Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up.

Science.gov (United States)

Abrams, Geoffrey D; Gupta, Anil K; Hussey, Kristen E; Tetteh, Elizabeth S; Karas, Vasili; Bach, Bernard R; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

2014-06-01

Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated. To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty. Randomized controlled trial; Level of evidence, 2. Patients undergoing arthroscopic repair of full-thickness rotator cuff tears were randomized into acromioplasty or nonacromioplasty groups. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California-Los Angeles (UCLA) score, and Short Form-12 (SF-12) health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Intraoperative data including tear size, repair configuration, and concomitant procedures were recorded. Follow-up examination was performed at regular intervals up to 2 years. Preoperative imaging was reviewed to classify the acromial morphologic type, acromial angle, and lateral acromial angulation. A total of 114 patients were initially enrolled in the study, and 95 (83%; 43 nonacromioplasty, 52 acromioplasty) were available for a minimum 2-year follow-up. There were no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles. Within groups, there was a significant (P < .001) improvement in all functional outcome scores from preoperatively to all follow-up time points, including 2 years, for the nonacromioplasty and acromioplasty groups (ASES score: 55.1-91.5, 48.8-89.0; Constant score: 48.3-75.0, 51.9-78.7, respectively). There were no significant differences in functional outcomes between nonacromioplasty and acromioplasty groups or between subjects with different acromial features at any time point. The results of this study demonstrate no difference in clinical outcomes after rotator cuff repair

Degenerative full thickness rotator cuff tears : Towards optimal management

NARCIS (Netherlands)

Lambers Heerspink, Frederik

2016-01-01

The shoulder is one of the most complex joints in the body. Besides a wide range of motion it also has to be stable. The rotator cuff is a major stabiliser of the glenohumoral joint. With increasing age rotator cuff tears are common. Successful treatment is described following surgical (rotator cuff

What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.

Science.gov (United States)

Boorman, Richard S; More, Kristie D; Hollinshead, Robert M; Wiley, James P; Mohtadi, Nicholas G; Lo, Ian K Y; Brett, Kelly R

2018-03-01

The purpose of this study was to examine 5-year outcomes in a prospective cohort of patients previously enrolled in a nonoperative rotator cuff tear treatment program. Patients with chronic (>3 months), full-thickness rotator cuff tears (demonstrated on imaging) who were referred to 1 of 2 senior shoulder surgeons were enrolled in the study between October 2008 and September 2010. They participated in a comprehensive, nonoperative, home-based treatment program. After 3 months, the outcome in these patients was defined as "successful" or "failed." Patients in the successful group were essentially asymptomatic and did not require surgery. Patients in the failed group were symptomatic and consented to undergo surgical repair. All patients were followed up at 1 year, 2 years, and 5 or more years. At 5 or more years, all patients were contacted for follow-up; the response rate was 84%. Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100 (SD, 16). Furthermore, between 2 and 5 years, only 3 patients who had previously been defined as having a successful outcome became more symptomatic and underwent surgical rotator cuff repair. Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 (SD, 11) at 5-year follow-up. The operative and nonoperative groups at 5-year follow-up were not significantly different (P = .11). Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation

International Nuclear Information System (INIS)

Kang, Chang Ho; Kim, Sam Soo; Kim, Jung Hyuk; Chung, Kyoo Byung; Kim, Yun Hwan; Oh, Yu-Whan; Jeong, Woong-Kyo; Kim, Baek Hyun

2009-01-01

The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small ( 3 cm). The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears. (orig.)

Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation

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Kang, Chang Ho [Kangwon National University Hospital, Department of Radiology, Kangwon-do (Korea); Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea); Kim, Sam Soo [Kangwon National University Hospital, Department of Radiology, Kangwon-do (Korea); Kim, Jung Hyuk; Chung, Kyoo Byung; Kim, Yun Hwan; Oh, Yu-Whan [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea); Jeong, Woong-Kyo [Korea University Anam Hospital, Korea University College of Medicine, Orthopaedic Surgery, Seoul (Korea); Kim, Baek Hyun [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan City (Korea)

2009-11-15

The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small (<1 cm), medium (1-3 cm), and large (>3 cm). The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears. (orig.)

Cost-effectiveness of magnetic resonance imaging versus ultrasound for the detection of symptomatic full-thickness supraspinatus tendon tears.

Science.gov (United States)

Gyftopoulos, Soterios; Guja, Kip E; Subhas, Naveen; Virk, Mandeep S; Gold, Heather T

2017-12-01

The purpose of this study was to determine the value of magnetic resonance imaging (MRI) and ultrasound-based imaging strategies in the evaluation of a hypothetical population with a symptomatic full-thickness supraspinatus tendon (FTST) tear using formal cost-effectiveness analysis. A decision analytic model from the health care system perspective for 60-year-old patients with symptoms secondary to a suspected FTST tear was used to evaluate the incremental cost-effectiveness of 3 imaging strategies during a 2-year time horizon: MRI, ultrasound, and ultrasound followed by MRI. Comprehensive literature search and expert opinion provided data on cost, probability, and quality of life estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs) through 2 years, with a willingness-to-pay threshold set to $100,000/QALY gained (2016 U.S. dollars). Costs and health benefits were discounted at 3%. Ultrasound was the least costly strategy ($1385). MRI was the most effective (1.332 QALYs). Ultrasound was the most cost-effective strategy but was not dominant. The incremental cost-effectiveness ratio for MRI was $22,756/QALY gained, below the willingness-to-pay threshold. Two-way sensitivity analysis demonstrated that MRI was favored over the other imaging strategies over a wide range of reasonable costs. In probabilistic sensitivity analysis, MRI was the preferred imaging strategy in 78% of the simulations. MRI and ultrasound represent cost-effective imaging options for evaluation of the patient thought to have a symptomatic FTST tear. The results indicate that MRI is the preferred strategy based on cost-effectiveness criteria, although the decision between MRI and ultrasound for an imaging center is likely to be dependent on additional factors, such as available resources and workflow. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial-thickness tears of the rotator cuff.

Science.gov (United States)

Brockmeyer, Matthias; Schmitt, Cornelia; Haupert, Alexander; Kohn, Dieter; Lorbach, Olaf

2017-12-01

The reliable diagnosis of partial-thickness tears of the rotator cuff is still elusive in clinical practise. Therefore, the purpose of the study was to determine the diagnostic accuracy of MR imaging and clinical tests for detecting partial-thickness tears of the rotator cuff as well as the combination of these parameters. 334 consecutive shoulder arthroscopies for rotator cuff pathologies performed during the time period between 2010 and 2012 were analyzed retrospectively for the findings of common clinical signs for rotator cuff lesions and preoperative MR imaging. These were compared with the intraoperative arthroscopic findings as "gold standard". The reports of the MR imaging were evaluated with regard to the integrity of the rotator cuff. The Ellman Classification was used to define partial-thickness tears of the rotator cuff in accordance with the arthroscopic findings. Descriptive statistics, sensitivity, specificity, positive and negative predictive value were calculated. MR imaging showed 80 partial-thickness and 70 full-thickness tears of the rotator cuff. The arthroscopic examination confirmed 64 partial-thickness tears of which 52 needed debridement or refixation of the rotator cuff. Sensitivity for MR imaging to identify partial-thickness tears was 51.6%, specificity 77.2%, positive predictive value 41.3% and negative predictive value 83.7%. For the Jobe-test, sensitivity was 64.1%, specificity 43.2%, positive predictive value 25.9% and negative predictive value 79.5%. Sensitivity for the Impingement-sign was 76.7%, specificity 46.6%, positive predictive value 30.8% and negative predictive value 86.5%. For the combination of MR imaging, Jobe-test and Impingement-sign sensitivity was 46.9%, specificity 85.4%, positive predictive value 50% and negative predictive value 83.8%. The diagnostic accuracy of MR imaging and clinical tests (Jobe-test and Impingement-sign) alone is limited for detecting partial-thickness tears of the rotator cuff. Additionally

Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

International Nuclear Information System (INIS)

Ilaslan, Hakan; Recht, Michael P.; Iannotti, Joseph P.

2007-01-01

To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear. (orig.)

Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

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Ilaslan, Hakan; Recht, Michael P. [Cleveland Clinic, Musculoskeletal Radiology/A21, Division of Radiology, Cleveland, OH (United States); Iannotti, Joseph P. [Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH (United States)

2007-06-15

To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear. (orig.)

Comparative studies of MRI and operative findings in rotator cuff tear

International Nuclear Information System (INIS)

Yamakawa, Seigo; Ichikawa, Norikazu; Itadera, Eichi; Hashizume, Hiroyuki; Inoue, Hajime

2001-01-01

A prospective study was performed to determine the accuracy of magnetic resonance imaging (MRI) compared with operative findings in the evaluation of patients associated with rotator cuff tears. Fifty-four of 60 shoulders (58 patients) examined by MRI were confirmed as full-thickness tears and 6 as partial-thickness tears at the time of surgery. The oblique coronal, oblique sagittal, and axial planes of T2-weighted images with the 0.5 tesla MRI system were obtained preoperatively and compared with operative findings. MRI correctly identified 46 of 54 full-thickness rotator cuff tears and 5 of 6 partial-thickness tears. A comparison of MRI and operative findings in full-thickness cuff tears showed a sensitivity of 85%, a specificity of 83%, and a positive prospective value (PPV) of 99%. A comparison of partial-thickness tears showed a sensitivity of 83%, a specificity of 85%, and PPV of 39%. Linear regression analysis showed an excellent correlation between the MRI assessment and measurement at the time of surgery (r=0.90, P<0.01). MRI was useful in evaluating large and medium-sized rotator cuff tears, but less useful in distinguishing small full-thickness tears from partial-thickness tears. (author)

MR Imaging of Rotator Cuff Tears: Correlation with Arthroscopy

Science.gov (United States)

Bhandary, Sudarshan; Khandige, Ganesh; Kabra, Utkarsh

2017-01-01

Introduction Rotator cuff tears are quite common and can cause significant disability. Magnetic Resonance Imaging (MRI) has now emerged as the modality of choice in the preoperative evaluation of patients with rotator cuff injuries, in view of its improved inherent soft tissue contrast and resolution. Aim To evaluate the diagnostic accuracy of routine MRI in the detection and characterisation of rotator cuff tears, by correlating the findings with arthroscopy. Materials and Methods This prospective study was carried out between July 2014 and August 2016 at the AJ Institute of Medical Sciences, Mangalore, Karnataka, India. A total of 82 patients were diagnosed with rotator cuff injury on MRI during this period, out of which 45 patients who underwent further evaluation with arthroscopy were included in this study. The data collected was analysed for significant correlation between MRI diagnosis and arthroscopic findings using kappa statistics. The sensitivity, specificity, predictive value and accuracy of MRI for the diagnosis of full and partial thickness tears were calculated using arthroscopic findings as the reference standard. Results There were 27 males and 18 females in this study. The youngest patient was 22 years and the oldest was 74 years. Majority of rotator cuff tears (78%) were seen in patients above the age of 40 years. MRI showed a sensitivity of 89.6%, specificity of 100%, positive predictive value of 100% and negative predictive value of 83.3% for the diagnosis of full thickness rotator cuff tears. For partial thickness tears, MRI showed a sensitivity of 100%, specificity of 86.6%, positive predictive value of 78.9% and negative predictive value of 100%. The accuracy was 93.1% for full thickness tears and 91.1% for partial thickness tears. The p-value was less than 0.01 for both full and partial thickness tears. There was good agreement between the MRI and arthroscopic findings, with kappa value of 0.85 for full thickness tears and 0.81 for partial

Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

International Nuclear Information System (INIS)

Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K.; Imhoff, A.B.

2007-01-01

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

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Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K. [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Imhoff, A.B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Munich (Germany)

2007-02-15

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

Epidemiology, natural history, and indications for treatment of rotator cuff tears.

Science.gov (United States)

Tashjian, Robert Z

2012-10-01

The etiology of rotator cuff disease is likely multifactorial, including age-related degeneration and microtrauma and macrotrauma. The incidence of rotator cuff tears increases with aging with more than half of individuals in their 80s having a rotator cuff tear. Smoking, hypercholesterolemia, and genetics have all been shown to influence the development of rotator cuff tearing. Substantial full-thickness rotator cuff tears, in general, progress and enlarge with time. Pain, or worsening pain, usually signals tear progression in both asymptomatic and symptomatic tears and should warrant further investigation if the tear is treated conservatively. Larger (>1-1.5 cm) symptomatic full-thickness cuff tears have a high rate of tear progression and, therefore, should be considered for earlier surgical repair in younger patients if the tear is reparable and there is limited muscle degeneration to avoid irreversible changes to the cuff, including tear enlargement and degenerative muscle changes. Smaller symptomatic full-thickness tears have been shown to have a slower rate of progression, similar to partial-thickness tears, and can be considered for initial nonoperative treatment due to the limited risk for rapid tear progression. In both small full-thickness tears and partial-thickness tears, increasing pain should alert physicians to obtain further imaging as it can signal tear progression. Natural history data, along with information on factors affecting healing after rotator cuff repair, can help guide surgeons in making appropriate decisions regarding the treatment of rotator cuff tears. The management of rotator cuff tears should be considered in the context of the risks and benefits of operative versus nonoperative treatment. Tear size and acuity, the presence of irreparable changes to the rotator cuff or glenohumeral joint, and patient age should all be considered in making this decision. Initial nonoperative care can be safely undertaken in older patients (>70

Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable.

Science.gov (United States)

Cho, Nam Su; Moon, Seong Cheol; Hong, Se Jung; Bae, Seong Hae; Rhee, Yong Girl

2017-09-01

The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. Cohort study; Level of evidence, 3. One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

International Nuclear Information System (INIS)

Fotiadou, Anastasia N.; Vlychou, Marianna; Papadopoulos, Periklis; Karataglis, Dimitrios S.; Palladas, Panagiotis; Fezoulidis, Ioannis V.

2008-01-01

Purpose: To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears. Materials and methods: Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery. Results: Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively. Conclusions: In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

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Fotiadou, Anastasia N. [Radiology Department, University Hospital of Larissa, Mezourlo 41110, Larissa (Greece); Radiology Department, G. Papanikolaou Hospital, Exochi 32100, Thessaloniki (Greece)], E-mail: natfot@yahoo.gr; Vlychou, Marianna [Radiology Department, University Hospital of Larissa, Mezourlo 41110, Larissa (Greece)], E-mail: mvlychou@med.uth.gr; Papadopoulos, Periklis [University Orthopaedic Clinic, G. Papanikolaou Hospital, Exochi 32100, Thessaloniki (Greece)], E-mail: perpap@otenet.gr; Karataglis, Dimitrios S. [University Orthopaedic Clinic, G. Papanikolaou Hospital, Exochi 32100, Thessaloniki (Greece)], E-mail: dkarataglis@yahoo.gr; Palladas, Panagiotis [Radiology Department, G. Papanikolaou Hospital, Exochi 32100, Thessaloniki (Greece)], E-mail: palladaspan@in.gr; Fezoulidis, Ioannis V. [Radiology Department, University Hospital of Larissa, Mezourlo 41110, Larissa (Greece)], E-mail: oswestanast@yahoo.gr

2008-10-15

Purpose: To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears. Materials and methods: Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery. Results: Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively. Conclusions: In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears.

Effects of artificial tear treatment on corneal epithelial thickness and corneal topography findings in dry eye patients.

