xanthogranuloma of the corneoscleral limbus in a 7-year-old boy. METHODS: A 7-year-old boy was referred for the evaluation of a painless limbal mass in the left eye, noticed 1 month previously. On examination, the visual acuity was 16/20 (OD) and 10/20 (OS) without correction, and the corrected visual acuity was 20/20 in both eyes. The other ocular findings were normal, except for an elevated, well circumscribed, smooth surfaced mass measured 9x6 mm at the upper temporal corneoscleral limbus of the left eye. After the excision of the mass, the frozen biopsy and the immunohistochemical staining for CD68 and S100 protein were performed. RESULTS: The lesion consisted of a red-brown, vascular, and raised mass. Histopathologically, there was a chronic granulomatous inflammation with stromal fibrosis, which included many giant cells immunoreactive for CD68 and S100 protein. There was no evidence of recurrence during follow-up period of 5 months and 20 months. CONCLUSIONS: The case was diagnosed as juvenile xanthogranuloma by the clinical and histopathologic findings. The juvenile xanthogranuloma of the corneoscleral limbal involvement is very rare and it can be treated with the surgical excision for the purpose of improvement of cosmetic problems without any recurrence. It seems to have very good prognosis when completely excised.
Biopsy ; Child ; Fibrosis ; Follow-Up Studies ; Giant Cells ; Humans ; Inflammation ; Male ; Prognosis ; Recurrence ; Uvea ; Visual Acuity ; Xanthogranuloma, Juvenile*

Background: Although the effectiveness of acromioplasty is controversial, it is commonly performed during rotator cuff repair to reduce external impingement. During follow-up, osteolysis under the acromion (acromial cupping) could be observed. However, this phenomenon has been rarely addressed in the literature. The purpose of this study was to compare the prevalence and severity of acromial cupping after rotator cuff repair depending on the concomitant performance of acromioplasty and evaluate the influence of acromial cupping on clinical and radiological outcome. Methods: This is a retrospective study involving patients who underwent arthroscopic rotator cuff repair for small-to-large fullthickness rotator cuff tears from October 2015 to March 2019 and clinical follow-up and magnetic resonance imaging at least 1 year postoperatively. A total of 110 patients were enrolled and divided into two groups depending on whether acromioplasty had been performed (group A) or not (group N). The prevalence of acromial cupping was evaluated in each group. In addition, we stratified patients according to the severity of acromial cupping to investigate its influence on healing and functional scores (visual analog scale [VAS], American Shoulder and Elbow Surgeons [ASES] score, simple shoulder test [SST], and Constant-Murley score). Results: There were 85 patients in group A and 25 patients in group N. The prevalence of acromial cupping and acromial cysts was as follows: 36.4% (40 patients) and 6.4% (7 patients), respectively, in the total subjects; 43.5% (37/85) and 5.9% (5/85), respectively, in group A; and 12.0% (3/25) and 8.0% (2/25), respectively, in group N. The prevalence of acromial cupping was significantly different between the two groups (p = 0.012). However, functional outcomes were not significantly different between groups stratified by the severity of acromial cupping (VAS, p = 0.464; ASES score, p = 0.902; SST, p = 0.816; and Constant-Murley score, p = 0.117). The difference in healing rate was statistically insignificant between groups (p = 0.726). Conclusions The incidence and severity of acromial cupping were significantly greater in patients who underwent rotator cuff repair with acromioplasty. It was a relatively common phenomenon, especially after acromioplasty. However, neither the existence nor the severity of acromial cupping affected functional outcomes or healing.

OBJECTIVE: Hyponatremia (Na<135 mEq/L) is associated with cerebral ischemia after subarachnoid hemorrhage (SAH) and the incidence was reported as 9-34% of treated cases of SAH. This study was undertaken to clarify the clinical factors of hyponatremia in ruptured intracranial aneurysms. METHODS: Total 170 consecutive patients with ruptured intracranial aneurysms were included in this study and the incidence and timing of hyponatremia were analyzed retrospectively. Clinical severity quantified by the Hunt and Hess grade and Fisher's grade at admission, location of ruptured aneurysm, presence of vasospasm, onset of hyponatremia, development of hydrocephalus and Glasgow Outcome Scale (GOS) were analyzed in patients with hyponatremia. RESULTS: Hyponatremia occurred in 32 (40.5%) of 79 patients with anterior cerebral artery (ACA) aneurysm group, in 18 (40.0%) of 45 patients with internal cerebral artery (ICA) aneurysm group and in nine (22.5%) of 40 patients with middle cerebral artery (MCA) aneurysm group. Hyponatremia occurred significantly more often in cases with vasospasm and hyrocephalus (p<0.05). Among vasospasm cases, hyponatremia was not associated with the location of aneurysm or hydrocepalus. Respective days of onset for symptomatic vasospasm and for hyponatremia were day 7.2+/-3.3 and day 9.9+/-5.5 following SAH (p<0.05). CONCLUSION: Hyponatremia occurred more frequently in patients with vasospasm and hydrocephalus. The onset of hyponatremia was delayed by 3 days following symptomatic vasospasm. Since careful observation for hyponatremia is required during therapy in patients with vasospasm.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Brain Ischemia ; Cerebral Arteries ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Hyponatremia* ; Incidence ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Retrospective Studies ; Subarachnoid Hemorrhage