Science.gov (United States)

Çakır, B; Doğan, E; Çelik, E; Babashli, T; Uçak, T; Alagöz, G

2018-05-01

To investigate the effects of artificial tear treatment on central corneal epithelial thickness, and central, mid-peripheral and peripheral corneal thicknesses in patients with dry eye disease (DED). Patients with DED underwent ocular examinations, including Schirmer-2 test, slit lamp examination for tear break-up time (BUT), corneal topography (CT) for measuring mean central, mid-peripheral and peripheral corneal thickness values and anterior segment optic coherence tomography (AS-OCT) for obtaining central corneal epithelial thickness. After artificial tear treatment (carboxymethylcellulose and sodium hyaluronate formulations) for one month, patients were examined again at a second visit and the results were compared. Sixty-one eyes of 33 female dry eye patients (mean age: 38.3±5.7 years) were enrolled. The mean follow-up time was 36.4±3.3 days. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment (P=0.000, P=0.000, respectively). Central corneal epithelium and mean mid-peripheral corneal thicknesses measured significantly higher after treatment (P=0.001, P=0.02). Changes in central and peripheral corneal thicknesses were not statistically significant. Artificial tear treatment in dry eye patients seems to increase central corneal epithelial and mid-peripheral corneal thicknesses. Measurement of corneal epithelial thickness can be a useful tool for evaluation of treatment response in dry eye patients. Further long-term prospective studies are needed to investigate this item. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears.

Science.gov (United States)

Keener, Jay D; Galatz, Leesa M; Teefey, Sharlene A; Middleton, William D; Steger-May, Karen; Stobbs-Cucchi, Georgia; Patton, Rebecca; Yamaguchi, Ken

2015-01-21

The purpose of this prospective study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears. Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospective longitudinal study. Two hundred and twenty-four subjects (118 initial full-thickness tears, fifty-six initial partial-thickness tears, and fifty controls) were followed for a median of 5.1 years. Validated functional shoulder scores were calculated (visual analog pain scale, American Shoulder and Elbow Surgeons [ASES], and simple shoulder test [SST] scores). Subjects were followed annually with shoulder ultrasonography and clinical evaluations. Tear enlargement was seen in 49% of the shoulders, and the median time to enlargement was 2.8 years. The occurrence of tear-enlargement events was influenced by the severity of the final tear type, with enlargement of 61% of the full-thickness tears, 44% of the partial-thickness tears, and 14% of the controls (p tear enlargement. One hundred subjects (46%) developed new pain. The final tear type was associated with a greater risk of pain development, with the new pain developing in 28% of the controls, 46% of the shoulders with a partial-thickness tear, and 50% of those with a full-thickness tear (p tear enlargement was associated with the onset of new pain (p muscle were associated with tear enlargement, with supraspinatus muscle degeneration increasing in 4% of the shoulders with a stable tear compared with 30% of the shoulders with tear enlargement (p tear showed increased infraspinatus muscle degeneration compared with 28% of those in which the tear had enlarged (p = 0.07). This study demonstrates the progressive nature of degenerative rotator cuff disease. The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear, and tear

Neotendon infilling of a full thickness rotator cuff foot print tear following ultrasound guided liquid platelet rich plasma injection and percutaneous tenotomy: favourable outcome up to one year [v1; ref status: indexed, http://f1000r.es/xz

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Arockia Doss

2013-01-01

Full Text Available This is a case report on excellent clinical outcome and neotendon infilling at one year follow up in a degenerative rotator cuff full thickness tear following percutaneous tenotomy and platelet rich plasma injection.

Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study.

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Gartsman, Gary M; Drake, Gregory; Edwards, T Bradley; Elkousy, Hussein A; Hammerman, Steven M; O'Connor, Daniel P; Press, Cyrus M

2013-11-01

The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024). Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears

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Ji Jong-Hun

2010-01-01

Full Text Available Background: There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. Materials and Methods: 22 patients of arthroscopic single row repair (group I and 25 patients who underwent double row repair (group II from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES. Results: In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Conclusions: Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

MRI in diagnosing partial thickness tears of the rotator cuff

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Ogawa, Takeshi

2000-01-01

In this study 270 patients who had been treated for 10 years and had suspected rupture of the tendon and complete or partial thickness tears of the rotator cuff were diagnosed. Among these patients, MRI images in 50 cases were investigated to establish the diagnostic criteria for partial thickness tears of the rotator cuff. The rupture sites included the bursal surface in 15 shoulders, the articular surface in 30 shoulders, complicated cases of both surfaces in five shoulders with no intrasubstance. As for the imaging method, T2-weighted images were employed and the oblique coronary section, which is parallel to the scapula, was used as a imaging plane. From the results of the variation of the MRI signal intensity in the tendon, it was found that the signal intensity increased to 80% in the rupture of the bursal surface and 93.3% in the rupture of the articular surface. As for sites where the signals in the tendon increased, these were found at the bursal side in 83.3% of rupture at the bursal surface, and at the articular side in 100% of rupture at the articular surface. From these findings, the MRI-diagnostic criteria of partial thickness tears of the rotator cuff was defined as those cases which show a localized increase in signal intensity on the oblique coronary surface of T2 weighted images, but not in whole layers of the tendon. A high diagnostic rate with these criteria could be obtained with a sensitivity of 82.0%, specificity 90.9%, accuracy 84.7%, and positive predictive value 95.3%. (author)

HIGH-RESOLUTION ULTRASONOGRAPHY OF SHOULDER FOR ROTATOR CUFF TEAR: CORRELATION WITH ARTHROSCOPIC FINDINGS

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Vishnumurthy H. Y

2016-09-01

Full Text Available INTRODUCTION Rotator cuff disease is the most common cause of shoulder pain. Ultrasonography being non-invasive, widely available, more cost-effective method and is the first choice in imaging of rotator cuff tears. Arthroscopy of shoulder is considered as the gold standard for diagnosis of rotator cuff tears. Objective of this study was to compare the diagnostic accuracy of high-resolution ultrasonography of shoulder for rotator cuff tears with arthroscopy of shoulder. METHODS Thirty patients clinically suspected to have rotator cuff tear who underwent ultrasonography and arthroscopy of shoulder were included in the study. Duration of study was for two years. All ultrasonography examinations were conducted in ultrasound machine using GE Voluson 730 PRO high frequency (10-12 MHz linear array transducer done by two experienced radiologists. Arthroscopies were done by two experienced shoulder arthroscopic surgeons. RESULTS Age of the patients with rotator cuff tears ranged from 40 to 80 years. 57% were females and 43% were males among the patients who had rotator cuff tears. 71.43% of the rotator cuff tears were found in the dominant arm. 64.28% of patients with rotator cuff tear had given history of fall or trauma to the corresponding shoulder within 6 months prior to presentation. 39.28% of patients who had rotator cuff tears were known diabetics. Supraspinatus tendon was the most commonly affected tendon, followed by infraspinatus and subscapularis tendons. For overall detection of rotator cuff tears, ultrasonography in comparison with the arthroscopy has sensitivity and specificity of 92.85% and 100%. For detection of full thickness rotator cuff tear, its sensitivity and specificity was 94.73% and 100% and for partial thickness rotator cuff tears 76.92% and 100%. Ultrasonography has 100% sensitivity and specificity for detection of supraspinatus full thickness tear. For supraspinatus partial thickness tear, sensitivity and specificity was 88

Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears.

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Ji, Jong-Hun; Shafi, Mohamed; Kim, Weon-Yoo; Kim, Young-Yul

2010-07-01

There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. 22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES). In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

Relationship of Tear Size and Location to Fatty Degeneration of the Rotator Cuff

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Kim, H. Mike; Dahiya, Nirvikar; Teefey, Sharlene A.; Keener, Jay D.; Galatz, Leesa M.; Yamaguchi, Ken

2010-01-01

Background: Fatty degeneration of the rotator cuff muscles may have detrimental effects on both anatomical and functional outcomes following shoulder surgery. The purpose of this study was to investigate the relationship between tear geometry and muscle fatty degeneration in shoulders with a deficient rotator cuff. Methods: Ultrasonograms of both shoulders of 262 patients were reviewed to assess the type of rotator cuff tear and fatty degeneration in the supraspinatus and infraspinatus muscles. The 251 shoulders with a full-thickness tear underwent further evaluation for tear size and location. The relationship of tear size and location to fatty degeneration of the supraspinatus and infraspinatus muscles was investigated with use of statistical comparisons and regression models. Results: Fatty degeneration was found almost exclusively in shoulders with a full-thickness rotator cuff tear. Of the 251 shoulders with a full-thickness tear, eighty-seven (34.7%) had fatty degeneration in either the supraspinatus or infraspinatus, or both. Eighty-two (32.7%) of the 251 full-thickness tears had a distance of 0 mm between the biceps tendon and anterior margin of the tear. Ninety percent of the full-thickness tears with fatty degeneration in both muscles had a distance of 0 mm posterior from the biceps, whereas only 9% of those without fatty degeneration had a distance of 0 mm. Tears with fatty degeneration had significantly greater width and length than those without fatty degeneration (p Tears with fatty degeneration had a significantly shorter distance posterior from the biceps than those without fatty degeneration (p tear width and length were found to be the most important predictors for infraspinatus fatty degeneration. Conclusions: Fatty degeneration of the rotator cuff muscles is closely associated with tear size and location. The finding of this study suggests that the integrity of the anterior supraspinatus tendon is important to the development of fatty

MR Imaging of a Posterior Root Tear of the Medial Meniscus: Diagnostic Accuracy of Various Tear Configurations and Associated Knee Abnormalities

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Lee, Hyang Mi; Shim, Jae Chan; Kim, Jin Goo; Lee, Jae Myeong; Nam, Mee Young; Lee, Ghi Jai; Kim, Ho Kyun; Suh, Jung Ho

2010-01-01

To evaluate the diagnostic accuracy of the various tear configurations in a medial meniscal posterior horn root tear and assess whether any correlation exists with other associated knee abnormalities in MR imaging. A retrospective review of 146 preoperative knee MR images were performed by one experienced musculoskeletal radiologist. The tear configuration and other abnormalities were evaluated. Sensitivity, specificity, and diagnostic accuracy of each configuration in the medial meniscal posterior horn root tear were calculated. A total of 48 medial meniscal posterior horn root tears including 38 full-thickness radial, 7 partial-thickness radial, and 3 complex tears were confirmed during arthroscopy. Overall, the sensitivity, specificity, and accuracy for the detection of medial meniscal posterior horn root tear were 92% (44/48), 99% (97/98), and 97% (141/146), respectively. For each tear configuration, sensitivity, specificity, and accuracy were 82% (31/38), 97% (105/108), and 93% (136/146) for full-thickness radial tears, respectively, and 43% (3/7), 94% (131/139), and 91% (134/146) for partial-thickness radial tears, respectively. The incidence of degenerative joint disease was 85% (41/48) for the tear group, revealing a strong association. In patients with a root tear and with degenerative joint disease, the incidence of high grade cartilage defects involving the medial femoral condyle was at 80% (33/41), compared to 56% (23/41) for the presence of medial meniscal extrusion. In contrast, a similar comparison of incidence for patients with no root tears but with degenerative joint disease was at 68% (17/25) and 26% (8/31), respectively. MR imaging is very sensitive for the detection of medial meniscal root tears, but has reduced the accuracy with regard to each tear configuration. Medial meniscal root tears showed a strong association with degenerative joint disease. High grade cartilage defects of the medial femoral condyle and medial meniscal extrusions also

MR Imaging of a Posterior Root Tear of the Medial Meniscus: Diagnostic Accuracy of Various Tear Configurations and Associated Knee Abnormalities

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Lee, Hyang Mi; Shim, Jae Chan; Kim, Jin Goo; Lee, Jae Myeong; Nam, Mee Young; Lee, Ghi Jai; Kim, Ho Kyun; Suh, Jung Ho [Inje University College of Medicine, Seoul Paik Hospital, Seoul (Korea, Republic of)

2010-11-15

To evaluate the diagnostic accuracy of the various tear configurations in a medial meniscal posterior horn root tear and assess whether any correlation exists with other associated knee abnormalities in MR imaging. A retrospective review of 146 preoperative knee MR images were performed by one experienced musculoskeletal radiologist. The tear configuration and other abnormalities were evaluated. Sensitivity, specificity, and diagnostic accuracy of each configuration in the medial meniscal posterior horn root tear were calculated. A total of 48 medial meniscal posterior horn root tears including 38 full-thickness radial, 7 partial-thickness radial, and 3 complex tears were confirmed during arthroscopy. Overall, the sensitivity, specificity, and accuracy for the detection of medial meniscal posterior horn root tear were 92% (44/48), 99% (97/98), and 97% (141/146), respectively. For each tear configuration, sensitivity, specificity, and accuracy were 82% (31/38), 97% (105/108), and 93% (136/146) for full-thickness radial tears, respectively, and 43% (3/7), 94% (131/139), and 91% (134/146) for partial-thickness radial tears, respectively. The incidence of degenerative joint disease was 85% (41/48) for the tear group, revealing a strong association. In patients with a root tear and with degenerative joint disease, the incidence of high grade cartilage defects involving the medial femoral condyle was at 80% (33/41), compared to 56% (23/41) for the presence of medial meniscal extrusion. In contrast, a similar comparison of incidence for patients with no root tears but with degenerative joint disease was at 68% (17/25) and 26% (8/31), respectively. MR imaging is very sensitive for the detection of medial meniscal root tears, but has reduced the accuracy with regard to each tear configuration. Medial meniscal root tears showed a strong association with degenerative joint disease. High grade cartilage defects of the medial femoral condyle and medial meniscal extrusions also

Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair.

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Gwak, Heui-Chul; Kim, Chang-Wan; Kim, Jung-Han; Choo, Hye-Jeung; Sagong, Seung-Yeob; Shin, John

2015-05-01

The purpose of this study was to evaluate the extension of delamination and the cuff integrity after arthroscopic repair of delaminated rotator cuff tears. Sixty-five patients with delaminated rotator cuff tears were retrospectively reviewed. The delaminated tears were divided into full-thickness delaminated tears and partial-thickness delaminated tears. To evaluate the medial extension, we calculated the coronal size of the delaminated portion. To evaluate the posterior extension, we checked the tendon involved. Cuff integrity was evaluated by computed tomography arthrography. The mean medial extension in the full-thickness and partial-thickness delaminated tears was 18.1 ± 6.0 mm and 22.7 ± 6.3 mm, respectively (P = .0084). The posterior extension into the supraspinatus and the infraspinatus was 36.9% and 32.3%, respectively, in the full-thickness delaminated tears, and it was 27.7% and 3.1%, respectively, in the partial-thickness delaminated tears (P = .0043). With regard to cuff integrity, 35 cases of anatomic healing, 10 cases of partial healing defects, and 17 cases of retear were detected. Among the patients with retear and partial healing of the defect, all the partially healed defects showed delamination. Three retear patients showed delamination, and 14 retear patients did not show delamination; the difference was statistically significant (P = .0001). The full-thickness delaminated tears showed less medial extension and more posterior extension than the partial-thickness delaminated tears. Delamination did not develop in retear patients, but delamination was common in the patients with partially healed defects. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Detection of rotator cuff tears: the value of MRI following ultrasound

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Rutten, Matthieu J.C.M.; Spaargaren, Gert-Jan; Jager, Gerrit J.; Loon, Ton van; Waal Malefijt, Maarten C. de; Kiemeney, Lambertus A.L.M.

2010-01-01

To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant. (orig.)

Detection of rotator cuff tears: the value of MRI following ultrasound

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Rutten, Matthieu J.C.M.; Spaargaren, Gert-Jan; Jager, Gerrit J. [Jeroen Bosch Ziekenhuis, Department of Radiology, NL' s-Hertogenbosch (Netherlands); Loon, Ton van [Jeroen Bosch Ziekenhuis, Department of Orthopedic Surgery, NL' s-Hertogenbosch (Netherlands); Waal Malefijt, Maarten C. de [Radboud University Nijmegen Medical Centre, Department of Orthopedic Surgery, Nijmegen (Netherlands); Kiemeney, Lambertus A.L.M. [Radboud University Nijmegen Medical Centre, Department of Epidemiology and Biostatistics and HTA, Geert Grooteplein Noord 21, P.O. Box 9101, Nijmegen (Netherlands)

2010-02-15

To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant. (orig.)

Predicting Retear after Repair of Full-Thickness Rotator Cuff Tear: Two-Point Dixon MR Imaging Quantification of Fatty Muscle Degeneration-Initial Experience with 1-year Follow-up.

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Nozaki, Taiki; Tasaki, Atsushi; Horiuchi, Saya; Ochi, Junko; Starkey, Jay; Hara, Takeshi; Saida, Yukihisa; Yoshioka, Hiroshi

2016-08-01

Purpose To determine the degree of preoperative fatty degeneration within muscles, postoperative longitudinal changes in fatty degeneration, and differences in fatty degeneration between patients with full-thickness supraspinatus tears who do and those who do not experience a retear after surgery. Materials and Methods This prospective study had institutional review board approval and was conducted in accordance with the Committee for Human Research. Informed consent was obtained. Fifty patients with full-thickness supraspinatus tears (18 men, 32 women; mean age, 67.0 years ± 8.0; age range, 41-91 years) were recruited. The degrees of preoperative and postoperative fatty degeneration were quantified by using a two-point Dixon magnetic resonance (MR) imaging sequence; two radiologists measured the mean signal intensity on in-phase [S(In)] and fat [S(Fat)] images. Estimates of fatty degeneration were calculated with "fat fraction" values by using the formula S(Fat)/S(In) within the supraspinatus, infraspinatus, and subscapularis muscles at baseline preoperative and at postoperative 1-year follow-up MR imaging. Preoperative fat fractions in the failed-repair group and the intact-repair group were compared by using the Mann-Whitney U test. Results The preoperative fat fractions in the supraspinatus muscle were significantly higher in the failed-repair group than in the intact-repair group (37.0% vs 19.5%, P muscle tended to progress at 1 year postoperatively in only the failed-repair group. Conclusion MR imaging quantification of preoperative fat fractions by using a two-point Dixon sequence within the rotator cuff muscles may be a viable method for predicting postoperative retear. (©) RSNA, 2016.

Long-Term MRI Findings in Operated Rotator Cuff Tear

International Nuclear Information System (INIS)

Kyroelae, K.; Niemitukia, L.; Jaroma, H.; Vaeaetaeinen, U.

2004-01-01

Purpose: To describe magnetic resonance imaging (MRI) findings at long-term follow-up after rotator cuff (RC) tear using standard MRI sequences without fat saturation. Material and Methods: Twenty-eight patients aged 55.8±7.6 underwent MRI examination 4.6±2.1 years after surgery for RC tear. Standard sequences in oblique coronal, oblique sagittal, and axial planes were obtained. The RC, including re-tears and tendon degeneration, was independently evaluated by two observers. Thickness of the supraspinatus tendon and narrowing of the subacromial space were measured. The clinical outcome was evaluated with the Constant score and compared with the MRI findings. Results: The RC tear was traumatic in 18 (64%) patients and degenerative in 10 (36%). At follow-up, 11 (39%) had normal RC tendons with good clinical outcome. Four (14%) patients had painful tendinosis without RC tear. A full-thickness RC tear was found in 7 (25%) patients and a partial tear in 6 (21%). In one patient with a full-thickness tear, and in two with partial tear, tendinosis was found in another of the RC tendons. The subacromial space was narrowed in 13 (46%) of the patients. A narrowing of the subacromial space correlated with re-tear (P<0.05). Conclusions: The RC may be evaluated with standard MRI sequences without fat saturation at long-term follow-up. A normal appearance of the RC is correlated with good clinical outcome, while re-tear and tendinosis are associated with pain

Comparing two acromegalic patients with respect to central corneal thickness, intraocular pressure, and tear insulin-like growth factor levels before and after treatment

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Kan Emrah

2015-01-01

Full Text Available The aim of the study was to compare the central corneal thickness (CCT, intraocular pressure (IOP, and tear insulin-like growth factor-1 (IGF-1 levels of 2 patients with acromegaly before and after the surgical treatment of the disease. CCTs, IOP levels, and tear IGF-1 values showed a decrease after the treatment in 2 patients. As we found higher CCT, IOP, and tear IGF-1 levels in the active phase of the disease in two acromegaly patients, detailed information about the activity of the disease may be important before the examination of these patients.

Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: Accuracy, and inter- and intra-observer agreements

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Jung, Joon-Yong; Jee, Won-Hee; Chun, Ho Jong; Ahn, Myeong Im (Dept. of Radiology, Seoul St. Mary' s Hospital, School of Medicine, Catholic Univ. of Korea, Seoul (Korea)), e-mail: whjee@catholic.ac.kr; Kim, Yang-Soo (Dept. of Orthopedic Surgery, Seoul St. Mary' s Hospital, School of Medicine, Catholic Univ. of Korea, Seoul (Korea))

2010-03-15

Background: Partial-thickness tear of the rotator cuff is a common cause of shoulder pain. Magnetic resonance (MR) arthrography has been described as a useful measure to diagnose rotator cuff abnormalities. Purpose: To determine the reliability and accuracy of MR arthrography with abduction and external rotation (ABER) view for the diagnosis of partial-thickness tears of the rotator cuff. Material and Methods: Among patients who underwent MR arthrographies, 22 patients (12 men, 10 women; mean age 45 years) who had either partial-thickness tear or normal tendon on arthroscopy were included. MR images were independently scored by two observers for partial-thickness tears of the rotator cuff. Interobserver and intraobserver agreements for detection of partial-thickness tears of the rotator cuff were calculated by using kappa coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate Z-score test. Differences in sensitivity and specificity for interpretations based on different imaging series were tested for significance using the McNemar statistic. Results: Sensitivity, specificity, and accuracy of each reader on MR imaging without ABER view were 83%, 90%, and 86%, and 83%, 80%, and 82%, respectively, whereas on overall interpretation including ABER view, the sensitivity, specificity, and accuracy of each reader were 92%, 70%, and 82%, and 92%, 80%, and 86%, respectively. Including ABER view, interobserver agreement for partial-thickness tear increased from kappa=0.55 to kappa=0.68. Likewise, intraobserver agreements increased from kappa=0.79 and 0.53 to kappa=0.81 and 0.70 for each reader, respectively. The areas under the ROC curves for each reader were 0.96 and 0.90, which were not significantly different. Conclusion: Including ABER view in routine sequences of MR arthrography increases the sensitivity, and inter- and intraobserver agreements for detecting partial-thickness tear of rotator cuff

Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: Accuracy, and inter- and intra-observer agreements

International Nuclear Information System (INIS)

Jung, Joon-Yong; Jee, Won-Hee; Chun, Ho Jong; Ahn, Myeong Im; Kim, Yang-Soo

2010-01-01

Background: Partial-thickness tear of the rotator cuff is a common cause of shoulder pain. Magnetic resonance (MR) arthrography has been described as a useful measure to diagnose rotator cuff abnormalities. Purpose: To determine the reliability and accuracy of MR arthrography with abduction and external rotation (ABER) view for the diagnosis of partial-thickness tears of the rotator cuff. Material and Methods: Among patients who underwent MR arthrographies, 22 patients (12 men, 10 women; mean age 45 years) who had either partial-thickness tear or normal tendon on arthroscopy were included. MR images were independently scored by two observers for partial-thickness tears of the rotator cuff. Interobserver and intraobserver agreements for detection of partial-thickness tears of the rotator cuff were calculated by using κ coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate Z-score test. Differences in sensitivity and specificity for interpretations based on different imaging series were tested for significance using the McNemar statistic. Results: Sensitivity, specificity, and accuracy of each reader on MR imaging without ABER view were 83%, 90%, and 86%, and 83%, 80%, and 82%, respectively, whereas on overall interpretation including ABER view, the sensitivity, specificity, and accuracy of each reader were 92%, 70%, and 82%, and 92%, 80%, and 86%, respectively. Including ABER view, interobserver agreement for partial-thickness tear increased from κ=0.55 to κ=0.68. Likewise, intraobserver agreements increased from κ=0.79 and 0.53 to κ=0.81 and 0.70 for each reader, respectively. The areas under the ROC curves for each reader were 0.96 and 0.90, which were not significantly different. Conclusion: Including ABER view in routine sequences of MR arthrography increases the sensitivity, and inter- and intraobserver agreements for detecting partial-thickness tear of rotator cuff tendon

Relationships between rotator cuff tear types and radiographic abnormalities

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Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying [Dept. of Diagnostic Radiology, College of Medicine, Chungbuk National University, Cheongju (Korea, Republic of)

2014-11-15

To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

Relationships between rotator cuff tear types and radiographic abnormalities

International Nuclear Information System (INIS)

Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying

2014-01-01

To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

High-resolution magnetic resonance imaging of rotator cuff tears using a microscopy coil. Noninvasive detection without intraarticular contrast material

International Nuclear Information System (INIS)

Hitachi, Shin; Takase, Kei; Higano, Shuichi; Takahashi, Shoki; Tanaka, Minoru; Tojo, Yuichi; Tabata, Shiro; Majima, Kazuhiro

2011-01-01

The aim of this study was to evaluate the feasibility of high-resolution magnetic resonance imaging (MRI) using a microscopy coil for the diagnosis of rotator cuff tears by comparing the method to conventional MRI and MRI arthrography. A total of 68 shoulders were prospectively studied using a 1.5-T MRI unit. Conventional MRI scans were obtained with a surface coil and high-resolution MRI scans with a microscopy coil. MRI arthrography was performed in 28 shoulders using a surface coil. MRI evaluation of tears of rotator cuff tendons was compared with arthroscopic findings and surgical results. The surgery revealed 40 full-thickness tears, 13 partial-thickness tears, and 15 intact cuffs. In all, 35 (88%) full-thickness tears were correctly diagnosed on conventional MRI and 40 (100%) on high-resolution MRI. MR arthrography delineated 11 of 12 (92%) full-thickness tears. Altogether, 5 (38%) of the partial-thickness tears were detected on conventional MRI, and 12 (92%) were clearly demonstrated on high-resolution MRI. MRI arthrography depicted three (60%) of five partial-thickness tears. High-resolution MRI showed higher sensitivity than conventional MRI (P<0.05) and had values equivalent to those of MRI arthrography for diagnosing partial-thickness tears. High-resolution MRI with a microscopy coil is a feasible, noninvasive technique for diagnosing rotator cuff tears. (author)

The evaluation of central corneal thickness and intraocular pressure in conjunction with tear IGF-1 levels in patients with acromegaly.

Science.gov (United States)

Kan, Emrah; Kan, Elif K; Okuyucu, Ali

2017-08-30

To compare the central corneal thickness (CCT), intraocular pressure (IOP), and tear insulin-like growth factor 1 (IGF-1) levels between patients with acromegaly and a control group and to evaluate the possible effect of tear IGF-1 and duration of the disease on CCT and IOP. We included 31 patients with acromegaly (study group) and 40 age- and sex-matched controls in the study. Patients with acromegaly were divided into 2 subgroups based on disease status (active/inactive). All participants underwent complete ophthalmologic evaluation including CCT and IOP values. Basal tear samples were collected from both groups and tear IGF-1 levels were measured. The CCT, IOP, and tear IGF-1 levels were compared between groups and subgroups and the association between tear IGF-I levels and ocular parameters (CCT, IOP) and disease duration were also evaluated. Central corneal thickness, IOP, and tear IGF-1 levels did not show a significant difference between study and control groups. We also did not find a significant difference in terms of CCT, IOP, or tear IGF-1 levels between subgroups of patients. Correlation analysis did not show an association between the duration of disease and tear IGF-1 levels with CCT or IOP. There was no significant difference in tear IGF-1 levels between patients with acromegaly and controls. Additionally, there was no correlation between disease duration and tear IGF-1 levels with CCT or IOP levels. This lack of association may suggest that tear IGF-1 levels might not have an effect on CCT or IOP findings in patients with acromegaly.

Shoulder-specific outcomes 1 year after nontraumatic full-thickness rotator cuff repair: a systematic literature review and meta-analysis.

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Gurnani, Navin; van Deurzen, Derek F P; van den Bekerom, Michel P J

2017-10-01

Nontraumatic full-thickness rotator cuff tears are commonly initially treated conservatively. If conservative treatment fails, rotator cuff repair is a viable subsequent option. The objective of the present meta-analysis is to evaluate the shoulder-specific outcomes one year after arthroscopic or mini-open rotator cuff repair of nontraumatic rotator cuff tears. A literature search was conducted in PubMed and EMBASE within the period January 2000 to January 2017. All studies measuring the clinical outcome at 12 months after nontraumatic rotator cuff repair of full-thickness rotator cuff tears were listed. We included 16 randomized controlled trials that met our inclusion criteria with a total of 1.221 shoulders. At 12 months after rotator cuff repair, the mean Constant score had increased 29.5 points; the mean American Shoulder and Elbow Score score increased by 38.6 points; mean Simple Shoulder Test score was 5.6 points; mean University of California Los Angeles score improved by 13.0 points; and finally, mean Visual Analogue Scale score decreased by 4.1 points. Based on this meta-analysis, significant improvements in the shoulder-specific indices are observed 12 months after nontraumatic arthroscopic or mini-open rotator cuff repair.

Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings.

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Sela, Yaron; Eshed, Iris; Shapira, Shachar; Oran, Ariel; Vogel, Guy; Herman, Amir; Perry Pritsch, Moshe

2015-02-01

Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre- and postoperative clinical findings. Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P = 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre- and postoperative physical examination or with postoperative clinical questionnaires scores. Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Structural Characteristics Are Not Associated With Pain and Function in Rotator Cuff Tears: The ROW Cohort Study.

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Curry, Emily J; Matzkin, Elizabeth E; Dong, Yan; Higgins, Laurence D; Katz, Jeffrey N; Jain, Nitin B

2015-05-01

Structural characteristics of rotator cuff tears are used in surgical decision making. However, data on the association of tear size with patient-reported pain and function are sparse. To assess the association of tear size, fatty infiltration, and muscle atrophy with shoulder pain/function in patients with cuff tears undergoing operative and nonoperative treatment. Cross-sectional study; Level of evidence, 3. A total of 67 patients with rotator cuff tears were recruited for this longitudinal cohort study. Patients were determined to have a cuff tear using clinical assessment and blinded magnetic resonance imaging review. The Shoulder Pain and Disability Index (SPADI) was used as a measure of shoulder pain and function. Tear size and thickness were not significantly associated with pain (SPADI pain score, 60.6 [95% CI, 49.8-71.5] for partial-thickness tear; 56.8 [95% CI, 42.8-70.7] for tear; 60.4 [95% CI, 51.7-69.0] for ≥2 cm full-thickness tear). Tear size and thickness were not associated with function (SPADI disability score, 42.7 [95% CI, 29.8-55.6] for partial-thickness tear; 37.6 [95% CI, 23.9-51.4] for tear; 45.1 [95% CI, 35.4-54.8] for ≥2 cm full-thickness tear). Fatty infiltration, muscle atrophy, and tendon retraction were also not significantly associated with SPADI pain and disability scores. A Mental Health Index score of tears undergoing operative and nonoperative treatment, pain and functional status were not associated with tear size and thickness, fatty infiltration, and muscle atrophy. Conversely, factors unrelated to cuff anatomy such as mental health, comorbidities, age, and sex were associated with pain/function. These findings have clinical implications during surgical decision making and suggest that pain and functional disability in patients with rotator cuff tears is multifactorial and should not solely be attributed to structural characteristics.

Rotator cuff tears in children and adolescents: experience at a large pediatric hospital

International Nuclear Information System (INIS)

Zbojniewicz, Andrew M.; Emery, Kathleen H.; Maeder, Matthew E.; Salisbury, Shelia R.

2014-01-01

Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

Rotator cuff tears in children and adolescents: experience at a large pediatric hospital

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Zbojniewicz, Andrew M.; Emery, Kathleen H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Maeder, Matthew E. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Lenox Hill Hospital, Department of Radiology, New York, NY (United States); Salisbury, Shelia R. [University of Cincinnati College of Medicine, Division of Biostatistics and Epidemiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

2014-06-15

Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

Tears of the Supraspinatus Tendon: Assessment with Indirect Magnetic Resonance Arthrography in 67 Patients with Arthroscopic Correlation

International Nuclear Information System (INIS)

Dyck, P. van; Gielen, J.L.; Parizel, P.M.

2009-01-01

Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (κ) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (κ = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (κ = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the basis of

Tears of the Supraspinatus Tendon: Assessment with Indirect Magnetic Resonance Arthrography in 67 Patients with Arthroscopic Correlation

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Dyck, P. van; Gielen, J.L.; Parizel, P.M. (Dept. of Radiology, Univ. Hospital Antwerp and Univ. of Antwerp, Antwerp (Belgium)) (and others)

2009-11-15

Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (kappa) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (kappa = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (kappa = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the

Role of ultrasound in rotator cuff tears

International Nuclear Information System (INIS)

Siddiqi, H.A.; Mirza, T.

2010-01-01

The study was designed to evaluate the efficacy of ultrasound in rotator cuff tears and to compare it with MRI. Total number of patients was thirty. All of these were above thirty years of age and were referred by clinicians, with shoulder pain for diagnostic workup. Post operative patients were excluded. Ultrasound and Magnetic Resonance Imaging (MRI) were performed on each patient. Same operator performed ultrasound in all patients. Ultrasound (US) and Magnetic Resonance Imaging (MRI) detected equal number of full thickness tears while two partial thickness tears were missed on US. Hypoechoic defect was the most important primary sign while cortical irregularity and fluid in subacromial and subdeltroid busra were the most important secondary signs on US. US was equally effective to MRI in detection of rotator cuff tears. It should be the primary investigation because of its availability, cost effective and real time evaluation provided significant expertise is developed, as it is highly operator dependent. (author)

Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences

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Jung, Joon-Yong; Jee, Won-Hee; Park, Michael Y.; Lee, So-Yeon [Seoul St. Mary' s Hospital, The Catholic University of Korea, Department of Radiology, Seoul (Korea, Republic of); Kim, Yang-Soo [Seoul St. Mary' s Hospital, The Catholic University of Korea, Department of Orthopedic Surgery, Seoul (Korea, Republic of)

2012-11-15

To assess the diagnostic performance of shoulder MR arthrography with 3D isotropic fat-suppressed (FS) turbo spin-echo sequence (TSE-SPACE) for supraspinatus tendon tears in comparison with 2D conventional sequences at 3.0 T. The study was HIPAA-compliant and approved by the institutional review board with a waiver of informed consent. Eighty-seven arthroscopically confirmed patients who underwent 3.0 T shoulder MR arthrography with 2D sequences and 3D TSE-SPACE were included in a consecutive fashion from March 2009 to February 2010. Two reviewers independently analyzed 2D sequences and 3D TSE-SPACE. Sensitivity, specificity, accuracy, and interobserver agreement ({kappa}) were compared between 2D sequences and 3D TSE-SPACE for full-thickness and partial-thickness supraspinatus tendon tears together and for partial-thickness supraspinatus tendon tears alone. There were 33 full-thickness tears and 28 partial-thickness tears of supraspinatus tendons. For full-thickness and partial-thickness supraspinatus tendon tears together, the mean sensitivity, specificity, and accuracy of both readers were 96, 92, and 94% on 2D sequences and 91, 84, and 89% on 3D TSE-SPACE. For partial-thickness supraspinatus tendon tears alone, the mean sensitivity, specificity, and accuracy were 95, 92, and 94% on 2D sequences and 84, 85, and 84% on 3D TSE-SPACE. There was no statistical difference between 2D sequences and 3D TSE-SPACE. Interobserver agreements were almost perfect on 2D conventional sequences and substantial on 3D TSE-SPACE. Compared with 2D conventional sequences, MR arthrography using 3D TSE-SPACE was comparable for diagnosing supraspinatus tendon tears despite limitations in detecting small partial-thickness tears and in discriminating between full-thickness and deep partial-thickness tears. (orig.)

Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences

International Nuclear Information System (INIS)

Jung, Joon-Yong; Jee, Won-Hee; Park, Michael Y.; Lee, So-Yeon; Kim, Yang-Soo

2012-01-01

To assess the diagnostic performance of shoulder MR arthrography with 3D isotropic fat-suppressed (FS) turbo spin-echo sequence (TSE-SPACE) for supraspinatus tendon tears in comparison with 2D conventional sequences at 3.0 T. The study was HIPAA-compliant and approved by the institutional review board with a waiver of informed consent. Eighty-seven arthroscopically confirmed patients who underwent 3.0 T shoulder MR arthrography with 2D sequences and 3D TSE-SPACE were included in a consecutive fashion from March 2009 to February 2010. Two reviewers independently analyzed 2D sequences and 3D TSE-SPACE. Sensitivity, specificity, accuracy, and interobserver agreement (κ) were compared between 2D sequences and 3D TSE-SPACE for full-thickness and partial-thickness supraspinatus tendon tears together and for partial-thickness supraspinatus tendon tears alone. There were 33 full-thickness tears and 28 partial-thickness tears of supraspinatus tendons. For full-thickness and partial-thickness supraspinatus tendon tears together, the mean sensitivity, specificity, and accuracy of both readers were 96, 92, and 94% on 2D sequences and 91, 84, and 89% on 3D TSE-SPACE. For partial-thickness supraspinatus tendon tears alone, the mean sensitivity, specificity, and accuracy were 95, 92, and 94% on 2D sequences and 84, 85, and 84% on 3D TSE-SPACE. There was no statistical difference between 2D sequences and 3D TSE-SPACE. Interobserver agreements were almost perfect on 2D conventional sequences and substantial on 3D TSE-SPACE. Compared with 2D conventional sequences, MR arthrography using 3D TSE-SPACE was comparable for diagnosing supraspinatus tendon tears despite limitations in detecting small partial-thickness tears and in discriminating between full-thickness and deep partial-thickness tears. (orig.)

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

International Nuclear Information System (INIS)

Tuite, M.J.; Turnbull, J.R.; Orwin, J.F.

1998-01-01

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56. Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity for these tears is lower than in recent articles, we found no significant difference between the sensitivity of MR for diagnosing posterior tears versus tears in the anterior half of the supraspinatus tendon. Rim-rent tears can be mistaken for intratendinous signal, and should be carefully looked for in younger patients with shoulder pain. (orig.)

Progression of Fatty Muscle Degeneration in Atraumatic Rotator Cuff Tears.

Science.gov (United States)

Hebert-Davies, Jonah; Teefey, Sharlene A; Steger-May, Karen; Chamberlain, Aaron M; Middleton, William; Robinson, Kathryn; Yamaguchi, Ken; Keener, Jay D

2017-05-17

The purpose of this prospective study was to examine the progression of fatty muscle degeneration over time in asymptomatic shoulders with degenerative rotator cuff tears. Subjects with an asymptomatic rotator cuff tear in 1 shoulder and pain due to rotator cuff disease in the contralateral shoulder were enrolled in a prospective cohort. Subjects were followed annually with shoulder ultrasonography, which evaluated tear size, location, and fatty muscle degeneration. Tears that were either full-thickness at enrollment or progressed to a full-thickness defect during follow-up were examined. A minimum follow-up of 2 years was necessary for eligibility. One hundred and fifty-six shoulders with full-thickness rotator cuff tears were potentially eligible. Seventy shoulders had measurable fatty muscle degeneration of at least 1 rotator cuff muscle at some time point. Patients with fatty muscle degeneration in the shoulder were older than those without degeneration (mean, 65.8 years [95% confidence interval (CI), 64.0 to 67.6 years] compared with 61.0 years [95% CI, 59.1 to 62.9 years]; p tears at baseline was larger in shoulders with degeneration than in shoulders that did not develop degeneration (13 and 10 mm wide, respectively, and 13 and 10 mm long; p Tears with fatty muscle degeneration were more likely to have enlarged during follow-up than were tears that never developed muscle degeneration (79% compared with 58%; odds ratio, 2.64 [95% CI, 1.29 to 5.39]; p muscle degeneration occurred more frequently in shoulders with tears that had enlarged (43%; 45 of 105) than in shoulders with tears that had not enlarged (20%; 10 of 51; p tears with enlargement and progression of muscle degeneration were more likely to extend into the anterior supraspinatus than were those without progression (53% and 17%, respectively; p tear size (p = 0.56). The median time from tear enlargement to progression of fatty muscle degeneration was 1.0 year (range, -2.0 to 6.9 years) for the

Full reflector thickness and isolation thickness on neutron transport

International Nuclear Information System (INIS)

Sakai, Tomohiro; Naito, Yoshitaka; Komuro, Yuichi.

1988-08-01

A method to determine ''full reflector thickness'' and ''isolation thickness'', which is utilized for criticality safety evaluation on nuclear fuel facilities, was proposed in this paper. Firstly, a calculation was tryed to obtain the two kinds of thicknesses from the result of criticality calculations for a specific case. Then, two simple equations which calculates the two kinds of thicknesses were made from the relation between reflector (or isolator) thickness and k eff , and one-group diffusion theory. Finally, we proposed a new method to determine the thicknesses. From the method we proposed, ''full reflector thickness'' and ''isolation thickness'' can be obtain using the equations and migration length of the reflector (or isolator) and infinite and effective multiplication factor of the fuel. (author)

Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

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Lee, Sung Hyun; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Se Jin; Park, Jin Sung

2017-07-01

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

Tear film measurement by optical reflectometry technique

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Lu, Hui; Wang, Michael R.; Wang, Jianhua; Shen, Meixiao

2014-01-01

Abstract. Evaluation of tear film is performed by an optical reflectometer system with alignment guided by a galvanometer scanner. The reflectometer system utilizes optical fibers to deliver illumination light to the tear film and collect the film reflectance as a function of wavelength. Film thickness is determined by best fitting the reflectance-wavelength curve. The spectral reflectance acquisition time is 15 ms, fast enough for detecting film thickness changes. Fast beam alignment of 1 s is achieved by the galvanometer scanner. The reflectometer was first used to evaluate artificial tear film on a model eye with and without a contact lens. The film thickness and thinning rate have been successfully quantified with the minimum measured thickness of about 0.3 μm. Tear films in human eyes, with and without a contact lens, have also been evaluated. A high-contrast spectral reflectance signal from the precontact lens tear film is clearly observed, and the thinning dynamics have been easily recorded from 3.69 to 1.31 μm with lipid layer thickness variation in the range of 41 to 67 nm. The accuracy of the measurement is better than ±0.58% of the film thickness at an estimated tear film refractive index error of ±0.001. The fiber-based reflectometer system is compact and easy to handle. PMID:24500519

[Endoscopic full-thickness resection].

Science.gov (United States)

Meier, B; Schmidt, A; Caca, K

2016-08-01

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?

International Nuclear Information System (INIS)

Schreinemachers, Saskia A.; Hulst, Victor P.M. van der; Woude, Henk-Jan van der; Willems, W.J.; Bipat, Shandra

2009-01-01

The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability. Institutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test. Weighted kappa values of ABER and conventional MR arthrography were 0.48-0.65 and 0.60-0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48-61% and 52-70%, respectively) and specificity (80-94% and 91-95%). Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears. (orig.)

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?

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Schreinemachers, Saskia A. [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Hulst, Victor P.M. van der; Woude, Henk-Jan van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Willems, W.J. [Onze Lieve Vrouwe Gasthuis, Orthopaedic Surgery, Amsterdam (Netherlands); Bipat, Shandra [University of Amsterdam (NL). Department of Radiology, Academic Medical Center (Netherlands)

2009-10-15

The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability. Institutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test. Weighted kappa values of ABER and conventional MR arthrography were 0.48-0.65 and 0.60-0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48-61% and 52-70%, respectively) and specificity (80-94% and 91-95%). Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears. (orig.)

Validity of GNRB® arthrometer compared to Telos™ in the assessment of partial anterior cruciate ligament tears.

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Lefevre, N; Bohu, Y; Naouri, J F; Klouche, S; Herman, S

2014-02-01

The main goal of this study was to compare the results of the GNRB(®) arthrometer to those of Telos™ in the diagnosis of partial thickness tears of the anterior cruciate ligament (ACL). A prospective study performed January-December 2011 included all patients presenting with a partial or full-thickness ACL tears without ACL reconstruction and with a healthy contralateral knee. Anterior laxity was measured in all patients by the Telos™ and GNRB(®) devices. This series included 139 patients, mean age 30.7 ± 9.3 years. Arthroscopic reconstruction was performed in 109 patients, 97 for complete tears and 12 single bundle reconstructions for partial thickness tears. Conservative treatment was proposed in 30 patients with a partial thickness tear. The correlation between the two devices was evaluated by the Spearman coefficient. The optimal laxity thresholds were determined with ROC curves, and the diagnostic value of the tests was assessed by the area under the curve (AUC). The differential laxities of full and partial thickness tears were significantly different with the two tests. The correlation between the results of laxity measurement with the two devices was fair, with the strongest correlation between Telos™ 250 N and GNRB(®) 250 N (r = 0.46, p = 0.00001). Evaluation of the AUC showed that the informative value of all tests was fair with the best results with the GNRB(®) 250 N: AUC = 0.89 [95 % CI 0.83-0.94]. The optimal differential laxity threshold with the GNRB(®) 250 N was 2.5 mm (Se = 84 %, Sp = 81 %). The diagnostic value of GNRB(®) was better than Telos™ for ACL partial thickness tears.

Discrepancy between fluoroscopic arthrography and magnetic resonance arthrography in patients with arthroscopically confirmed supraspinatus tendon tears: The additional benefit of cine fluoroscopic arthrography images

International Nuclear Information System (INIS)

Hahn, Seok; Lee, Young Han; Suh, Jin Suck

2016-01-01

To determine the additional diagnostic benefits of fluoroscopic arthrography (FA) in patients with full-thickness supraspinatus tendon (SST) tears by comparing FA images with magnetic resonance arthrography (MRA) images. This study included FA and MRA images of 53 patients who were confirmed to have full-thickness SST tears by arthroscopy. In the FA analysis, the presence of contrast leakage into the subacromial-subdeltoid bursa was recorded. In the MRA analysis, contrast leakage, retraction of a torn tendon, width and length of the tear, and supraspinatus atrophy were evaluated. Patients were divided into the concordant group or the discordant group based on the presence of contrast leakage to compare the characteristics of SST tears. We used Fisher's exact test and two-sample t-test for the comparison. Of the 53 patients, 34 were included in the concordant group and 19 were included in the discordant group. In the concordant group, the grades of retraction were higher than those in the discordant group; the width and length of the tears were larger. Muscle atrophy was more severe in the concordant group. A full-thickness SST tear did not always exhibit contrast leakage on FA, particularly small SST tears or tears with low-grade retraction. FA can provide diagnostic information regarding the severity of full-thickness SST tears by itself

Discrepancy between fluoroscopic arthrography and magnetic resonance arthrography in patients with arthroscopically confirmed supraspinatus tendon tears: The additional benefit of cine fluoroscopic arthrography images

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Hahn, Seok; Lee, Young Han; Suh, Jin Suck [Dept. Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2016-12-15

To determine the additional diagnostic benefits of fluoroscopic arthrography (FA) in patients with full-thickness supraspinatus tendon (SST) tears by comparing FA images with magnetic resonance arthrography (MRA) images. This study included FA and MRA images of 53 patients who were confirmed to have full-thickness SST tears by arthroscopy. In the FA analysis, the presence of contrast leakage into the subacromial-subdeltoid bursa was recorded. In the MRA analysis, contrast leakage, retraction of a torn tendon, width and length of the tear, and supraspinatus atrophy were evaluated. Patients were divided into the concordant group or the discordant group based on the presence of contrast leakage to compare the characteristics of SST tears. We used Fisher's exact test and two-sample t-test for the comparison. Of the 53 patients, 34 were included in the concordant group and 19 were included in the discordant group. In the concordant group, the grades of retraction were higher than those in the discordant group; the width and length of the tears were larger. Muscle atrophy was more severe in the concordant group. A full-thickness SST tear did not always exhibit contrast leakage on FA, particularly small SST tears or tears with low-grade retraction. FA can provide diagnostic information regarding the severity of full-thickness SST tears by itself.

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

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Tuite, M J; Turnbull, J R; Orwin, J F [Wisconsin Univ., Madison, WI (United States). Dept. of Radiology

1998-05-01

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as centered in the anterior or posterior half of the cuff, and as either in the critical zone or adjacent to the bony insertion. The original MR interpretation was compared with the arthroscopic findings. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years)(P=0.23). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56 (P=0.17). The average age of the 9 patients with rim-rent tears was 31 years, while that of the 28 patients with similarly-sized partial tears not involving the insertion was 40 years old (P=0.048). Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity

Goldmann tonometry tear film error and partial correction with a shaped applanation surface

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McCafferty SJ

2018-01-01

Full Text Available Sean J McCafferty,1–4 Eniko T Enikov,5 Jim Schwiegerling,2,3 Sean M Ashley1,3 1Intuor Technologies, 2Department of Ophthalmology, University of Arizona College of Medicine, 3University of Arizona College of Optical Science, 4Arizona Eye Consultants, 5Department of Mechanical and Aerospace, University of Arizona College of Engineering, Tucson, AZ, USA Purpose: The aim of the study was to quantify the isolated tear film adhesion error in a Goldmann applanation tonometer (GAT prism and in a correcting applanation tonometry surface (CATS prism.Methods: The separation force of a tonometer prism adhered by a tear film to a simulated cornea was measured to quantify an isolated tear film adhesion force. Acrylic hemispheres (7.8 mm radius used as corneas were lathed over the apical 3.06 mm diameter to simulate full applanation contact with the prism surface for both GAT and CATS prisms. Tear film separation measurements were completed with both an artificial tear and fluorescein solutions as a fluid bridge. The applanation mire thicknesses were measured and correlated with the tear film separation measurements. Human cadaver eyes were used to validate simulated cornea tear film separation measurement differences between the GAT and CATS prisms.Results: The CATS prism tear film adhesion error (2.74±0.21 mmHg was significantly less than the GAT prism (4.57±0.18 mmHg, p<0.001. Tear film adhesion error was independent of applanation mire thickness (R2=0.09, p=0.04. Fluorescein produces more tear film error than artificial tears (+0.51±0.04 mmHg; p<0.001. Cadaver eye validation indicated the CATS prism’s tear film adhesion error (1.40±0.51 mmHg was significantly less than that of the GAT prism (3.30±0.38 mmHg; p=0.002.Conclusion: Measured GAT tear film adhesion error is more than previously predicted. A CATS prism significantly reduced tear film adhesion error by ~41%. Fluorescein solution increases the tear film adhesion compared to

Goldmann tonometry tear film error and partial correction with a shaped applanation surface.

Science.gov (United States)

McCafferty, Sean J; Enikov, Eniko T; Schwiegerling, Jim; Ashley, Sean M

2018-01-01

The aim of the study was to quantify the isolated tear film adhesion error in a Goldmann applanation tonometer (GAT) prism and in a correcting applanation tonometry surface (CATS) prism. The separation force of a tonometer prism adhered by a tear film to a simulated cornea was measured to quantify an isolated tear film adhesion force. Acrylic hemispheres (7.8 mm radius) used as corneas were lathed over the apical 3.06 mm diameter to simulate full applanation contact with the prism surface for both GAT and CATS prisms. Tear film separation measurements were completed with both an artificial tear and fluorescein solutions as a fluid bridge. The applanation mire thicknesses were measured and correlated with the tear film separation measurements. Human cadaver eyes were used to validate simulated cornea tear film separation measurement differences between the GAT and CATS prisms. The CATS prism tear film adhesion error (2.74±0.21 mmHg) was significantly less than the GAT prism (4.57±0.18 mmHg, p film adhesion error was independent of applanation mire thickness ( R 2 =0.09, p =0.04). Fluorescein produces more tear film error than artificial tears (+0.51±0.04 mmHg; p film adhesion error (1.40±0.51 mmHg) was significantly less than that of the GAT prism (3.30±0.38 mmHg; p =0.002). Measured GAT tear film adhesion error is more than previously predicted. A CATS prism significantly reduced tear film adhesion error bŷ41%. Fluorescein solution increases the tear film adhesion compared to artificial tears, while mire thickness has a negligible effect.

Fracture assessment of weld material from a full-thickness clad RPV shell segment

International Nuclear Information System (INIS)

Keeney, J.A.; Bass, B.R.; McAfee, W.J.

1996-01-01

Fracture analysis was applied to full-thickness clad beam specimens containing shallow cracks in material for which metallurgical conditions are prototypic of those found in reactor pressure vessels (RPV) at beginning of life. The beam specimens were fabricated from a section of an RPV wall (removed from a canceled nuclear plant) that includes weld, plate, and clad material. Metallurgical factors potentially influencing fracture toughness for shallow cracks in the beam specimens include gradients of material properties and residual stresses due to welding and cladding applications. Fracture toughness estimates were obtained from load vs load-line displacement and load vs crack-mouth-opening displacement data using finite-element methods and estimation schemes based on the η-factor method. One of the beams experienced a significant amount of precleavage stable ductile tearing. Effects of precleavage tearing on estimates of fracture toughness were investigated using continuum damage models. Fracture toughness results from the clad beam specimens were compared with other deep- and shallow-crack single-edge notch bend (SENB) data generated previously from A533 Grade B plate material. Range of scatter for the clad beam data is consistent with that from the laboratory-scale SENB specimens tested at the same temperature

Peripheral Neuropathy and Tear Film Dysfunction in Type 1 Diabetes Mellitus

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Stuti L. Misra

2014-01-01

Full Text Available Purpose. To compare tear film metrics in patients with type 1 diabetes mellitus (DM and healthy controls and investigate the association between peripheral neuropathy and ocular surface quality. Methods. Dry eye symptoms were quantified in 53 patients with type 1 DM and 40 age-matched controls. Ocular examination included tear film lipid layer thickness grading, tear film stability and quantity measurement, and retinal photography. DM individuals additionally underwent a detailed neuropathy assessment. Results. Neither mean age nor dry eye symptom scores differed significantly between the DM and control groups (P=0.12 and P=0.33, resp.. Tear lipid thickness (P=0.02, stability (P<0.0001, and quantity (P=0.01 were significantly lower in the DM group. Corneal sensitivity was also reduced in the DM group (P<0.001 and tear film stability was inversely associated with total neuropathy score (r=-0.29, P=0.03. Conclusion. The DM group exhibited significantly reduced tear film stability, secretion, and lipid layer quality relative to the age-matched control group. The negative correlation between tear film parameters and total neuropathy score suggests that ocular surface abnormalities occur in parallel with diabetic peripheral neuropathy.

Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis

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Smith, T.O., E-mail: toby.smith@uea.ac.uk [Department of Physiotherapy, University of East Anglia (United Kingdom); Back, T. [Department of Physiotherapy, Norfolk and Norwich University Hospital, London (United Kingdom); Toms, A.P. [Department of Radiology, Norfolk and Norwich University Hospital, London (United Kingdom); Hing, C.B. [Department of Orthopaedic Surgery, St George' s Hospital, London (United Kingdom)

2011-11-15

Aim: To determine the diagnostic accuracy of ultrasound to detect partial and complete thickness rotator cuff tears based on all available clinical trials. Materials and methods: An electronic search of databases registering published and unpublished literature was conducted. All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tear were included. The methodological quality of each included study was assessed using the QUADAS form. When appropriate, pooled sensitivity and specificity analysis was conducted, with an assessment of the summary receiver operating characteristic (ROC) curve for each analysis. Results: Sixty-two studies assessing 6007 patients and 6066 shoulders were included. Ultrasonography had good sensitivity and specificity for the assessment of partial thickness (sensitivity 0.84; specificity 0.89), and full-thickness rotator cuff tears (sensitivity 0.96; specificity 0.93). However, the literature poorly described population characteristics, assessor blinding, and was based on limited sample sizes. The literature assessing transducer frequency was particularly small in size. Conclusion: Ultrasonography is an appropriate radiological technique for the assessment of rotator cuff tears with an acceptable sensitivity and specificity. The diagnostic test accuracy of ultrasound is superior for the detection of full-thickness compared to partial-thickness cuff tears. Further study assessing the effect of transducer frequency is warranted.

Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systematic review and meta-analysis

International Nuclear Information System (INIS)

Smith, T.O.; Back, T.; Toms, A.P.; Hing, C.B.

2011-01-01

Aim: To determine the diagnostic accuracy of ultrasound to detect partial and complete thickness rotator cuff tears based on all available clinical trials. Materials and methods: An electronic search of databases registering published and unpublished literature was conducted. All diagnostic accuracy studies that directly compared the accuracy of ultrasound (the index test) to either arthroscopic or open surgical findings (the reference test) for rotator cuff tear were included. The methodological quality of each included study was assessed using the QUADAS form. When appropriate, pooled sensitivity and specificity analysis was conducted, with an assessment of the summary receiver operating characteristic (ROC) curve for each analysis. Results: Sixty-two studies assessing 6007 patients and 6066 shoulders were included. Ultrasonography had good sensitivity and specificity for the assessment of partial thickness (sensitivity 0.84; specificity 0.89), and full-thickness rotator cuff tears (sensitivity 0.96; specificity 0.93). However, the literature poorly described population characteristics, assessor blinding, and was based on limited sample sizes. The literature assessing transducer frequency was particularly small in size. Conclusion: Ultrasonography is an appropriate radiological technique for the assessment of rotator cuff tears with an acceptable sensitivity and specificity. The diagnostic test accuracy of ultrasound is superior for the detection of full-thickness compared to partial-thickness cuff tears. Further study assessing the effect of transducer frequency is warranted.

Tear-Film Evaporation Rate from Simultaneous Ocular-Surface Temperature and Tear-Breakup Area.

Science.gov (United States)

Dursch, Thomas J; Li, Wing; Taraz, Baseem; Lin, Meng C; Radke, Clayton J

2018-01-01

A corneal heat-transfer model is presented to quantify simultaneous measurements of fluorescein tear-breakup area (TBA) and ocular-surface temperature (OST). By accounting for disruption of the tear-film lipid layer (TFLL), we report evaporation rates through lipid-covered tear. The modified heat-transfer model provides new insights into evaporative dry eye. A quantitative analysis is presented to assess human aqueous tear evaporation rate (TER) through intact TFLLs from simultaneous in vivo measurement of time-dependent infrared OST and fluorescein TBA. We interpret simultaneous OST and TBA measurements using an extended heat-transfer model. We hypothesize that TBAs are ineffectively insulated by the TFLL and therefore exhibit higher TER than does that for a well-insulting TFLL-covered tear. As time proceeds, TBAs increase in number and size, thereby increasing the cornea area-averaged TER and decreasing OST. Tear-breakup areas were assessed from image analysis of fluorescein tear-film-breakup video recordings and are included in the heat-transfer description of OST. Model-predicted OSTs agree well with clinical experiments. Percent reductions in TER of lipid-covered tear range from 50 to 95% of that for pure water, in good agreement with literature. The physical picture of noninsulating or ruptured TFLL spots followed by enhanced evaporation from underlying cooler tear-film ruptures is consistent with the evaporative-driven mechanism for local tear rupture. A quantitative analysis is presented of in vivo TER from simultaneous clinical measurement of transient OST and TBA. The new heat-transfer model accounts for increased TER through expanding TBAs. Tear evaporation rate varies strongly across the cornea because lipid is effectively missing over tear-rupture troughs. The result is local faster evaporation compared with nonruptured, thick lipid-covered tear. Evaporative-driven tear-film ruptures deepen to a thickness where fluorescein quenching commences and local

The relationship between tear severity, fatty infiltration, and muscle atrophy in the supraspinatus.

Science.gov (United States)

Barry, Jeffrey J; Lansdown, Drew A; Cheung, Sunny; Feeley, Brian T; Ma, C Benjamin

2013-01-01

Fatty infiltration and muscle atrophy have been described as interrelated characteristic changes that occur within the muscles of the rotator cuff after cuff tears, and both are independently associated with poor outcomes after surgical repair. We hypothesize that fatty infiltration and muscle atrophy are two distinct processes independently associated with supraspinatus tears. A retrospective review of 377 patients who underwent shoulder magnetic resonance imaging at one institution was performed. Multivariate analysis was performed based on parameters including age, sex, rotator cuff tear severity, fatty infiltration grade, and muscle atrophy. A total of 116 patients (30.8%) had full-thickness tears of the supraspinatus, 153 (40.6%) had partial thickness tears, and 108 (28.7%) had no evidence of tear. With increasing tear severity, the prevalence of substantial fatty infiltration (grade ≥2) increased: 6.5% of patients with no tears vs 41.4% for complete tears (P tear severity: 36.1% of no tears vs 77.6% of complete tears (P muscle atrophy when taking into account sex, age, and tear severity. Fatty infiltration and muscle atrophy are independently associated processes. Fatty infiltration is also related to increasing age, muscle tear severity, and sex, whereas muscle atrophy is related to increasing age but not tear severity. In patients without rotator cuff tears, fatty infiltration and atrophy prevalence increased independently with increasing age. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Full-thickness skin mesh graft vaginoplasty: a skin sparing technique

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Guilherme Lang Motta

Full Text Available ABSTRACT Introduction: The ideal vaginoplasty method should promote good cosmetic and functional results with low morbidity. We describe a new technique for congenital vaginal agenesis using a full-thickness perforated skin graft. Materials and Methods: We report an 18 year old patient with vaginal agenesis (Morris syndrome that undergone a modified version of McIndoe vaginoplasty. Patient is set in a low lithotomy position and lateral traction sutures are placed in labia and a 16Fr urethral catheter inserted. An inverted “V”-shaped incision is made in the mucosal plaque below the urethra. Blunt dissection in a cephalic posterior direction forms a space between the rectum and urethra. Special care is taken to avoid rectal tear during this maneuver. A full-thickness skin graft is removed from the lower abdomen measuring 12.0×6.0cm as an aesthetic abdominoplasty. The fat tissue is removed, remaining epidermis and dermis and the graft is perforated, allowing a great surface increase. After suturing over a mold, the graft is fixed in the created space. The donor site is closed with intradermal transversal suture. Results: From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent this technique. There were no major complications or need for blood transfusions. At the six-month follow-up, all patients reported satisfactory sexual intercourse. There were no significant complications at donor site or neovagina that needed surgical intervention. Conclusion: Vaginal reconstruction using the perforated graft is viable with excellent functional results. Applying this modification, we yielded the good results of a classic McIndoe technique with lower donor site morbidity.

Location of Rotator Cuff Tear Initiation: A Magnetic Resonance Imaging Study of 191 Shoulders.

Science.gov (United States)

Jeong, Jeung Yeol; Min, Seul Ki; Park, Keun Min; Park, Yong Bok; Han, Kwang Joon; Yoo, Jae Chul

2018-03-01

Degenerative rotator cuff tears (RCTs) are generally thought to originate at the anterior margin of the supraspinatus tendon. However, a recent ultrasonography study suggested that they might originate more posteriorly than originally thought, perhaps even from the isolated infraspinatus (ISP) tendon, and propagate toward the anterior supraspinatus. Hypothesis/Purpose: It was hypothesized that this finding could be reproduced with magnetic resonance imaging (MRI). The purpose was to determine the most common location of degenerative RCTs by using 3-dimensional multiplanar MRI reconstruction. It was assumed that the location of the partial-thickness tears would identify the area of the initiation of full-thickness tears. Cross-sectional study; Level of evidence, 3. A retrospective analysis was conducted including 245 patients who had RCTs (nearly full- or partial-thickness tears) at the outpatient department between January 2011 and December 2013. RCTs were measured on 3-dimensional multiplanar reconstruction MRI with OsiriX software. The width and distance from the biceps tendon to the anterior margin of the tear were measured on T2-weighted sagittal images. In a spreadsheet, columns of consecutive numbers represented the size of each tear (anteroposterior width) and their locations with respect to the biceps brachii tendon. Data were pooled to graphically represent the width and location of all tears. Frequency histograms of the columns were made to visualize the distribution of tears. The tears were divided into 2 groups based on width (group A, location related to size. The mean width of all RCTs was 11.9 ± 4.1 mm, and the mean length was 11.1 ± 5.0 mm. Histograms showed the most common location of origin to be 9 to 10 mm posterior to the biceps tendon. The histograms of groups A and B showed similar tear location distributions, indicating that the region approximately 10 mm posterior to the biceps tendon is the most common site of tear initiation. These

Functional evaluation of patient after arthroscopic repair of rotator cuff tear.

Science.gov (United States)

Kumar, Rohit; Jadhav, Umesh

2014-06-01

Rotator cuff tear is a common problem either after trauma or after degenerative tear in old age group. Arthroscopic repair is the current concept of rotator cuff repair. Here, we are trying to evaluate the functional outcome after arthroscopic repair of full thickness rotator cuff tear (single row) in Indian population. Twenty five patients (14 males and 11 females) who underwent arthroscopic repair of full thickness rotator cuff tear at a single institution were included in the study. Postoperatively patient's shoulder was rated according to UCLA score, pain was graded according to the visual analog score. The range of motion was analysed and documented. The mean age of the patients were 50.48 years. The preoperative VAS score mode was 7 and post operative VAS was 1 (p value fair in 12% (n = 3), excellent in 8% (n = 2) and poor results were seen in none of the patients. The mean UCLA improved from a score of 15.84 to 30.28 with a p value advantages, hence we used a single row repair considering the Indian population and the cost effectiveness of the surgery with good to excellent results.

Rotator cuff tear state modulates self-renewal and differentiation capacity of human skeletal muscle progenitor cells.

Science.gov (United States)

Thomas, Kelsey A; Gibbons, Michael C; Lane, John G; Singh, Anshuman; Ward, Samuel R; Engler, Adam J

2017-08-01

Full thickness rotator cuff tendon (RCT) tears have long-term effects on RC muscle atrophy and fatty infiltration, with lasting damage even after surgical tendon repair. Skeletal muscle progenitor cells (SMPs) are critical for muscle repair in response to injury, but the inability of RC muscles to recover from chronic RCT tear indicates possible deficits in repair mechanisms. Here we investigated if muscle injury state was a crucial factor during human SMP expansion and differentiation ex vivo. SMPs were isolated from muscles in patients with no, partial-thickness (PT), or full-thickness (FT) RCT tears. Despite using growth factors, physiological niche stiffness, and muscle-mimetic extracellular matrix (ECM) proteins, we found that SMPs isolated from human RC muscle with RCT tears proliferated slower but fused into myosin heavy chain (MHC)-positive myotubes at higher rates than SMPs from untorn RCTs. Proteomic analysis of RC muscle tissue revealed shifts in muscle composition with pathology, as muscle from massive RCT tears had increased ECM deposition compared with no tear RC muscle. Together these data imply that the remodeled niche in a torn RCT primes SMPs not for expansion but for differentiation, thus limiting longer-term self-renewal necessary for regeneration after surgical repair. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1816-1823, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

MR imaging of delamination tears of the rotator cuff tendons

International Nuclear Information System (INIS)

Walz, Daniel M.; Chen, Steven; Miller, Theodore T.; Hofman, Josh

2007-01-01

The objective was to describe the imaging appearances and location of delamination tears of the rotator cuff tendons on non-contrast conventional MR imaging. This study was reviewed and approved by our Institutional Review Board. The reports of 548 consecutive MR examinations of the shoulder were reviewed, looking for mention or description of delamination tears of the rotator cuff. The images of the identified cases were then reviewed by two radiologists to confirm the findings. Correlation with surgical and arthroscopic information was then performed. Delamination tears were defined as horizontal retraction of either the bursal or articular surface of the tendon, manifest as thickening of the torn retracted edge, and/or interstitial splitting of the tendon, manifest as fluid-like high signal intensity on fat-suppressed T2-weighted oblique coronal images. Fourteen cases of delamination tears were identified in 13 patients. Ten of the cases involved the supraspinatus tendon, all with articular surface involvement. Nine of these supraspinatus cases were isolated tears and one occurred as part of a full thickness tear. All 10 of these supraspinatus cases showed medial retraction of the articular surface of the tendon, with thickening of the retracted edge, and 5 of the 10 had a demonstrable horizontal cleft in the interstitium. Four cases involved the subscapularis tendon, with articular surface disruption in three and pure interstitial delamination in one. Medial subluxation of the tendon of the long head of the biceps was present in all four cases. No delamination tears occurred on the bursal surface. Only three of the 14 shoulders underwent surgical repair with one confirmation of supraspinatus delamination, one confirmation of a subscapularis tear that had become a full thickness tear 10 months after initial imaging and another interstitial subscapularis delamination that was not identified arthroscopically. Delamination tears occur most often in the

MR imaging of delamination tears of the rotator cuff tendons

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Walz, Daniel M.; Chen, Steven [North Shore University Hospital, Department of Radiology, Manhasset, NY (United States); Miller, Theodore T. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Hofman, Josh [Long Island Jewish Medical Center, New Hyde Park, NY (United States)

2007-05-15

The objective was to describe the imaging appearances and location of delamination tears of the rotator cuff tendons on non-contrast conventional MR imaging. This study was reviewed and approved by our Institutional Review Board. The reports of 548 consecutive MR examinations of the shoulder were reviewed, looking for mention or description of delamination tears of the rotator cuff. The images of the identified cases were then reviewed by two radiologists to confirm the findings. Correlation with surgical and arthroscopic information was then performed. Delamination tears were defined as horizontal retraction of either the bursal or articular surface of the tendon, manifest as thickening of the torn retracted edge, and/or interstitial splitting of the tendon, manifest as fluid-like high signal intensity on fat-suppressed T2-weighted oblique coronal images. Fourteen cases of delamination tears were identified in 13 patients. Ten of the cases involved the supraspinatus tendon, all with articular surface involvement. Nine of these supraspinatus cases were isolated tears and one occurred as part of a full thickness tear. All 10 of these supraspinatus cases showed medial retraction of the articular surface of the tendon, with thickening of the retracted edge, and 5 of the 10 had a demonstrable horizontal cleft in the interstitium. Four cases involved the subscapularis tendon, with articular surface disruption in three and pure interstitial delamination in one. Medial subluxation of the tendon of the long head of the biceps was present in all four cases. No delamination tears occurred on the bursal surface. Only three of the 14 shoulders underwent surgical repair with one confirmation of supraspinatus delamination, one confirmation of a subscapularis tear that had become a full thickness tear 10 months after initial imaging and another interstitial subscapularis delamination that was not identified arthroscopically. Delamination tears occur most often in the

[Epidemiologic study of tear film lipid layer thickness measurement in the population of Taishitun Community in Beijing].

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Liang, Q F; Du, X H; Su, Y D; Wang, N L; Wei, Z J; Labbé, Antoine

2017-07-11

Objective: To investigate the distribution of tear film lipid layer thickness (LLT) and the relationship between symptoms and signs of dry eye and tear film LLT in the population of Taishitun Community in Beijing. Methods: A cross-sectional study. From May 2016 to August 2016, three streets of Taishitun Community were randomly selected as survey districts and 540 persons were taken as investigation subjects. Every participant completed 6 items of dry eye examinations as follows: questionnaire (Ocular Surface Disease Index, OSDI), measurement of tear film LLT, tear film break-up time (TBUT), corneal and conjunctival staining, SchirmerⅠtest and the infrared meibomian photography. According to their age, all participants were divided into four groups: junior group (analysis and multivariate Logistic regression analysis, distribution of the variables of LLT and the relationship between dry eye symptoms and LLT were studied. Results: A total of 473 residents finally participated in this study, and the response ratio was 87.6%. The values of LLT were normally distributed. The average LLT was (59.87±18.50) nm [(60.16±19.15) nm in males and (59.67±18.57) nm in females], and the comparison of LLT with different genders was not statistically significant ( t= 0.198, P= 0.843). The tear film LLT of four different age groups had statistical significance ( F= 15.092, P0.05. F= 0.538, P >0.05). In the OSDI symptom questionnaire, only blurred vision and decreased visual acuity were related to the tear film LLT ( Pfilm LLT ( P> 0.05). Conclusions: In Taishitun Community of Beijing, the values of tear film LLT had a normal distribution. The LLT was positively correlated with age, but inversely correlated with the severity of the symptoms of dry eye. There was no significant correlation between the LLT and the TBUT, SchirmerⅠtest result and meibomian gland loss rate. (Chin J Ophthalmol, 2017, 53: 495-501) .

Tearing resistance of some co-polyester sheets

International Nuclear Information System (INIS)

Kim, Ho Sung; Karger-Kocsis, Jozsef

2004-01-01

A three-zone model consisting of initial, evolutionary and stabilised plastic zones for tearing resistance was proposed for polymer sheets. An analysis with the model, based on the essential work of fracture (EWF) approach, was demonstrated to be capable for predicting specific total work of fracture along the tear path across all the plastic zones although accuracy of specific essential work of fracture is subject to improvement. Photo-elastic images were used for identification of plastic deformation sizes and profiles. Fracture mode change during loading was described in relation with the three zones. Tearing fracture behaviour of extruded mono- and bi-layer sheets of different types of amorphous co-polyesters and different thicknesses was investigated. Thick material exhibited higher specific total work of tear fracture than thin mono-layer sheet in the case of amorphous polyethylene terephthalate (PET). This finding was explained in terms of plastic zone size formed along the tear path, i.e., thick material underwent larger plastic deformation than thin material. When PET and polyethylene terephthalate glycol (PETG) were laminated with each other, specific total work of fracture of the bi-layer sheets was not noticeably improved over that of the constituent materials

Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion

International Nuclear Information System (INIS)

Schlossberg, S.; Umans, H.; Flusser, G.; DiFelice, G.S.; Lerer, D.B.

2007-01-01

To determine the frequency of medial meniscal extrusion (MME) versus ''medial meniscal intrusion'' in the setting of bucket handle tears. Images were evaluated for previously reported risk factors for MME, including: medial meniscal root tear, radial tear, degenerative joint disease and joint effusion. Forty-one consecutive cases of bucket handle tear of the medial meniscus were reviewed by consensus by two musculoskeletal radiologists. Imaging was performed using a 1.5 GE Signa MR unit. Patient age, gender, medial meniscal root integrity, MME, medial meniscal intrusion, degenerative joint disease, effusion and anterior cruciate ligament (ACL) tear were recorded. Thirteen females and 27 males (age 12-62 years, median=30 years) were affected; one had bucket handle tear of each knee. Effusion was small in 13, moderate in 9 and large in 18. Degenerative joint disease was mild in three, moderate in two and severe in one. 26 ACL tears included three partial and three chronic. Medial meniscal root tear was complete in one case and partial thickness in two. None of the 40 cases with an intact or partially torn medial meniscal root demonstrated MME. MME of 3.1 mm was seen in the only full-thickness medial meniscal root tear, along with chronic ACL tear, moderate degenerative joint disease and large effusion. Medial meniscal intrusion of the central bucket handle fragment into the intercondylar notch was present in all 41 cases. Given an intact medial meniscal root in the setting of a ''pure'' bucket handle tear, there is no MME. (orig.)

Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis.

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Artur Bachta

Full Text Available To investigate the diagnostic performance and reliability of ultrasonography (US in detecting and grading common extensor tendon (CET tear in patients with chronic lateral epicondylitis (LE, using magnetic resonance imaging (MRI as the reference standard.The study comprised fifty-eight chronic LE patients. Each patient underwent US and MRI. CET status was classified as: high-grade tear (≥50% thickness, low-grade tear (<50% thickness, suspected tear (possible but not evident tear, no tear. Additionally, the following dichotomous scale was used: confirmed or unconfirmed CET tear. Relative US parameters (versus MRI for detecting CET tear included: sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV and accuracy. The agreement between US and MRI findings was measured using the weighted Cohen kappa coefficient (κ.US showed moderate agreement with MRI in detecting and grading CET tear (κ = 0.49. Sensitivity, specificity, and accuracy in CET tear detecting by US were 64.52%, 85.19%, and 72.73%, respectively. PPV and NPV of US were 83.33% and 67.65%, respectively. No patient with unconfirmed CET tear on US had high-grade CET tear on MRI.Ultrasonography is a valuable imaging modality that can be used as a screening tool to exclude high-grade CET tear in chronic LE patients. Once a tear is evident on US, MRI should be considered to assess precisely the extent of tendon injury.

Interferometric characterization of tear film dynamics

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Primeau, Brian Christopher

The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

Choroidal thickness in Malaysian eyes with full-thickness macular holes

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Chew Y Tan

2018-02-01

Full Text Available AIM: To compare choroidal thickness at the macula in eyes with unilateral idiopathic full-thickness macular holes(FTMHwith that of unaffected fellow eyes, and eyes of normal control patients.METHODS: Cross-sectional study. Thirty patients with unilateral idiopathic FTMH and thirty age, sex, and race-matched controls were recruited. Axial lengths were measured using laser interferometry. Enhanced depth imaging optical coherence tomography images were obtained using Heidelberg spectral-domain optical coherence tomography. Choroidal thickness was measured at the fovea, and at 1 mm and 2 mm nasally, temporally, superiorly and inferiorly from the center of the fovea. Statistical analysis was performed using independent and paired t-tests, chi-square tests, and Pearson correlation tests(PRESULTS: The mean subfoveal choroidal thickness was 201.0±44.0 μm in the FTMH group, 225.3±51.4 μm in the fellow eye group and 262.3±70.3 μm in the control group. The choroid was thinner in FTMH eyes at all locations when compared to control eyes(PPP>0.05. Choroidal thickness was generally highest subfoveally and lowest nasally. Subfoveal choroidal thickness was negatively correlated with age(r=-0.278, P=0.032, and axial length(r=-0.328, P=0.011.CONCLUSION: Choroidal thickness is lower in both eyes of patients with unilateral FTMH compared to healthy control eyes.

Organization of lipids in the tear film: a molecular-level view.

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Alicja Wizert

Full Text Available Biophysical properties of the tear film lipid layer are studied at the molecular level employing coarse grain molecular dynamics (MD simulations with a realistic model of the human tear film. In this model, polar lipids are chosen to reflect the current knowledge on the lipidome of the tear film whereas typical Meibomian-origin lipids are included in the thick non-polar lipids subphase. Simulation conditions mimic those experienced by the real human tear film during blinks. Namely, thermodynamic equilibrium simulations at different lateral compressions are performed to model varying surface pressure, and the dynamics of the system during a blink is studied by non-equilibrium MD simulations. Polar lipids separate their non-polar counterparts from water by forming a monomolecular layer whereas the non-polar molecules establish a thick outermost lipid layer. Under lateral compression, the polar layer undulates and a sorting of polar lipids occurs. Moreover, formation of three-dimensional aggregates of polar lipids in both non-polar and water subphases is observed. We suggest that these three-dimensional structures are abundant under dynamic conditions caused by the action of eye lids and that they act as reservoirs of polar lipids, thus increasing stability of the tear film.

Radiographic diagnosis of rotator cuff tear based on the supraspinatus muscle radiodensity

International Nuclear Information System (INIS)

Stallenberg, B.; Rommens, J.; Metens, T.; Gevenois, P.A.; Legrand, C.; De Maertelaer, V.

2001-01-01

Objective. To evaluate the supraspinatus muscle radiodensity on the outlet view as an indication of a tendon tear.Design and patients. Plain radiographs and magnetic resonance imaging (MRI) examinations were obtained on both shoulders of 40 subjects aged 23-70 years, including 13 asymptomatic volunteers and 27 patients. Two readers analyzed the superior contour and the heterogeneity of the supraspinatus muscle radiodensity and compared them with the MRI findings.Results and conclusion. Significant concordances (P<0.001) were found between the assessments of the superior contour and the heterogeneity of the muscle radiodensity, respectively, on plain radiographs and MR images. For the diagnosis of a full-thickness tear, the analysis of the superior contour and the heterogeneity of the muscle radiodensity reached an accuracy of 85% and 80% respectively. Stepwise discriminant analyses showed low to moderate benefit of considering the contour and the heterogeneity simultaneously. The inter- and intraobserver agreement ranged from moderate to good. We conclude that on the outlet view, modifications in the superior contour and heterogeneity of the supraspinatus muscle radiodensity suggest a full-thickness tear. (orig.)

A biomechanical and histological comparison of the suture bridge and conventional double-row techniques of the repair of full-thickness rotator cuff tears in a rabbit model.

Science.gov (United States)

Fei, Wenyong; Guo, Weichun

2015-06-16

The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique. Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2(nd), 4(th), or 8(th) week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8(th) week. The load to failure of the SB group was 134.59 ± 17.69 N at the 8(th) postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4(th) and 8(th) weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally. The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.

Rotator cuff tear reduces muscle fiber specific force production and induces macrophage accumulation and autophagy.

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Gumucio, Jonathan P; Davis, Max E; Bradley, Joshua R; Stafford, Patrick L; Schiffman, Corey J; Lynch, Evan B; Claflin, Dennis R; Bedi, Asheesh; Mendias, Christopher L

2012-12-01

Full-thickness tears to the rotator cuff can cause severe pain and disability. Untreated tears progress in size and are associated with muscle atrophy and an infiltration of fat to the area, a condition known as "fatty degeneration." To improve the treatment of rotator cuff tears, a greater understanding of the changes in the contractile properties of muscle fibers and the molecular regulation of fatty degeneration is essential. Using a rat model of rotator cuff injury, we measured the force generating capacity of individual muscle fibers and determined changes in muscle fiber type distribution that develop after a full thickness rotator cuff tear. We also measured the expression of mRNA and miRNA transcripts involved in muscle atrophy, lipid accumulation, and matrix synthesis. We hypothesized that a decrease in specific force of rotator cuff muscle fibers, an accumulation of type IIb fibers, and an upregulation in fibrogenic, adipogenic, and inflammatory gene expression occur in torn rotator cuff muscles. Thirty days following rotator cuff tear, we observed a reduction in muscle fiber force production, an induction of fibrogenic, adipogenic, and autophagocytic mRNA and miRNA molecules, and a dramatic accumulation of macrophages in areas of fat accumulation. Copyright © 2012 Orthopaedic Research Society.

Non-Exposure, Device-Assisted Endoscopic Full-thickness Resection.

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Bauder, Markus; Schmidt, Arthur; Caca, Karel

2016-04-01

Recent developments have expanded the frontier of interventional endoscopy toward more extended resections following surgical principles. This article presents two new device-assisted techniques for endoscopic full-thickness resection in the upper and lower gastrointestinal tract. Both methods are nonexposure techniques avoiding exposure of gastrointestinal contents to the peritoneal cavity by a "close first-cut later" principle. The full-thickness resection device is a novel over-the-scope device designed for clip-assisted full-thickness resection of colorectal lesions. Endoscopic full-thickness resection of gastric subepithelial tumors can be performed after placing transmural sutures underneath the tumor with a suturing device originally designed for endoscopic antireflux therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure

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Woods TC

2014-06-01

Full Text Available Tom C Woods,4 Michael J Carroll,1 Atiba A Nelson,2 Kristie D More,2 Randa Berdusco,1 Stephen Sohmer,3 Richard S Boorman,1,2 Ian KY Lo1,21Department of Surgery, 2Sport Medicine Centre, University of Calgary, Calgary, AB, Canada; 3Department of Orthopaedics, University of British Columbia, Vancouver, 4St Joseph's Hospital, Comox, BC, CanadaPurpose: The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA lesions.Patients and methods: Patients in the senior author's practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8 and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test. All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram.Results: There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2 and Simple Shoulder Test (4.6±3.2 to 10.1±3.8 scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect.Conclusion: Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair.Keywords: rotator cuff, PASTA lesion, transtendon repair

Painful locking of the knee due to bucket handle tear of

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HE Rui

2011-04-01

Full Text Available 【Abstract】 A case of swelling and anterior painful knee due to tear of mediopatellar plica is reported. The patient also felt clunk of the patellofemoral joint and knee locking. Under arthroscopic examination, a thick and fibrous plica was found medial to patellar, and a bucket tear along the plica from medial patellar retinaculum to infrapatellar fat pad. Polarized microscopic examination showed collagen fiber fragment and loss of light reflecting property. Neuroimmunohistology suggested up-regulation of synovial plica innervation in the area around the crack. This may be related to the pain. The bucket tear of mediopatellar plicacaused pain and lock of knee are more common than previously reported. Key words: Knee injuries; Arthroscopy; Patellofemoral joint

EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE

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Edwards, Peter; Ebert, Jay; Joss, Brendan; Bhabra, Gev; Ackland, Tim; Wang, Allan

2016-01-01

The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries. Level of Evidence Level 5 PMID:27104061

Accuracy of MR imaging in partial tears of rotator cuff

International Nuclear Information System (INIS)

Eto, Masao; Ito, Nobuyuki; Tomonaga, Tadashi; Harada, Shin'ichi; Rabbi, M.E.; Iwasaki, Katsuro

1997-01-01

MRI is very useful for the diagnosis of the rotator cuff tear However. in case of partial tears it is sometimes controvertible. In this study, we studied the accuracy of MRI in the diagnosis of partial tears. 67 patients who underwent MRI investigation before operation were chosen for this study. There were 61 males and 6 females, ranging from 30 to 80 years (mean: 54.8 years at the time of operation). MRI was performed with 1.5T superconductive system with shoulder surface coil. MPGR T2-weighted images were performed in the coronal oblique and sagittal oblique planes. Complete tears were diagnosed when full thickness high intensity was observed in the rotator cuff, whereas with partial high intensity of the rotator cuff, was considered as partial tears. MRI demonstrated 77.8% sensitivity, 91.4% specificity and 89.6% accuracy in the diagnosis of partial tear. In 8 cases MRI had misinterpretation. In MPGR T2-weighted images, not only the partial tears but the degenerative changes also show high intensity of the rotator cuff. Therefore, it is difficult to differentiate and maybe this is the reason of misinterpretations of partial tears by MRI. MRI provided with useful pre-operative informations of partial tears of the rotator cuff. However, in few cases it is hard to differentiate for the degenerative changes of the rotator cuff. (author)

16-slice MDCT arthrography of the shoulder: accuracy for detection of glenoid labral and rotator cuff tears

International Nuclear Information System (INIS)

Kim, Gang Deuk; Kim, Huoung Jun; Kim, Hye Won; Oh, Jung Taek; Juhng, Seon Kwan; Lee, Sung Ah

2007-01-01

We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US

16-slice MDCT arthrography of the shoulder: accuracy for detection of glenoid labral and rotator cuff tears

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Kim, Gang Deuk; Kim, Huoung Jun; Kim, Hye Won; Oh, Jung Taek; Juhng, Seon Kwan [Wonkwang University Hospital, Iksan (Korea, Republic of); Lee, Sung Ah [Seoul Medical Center, Seoul (Korea, Republic of)

2007-04-15

We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US.

The natural course of nonoperatively treated rotator cuff tears: an 8.8-year follow-up of tear anatomy and clinical outcome in 49 patients.

Science.gov (United States)

Moosmayer, Stefan; Gärtner, Anne V; Tariq, Rana

2017-04-01

The natural course of nonoperatively treated rotator cuff tears is not fully understood. We explored the long-term development of tear anatomy and assessed functional outcomes. Eighty-nine small to medium-sized full-thickness tears of the rotator cuff, all primarily treated by physiotherapy, were identified retrospectively. Twenty-three tears needed surgical treatment later on, and 17 patients were unable to meet for follow-up. The remaining 49 still unrepaired tears were re-examined after 8.8 (8.2-11.0) years with sonography. Re-examination by magnetic resonance imaging was possible for 37 patients. Shoulder function was assessed with shoulder scores. Primary outcome measures were progression of tear size, muscle atrophy, and fatty degeneration and the Constant score (CS). Mean tear size increased by 8.3 mm in the anterior-posterior plane (P = .001) and by 4.5 mm in the medial-lateral plane (P = .001). Increase of tear size was -5 to +9.9 mm in 33 patients, 10 to 19.9 mm in 8 patients, and ≥20 mm in 8 patients. The CS was 81 points for tear increases Muscle atrophy and fatty degeneration progressed in 18 and 15 of the 37 patients, respectively. In tears with no progression of atrophy, the CS was 82 points compared with 75.5 points in tears with progression (P = .04). Anatomic tear deterioration was found in the majority of patients, but it was often moderate. Large tear size increases and progression of muscle atrophy were correlated to a poorer functional outcome. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis

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McGarvey, Ciaran; Harb, Ziad; Smith, Christian; Ajuied, Adil [Guy' s and St Thomas' Hospital, King' s Health Partners, Department of Trauma and Orthopaedics, London (United Kingdom); Houghton, Russell [Guy' s and St Thomas' Hospital, King' s Health Partners, Department of Radiology, London (United Kingdom); Corbett, Steven [Guy' s and St Thomas' Hospital, King' s Health Partners, Department of Trauma and Orthopaedics, London (United Kingdom); Fortius Clinic, London (United Kingdom)

2016-02-15

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p < 0.001). There was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA. Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears. (orig.)

Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis

International Nuclear Information System (INIS)

McGarvey, Ciaran; Harb, Ziad; Smith, Christian; Ajuied, Adil; Houghton, Russell; Corbett, Steven

2016-01-01

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p < 0.001). There was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA. Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears. (orig.)

Post-lens tear turbidity and visual quality after scleral lens wear.

Science.gov (United States)

Carracedo, Gonzalo; Serramito-Blanco, Maria; Martin-Gil, Alba; Wang, Zicheng; Rodriguez-Pomar, Candela; Pintor, Jesús

2017-11-01

The aim was to evaluate the turbidity and thickness of the post-lens tear layer and its effect on visual quality in patients with keratoconus after the beginning of lens wear and before lens removal at the end of eight hours. Twenty-six patients with keratoconus (aged 36.95 ± 8.95 years) participated voluntarily in the study. The sample was divided into two groups: patients with intrastromal corneal ring (ICRS group) and patients without ICRS (KC group). Distance visual acuity (VA), contrast sensitivity, pachymetry, post-lens tear layer height and post-lens tear layer turbidity (percentage area occupied and number of particles per mm 2 ) were evaluated with optical coherence tomography before and after wearing a scleral lens. A significant increase of turbidity was found in all groups assessed (p turbidity parameters with distance VA but no correlation between turbidity and post-lens tear layer thickness at the beginning was found (p > 0.05). A strong correlation in all groups between the post-lens tear layer at the beginning and differences of tear layer thickness between two measures was also found (p turbidity. © 2017 Optometry Australia.

Assessment of lamellar tearing

International Nuclear Information System (INIS)

McEnerney, J.W.

1978-03-01

Information on lamellar tearing is summarized and related to proposed ASME Code requirements. Lamellar tearing is characterized as a complex phenomenon related to poor short transverse ductility and through-thickness strain. The material, welding, and design variables that affect lamellar tearing are shown to be complex and interrelated. The commonly reported tests for assessing material susceptibility are described, with the controversy over their validity being carefully detailed. Although the use of a nondestructive test such as ultrasonic examination is most desirable, a widely applicable test method does not appear to be available. Of the destructive tests, the short transverse tensile reduction-of-area currently offers the most applicable means of assessing material susceptibility. However, because of the importance of matrix toughness, the short transverse Charpy V-notch test should be considered for use as an additional test if acceptance limits are developed. The ultrasonic detection of lamellar tears is susceptible to interpretation errors, which can make it overly conservative and lead to unnecessary repairs. The repair of tears is described as costly, difficult, and sometimes ineffective. Current design requirements appear to preclude any failures during static and fatigue service loads. However, without improvement of short transverse ductility, certain dynamic service loads could cause lamellar tearing failures. Two alternate design paths are recommended to prevent tearing during fabrication or service loading. The current and proposed ASME requirements dealing with lamellar tearing are reviewed and recommendations are made

Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis.

Science.gov (United States)

McGarvey, Ciaran; Harb, Ziad; Smith, Christian; Houghton, Russell; Corbett, Steven; Ajuied, Adil

2016-02-01

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA. Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears.

Rotator cuff tears: An evidence based approach

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Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

2015-01-01

Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and

Superior glenoid inclination and rotator cuff tears.

Science.gov (United States)

Chalmers, Peter N; Beck, Lindsay; Granger, Erin; Henninger, Heath; Tashjian, Robert Z

2018-03-23

The objectives of this study were to determine whether glenoid inclination (1) could be measured accurately on magnetic resonance imaging (MRI) using computed tomography (CT) as a gold standard, (2) could be measured reliably on MRI, and (3) whether it differed between patients with rotator cuff tears and age-matched controls without evidence of rotator cuff tears or glenohumeral osteoarthritis. In this comparative retrospective radiographic study, we measured glenoid inclination on T1 coronal MRI corrected into the plane of the scapula. We determined accuracy by comparison with CT and inter-rater reliability. We compared glenoid inclination between patients with full-thickness rotator cuff tears and patients aged >50 years without evidence of a rotator cuff tear or glenohumeral arthritis. An a priori power analysis determined adequate power to detect a 2° difference in glenoid inclination. (1) In a validation cohort of 37 patients with MRI and CT, the intraclass correlation coefficient was 0.877, with a mean difference of 0° (95% confidence interval, -1° to 1°). (2) For MRI inclination, the inter-rater intraclass correlation coefficient was 0.911. (3) Superior glenoid inclination was 2° higher (range, 1°-4°, P rotator cuff tear group of 192 patients than in the control cohort of 107 patients. Glenoid inclination can be accurately and reliably measured on MRI. Although superior glenoid inclination is statistically greater in those with rotator cuff tears than in patients of similar age without rotator cuff tears or glenohumeral arthritis, the difference is likely below clinical significance. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

Directory of Open Access Journals (Sweden)

Asem A. Al-Hiari

2013-05-01

Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

Directory of Open Access Journals (Sweden)

Ignacio Carbonel

2013-01-01

Full Text Available Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI, and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001. Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001. MRI studies showed 24 cases of tear after repair (29%. Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

Muscle Weakness in the Empty and Full Can Tests Cannot Differentiate Rotator Cuff Tear from Cervical Spondylotic Amyotrophy: Pain Provocation is a Useful Finding.

Science.gov (United States)

Iwata, Eiichiro; Shigematsu, Hideki; Inoue, Kazuya; Egawa, Takuya; Sakamoto, Yoshihiro; Tanaka, Yasuhito

2017-01-01

Rotator cuff tears and cervical spondylotic amyotrophy (CSA) are often confused as the main symptom in those with difficulty in shoulder elevation. Empty and full can tests are frequently used for the clinical diagnosis of rotator cuff tears. The aim of the present study was to investigate whether the empty and full can test results can help differentiate rotator cuff tears from CSA. Twenty-seven consecutive patients with rotator cuff tears and 25 with CSA were enrolled. We prospectively performed empty and full can tests in patients with rotator cuff tears and CSA. The following signs were considered positive: (a) muscle weakness during the empty can test, (b) muscle weakness during the full can test, (c) pain provocation during the empty can test, and (d) pain provocation during the full can test. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of rotator cuff tears for each positive finding. The sensitivity and specificity of each index were as follows (sensitivity, specificity, PPV, NPV): (a) 77.8%, 0%, 45.7%, 0%; (b) 66.7%, 4.0%, 42.9%, 10.0%; (c) 88.9%, 96.0%, 96.0%, 88.9%; and (d) 74.1%, 96.0%, 95.2%, 77.4%. There were significant differences for each index. Muscle weakness during the empty and full can tests was not useful in differentiating rotator cuff tears from CSA because of low specificity and PPV. However, pain provocation was useful in differentiating these two conditions because of high specificity and PPV.

Hypertrophic changes of the teres minor muscle in rotator cuff tears: quantitative evaluation by magnetic resonance imaging.

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Kikukawa, Kenshi; Ide, Junji; Kikuchi, Ken; Morita, Makoto; Mizuta, Hiroshi; Ogata, Hiroomi

2014-12-01

Few reports have assessed the teres minor (TM) muscle in rotator cuff tears. This study aimed to quantitatively analyze the morphologic changes of the TM muscle in patients with or without rotator cuff tears by magnetic resonance imaging (MRI). This retrospective study consisted of 279 subjects classified on the basis of interpretations of conventional MRI observations into 6 groups: no cuff tear; partial-thickness supraspinatus (SSP) tear; full-thickness SSP tear; SSP and subscapularis tears; SSP and infraspinatus (ISP) tears; and SSP, ISP, and subscapularis tears. With use of ImageJ software (National Institutes of Health, Bethesda, MD, USA) for oblique sagittal MRI, we measured the areas of ISP, TM, and anatomic external rotation (ISP + TM) muscles on the most lateral side in which the scapular spine was in contact with the scapular body. The occupational ratios of the TM muscle area to the anatomic external rotation muscle area were calculated. Ratios above the maximum of the 95% confidence intervals of the occupational ratio in the no-tear group were defined as hypertrophy of the TM muscle. Occupational ratios of the TM muscle in the no-tear group followed a normal distribution, and ratios >0.288 were defined as hypertrophic. Hypertrophic changes of the TM muscle were confirmed in rotator cuff tears involving the ISP tendon. A negative correlation was found between the occupational ratios of TM and ISP (P muscle appeared hypertrophic in rotator cuff tears involving the ISP, and the progression of ISP muscle atrophy seemed to induce the development of this compensatory hypertrophy. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears at 3.0 T.

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Lee, Ji Hyun; Yoon, Young Cheol; Jee, Sukkyung

2015-06-01

Indirect magnetic resonance (MR) arthrography is a non-invasive method for shoulder imaging. However, there are no studies that have examined the diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears in a large patient population. To assess the diagnostic performance of indirect fast spin-echo (FSE) MR arthrography for the diagnosis of rotator cuff tears at 3.0 T. A total of 149 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery were enrolled in this retrospective study. Two musculoskeletal radiologists evaluated images from each patient for the presence of supraspinatus-infraspinatus (SSP-ISP) or subscapularis (SSC) tendon tears. Using the arthroscopic findings as the reference standard, the overall diagnostic performance and detection rates for SSP-ISP and SSC tendon tears were calculated. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSP-ISP tendon tears were 94% and 95%, 89% and 85%, and 93% and 93%, respectively. The sensitivity of imaging for detection of SSP-ISP tendon tears by readers I and II were 100% and 100% for full-thickness tears and 84% and 86% for partial-thickness tears, respectively. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSC tendon tears were 80% and 76%, 89% and 93%, and 85% and 85%, respectively. Indirect MR arthrography is useful for the detection of SSP-ISP and SSC tendon tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings

International Nuclear Information System (INIS)

Park, Lawrence S.; Jacobson, Jon A.; Jamadar, David A.; Caoili, Elaine; Kalume-Brigido, Monica; Wojtys, Edward

2007-01-01

We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear. (orig.)

Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears.

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Kum, Dong Ho; Kim, Jun Ho; Park, Keun Min; Lee, Eun Su; Park, Yong Bok; Yoo, Jae Chul

2017-06-01

Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups ( p rotator cuff tears in a Korean population.

Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique.

Science.gov (United States)

Lee, Kwang Won; Yang, Dae Suk; Lee, Gyu Sang; Ma, Chang Hyun; Choy, Won Sik

2018-05-23

This retrospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the suture-bridge and double-row modified Mason-Allen techniques. From January 2012 to May 2013, 76 consecutive cases of full-thickness rotator cuff tear, 1 to 4 cm in the sagittal plane, for which arthroscopic rotator cuff repair was performed, were included. The suture-bridge technique was used in 37 consecutive shoulders; and the double-row modified Mason-Allen technique, in 39 consecutive shoulders. Clinical outcomes at a minimum of 2 years (mean, 35.7 months) were evaluated postoperatively using the visual analog scale; University of California, Los Angeles Shoulder Scale; American Shoulder and Elbow Surgeons Subjective Shoulder Scale; and Constant score. Postoperative cuff integrity was evaluated at a mean of 17.7 months by magnetic resonance imaging. At the final follow-up, the clinical outcomes improved in both groups (all P  .05). The retear rate was 18.9% in the shoulders subjected to suture-bridge repair and 12.8% in the double-row modified Mason-Allen group; the difference was not significant (P = .361). Despite the presence of fewer suture anchors, the patients who underwent double-row modified Mason-Allen repair had comparable shoulder functional outcomes and a comparable retear rate with those who underwent suture-bridge repair. Therefore, the double-row modified Mason-Allen repair technique can be considered an effective treatment for patients with medium- to large-sized full-thickness rotator cuff tears. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Acute Medial Plantar Fascia Tear.

Science.gov (United States)

Pascoe, Stephanie C; Mazzola, Timothy J

2016-06-01

A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

Surgical Versus Nonsurgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation.

Science.gov (United States)

Kweon, Christopher; Gagnier, Joel J; Robbins, Christopher B; Bedi, Asheesh; Carpenter, James E; Miller, Bruce S

2015-10-01

Rotator cuff tears are a common shoulder disorder resulting in significant disability to patients and financial burden on the health care system. While both surgical and nonsurgical management are accepted treatment options, there is a paucity of data to support a treatment algorithm for care providers. Defining variables to guide treatment allocation may be important for patient education and counseling, as well as to deliver the most efficient care plan at the time of presentation. To identify independent variables at the time of initial clinical presentation that are associated with preferred allocation to surgical versus nonsurgical management for patients with known full-thickness rotator cuff tears. Case control study; Level of evidence, 3. A total of 196 consecutive adult patients with known full-thickness rotator cuff tears were enrolled into a prospective cohort study. Robust data were collected for each subject at baseline, including age, sex, body mass index (BMI), shoulder activity score, smoking status, size of cuff tear, duration of symptoms, functional comorbidity index, the American Shoulder and Elbow Surgeons (ASES) score, the Western Ontario Rotator Cuff index (WORC), and the Veterans Rand 12-Item Health Survey (VR-12). Logistic regression was performed to identify variables associated with treatment allocation, and the corresponding odds ratios were calculated. Of the 196 patients enrolled, 112 underwent surgical intervention and 84 nonoperative management. With covariates controlled for, significant baseline patient characteristics predictive of eventual allocation to surgical treatment included younger age, lower BMI, and durations of symptoms less than 1 year. Increasing age, higher BMI, and duration of symptoms longer than 1 year were predictive of nonsurgical treatment. Factors that were not associated with treatment allocation included sex, tear size, functional comorbidity score, or any of the patient-derived outcome scores at presentation

[Assessment of lipid layer thickness of tear film in the diagnosis of dry-eye syndrome in children after the hematopoietic stem cell transplantation].

Science.gov (United States)

Kurpińska, Małgorzata; Gorczyńska, Ewa; Owoc-Lempach, Joanna; Bernacka, Aleksandra; Misiuk-Hojło, Marta; Chybicka, Alicja

2011-01-01

Dry eye syndrome (DES), also known as keratoconjunctivitis sicca (KCS) is recognized as the most frequent ocular complication after allogeneic stem cell transplantation (allo-SCT). KCS can appear either due to insufficient tear production or excessive tear evaporation, both resulting in tears hyperosmolarity that leads to ocular damage. The evaporation rate and better film stability is determined primarily by the status of the lipid layer. Observation and classification of tear film lipid layer interference patterns in normal and dry eyes in patients after allogeneic stem cell transplantation with a follow-up time of 6 months-5 years (median 26.54 months). Investigation of the relation between the lipid layer interference patterns in normal and dry eyes and the results of other dry eye examinations and complaints. Relation between DES and conditioning regimes, including total body irradiation and high-dose chemotherapy, immunosuppressive drugs, the time after allogeneic stem cell transplantation and chronic graft-versus-host disease. Precorneal tears lipid layer interference patterns, were examined in 114 eyes in treatment group with the Tearscope-plus. Patient with dry eye were identified on the basis of Schirmer test scores and/or tear breakup time, and positive lissamine and/or fluorescein staining. 42 of 114 eyes (36.8%) developed DES after allo-SCT A significant correlation between thickness of lipid layer and BUT, Schirmer test, lissamine green and fluorescein staining was found in the treatment group. A significant association was found between present chronic GVHD and DES in children. DES was not associated with TBI, corticosteroids, immunosuppressive drugs and the time in the present study. Tears lipid layer interference patterns are highly correlated with the diagnosis of DES. Tears lipid layer interference patterns ( noninvasive method), can be used to diagnose early DES in children after allo-SCT. Chronic GVHD play a major role in development of DES

Comparison between T2*- and T2-weighted images in diagnosing rotator cuff tears

International Nuclear Information System (INIS)

Kumagai, Hideo; Ito, Hisao; Kubo, Atsushi.

1995-01-01

This study was performed to determine the merits of T2 * -weighted images in diagnosing rotator cuff tear, compared with T2-weighted images. T2- and T2 * -weighted images were obtained in 10 asymptomatic volunteers and 94 patients with symptoms referable to the rotator cuff. The increased signal with full thickness of the rotator cuff was not shown on either T2- or T2 * -weighted images in the volunteers. These findings on T2-weighted images and on T2 * -weighted images were observed in 33 and 58 of 94 patients with symptoms, respectively. Every patient who showed these abnormal findings on T2-weighted images had the abnormal findings on T2 * -weighted images. These findings on T2 * -weighted images were wider than those on T2-weighted images in 20 of 33 patients. Surgical findings were available in 21 of 94 patients. Rotator cuff tears were surgically confirmed in 20 patients whose MR images showed increased signal lesions on both T2- and T2 * -weighted images. On the other hand, one patient who did not have rotator cuff tear showed increased signal lesion with full thickness on T2 * -weighted images, but not on T2-weighted images. We think increased signal lesions on T2-weighted images may strongly suggest rotator cuff tear, whereas those on T2 * -weighted images are not specific. (author)

Rotator cuff tear measurement by arthropneumotomography

International Nuclear Information System (INIS)

Kilcoyne, R.F.; Matsen, F.A. III

1983-01-01

Five years of experience with a method of shoulder arthrography using upright tomography in cases of suspected or known rotator cuff tears has demonstrated its effectiveness. The value of the procedure lies in its ability to demonstrate the size of the cuff tear and the thickness of the remaining cuff tissue. This information provides the surgeon with a preoperative estimate of the difficulty of the repair and the prognosis for a good functional recovery. In 33 cases, there was good correlation between the upright thin-section tomogram findings and the surgical results. The tomograms provided better information about the size of the tear and the quality of the remaining cuff than did plain arthrograms

Duodenal endoscopic full-thickness resection (with video).

Science.gov (United States)

Schmidt, Arthur; Meier, Benjamin; Cahyadi, Oscar; Caca, Karel

2015-10-01

Endoscopic resection of duodenal non-lifting adenomas and subepithelial tumors is challenging and harbors a significant risk of adverse events. We report on a novel technique for duodenal endoscopic full-thickness resection (EFTR) by using an over-the-scope device. Data of 4 consecutive patients who underwent duodenal EFTR were analyzed retrospectively. Main outcome measures were technical success, R0 resection, histologic confirmation of full-thickness resection, and adverse events. Resections were done with a novel, over-the-scope device (full-thickness resection device, FTRD). Four patients (median age 60 years) with non-lifting adenomas (2 patients) or subepithelial tumors (2 patients) underwent EFTR in the duodenum. All lesions could be resected successfully. Mean procedure time was 67.5 minutes (range 50-85 minutes). Minor bleeding was observed in 2 cases; blood transfusions were not required. There was no immediate or delayed perforation. Mean diameter of the resection specimen was 28.3 mm (range 22-40 mm). Histology confirmed complete (R0) full-thickness resection in 3 of 4 cases. To date, 2-month endoscopic follow-up has been obtained in 3 patients. In all cases, the over-the-scope clip was still in place and could be removed without adverse events; recurrences were not observed. EFTR in the duodenum with the FTRD is a promising technique that has the potential to spare surgical resections. Modifications of the device should be made to facilitate introduction by mouth. Prospective studies are needed to further evaluate efficacy and safety for duodenal resections. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Artificially modified collagen fibril orientation affects leather tear strength.

Science.gov (United States)

Kelly, Susyn J; Wells, Hannah C; Sizeland, Katie H; Kirby, Nigel; Edmonds, Richard L; Ryan, Tim; Hawley, Adrian; Mudie, Stephen; Haverkamp, Richard G

2018-07-01

Ovine leather has around half the tear strength of bovine leather and is therefore not suitable for high-value applications such as shoes. Tear strength has been correlated with the natural collagen fibril alignment (orientation index, OI). It is hypothesized that it could be possible to artificially increase the OI of the collagen fibrils and that an artificial increase in OI could increase tear strength. Ovine skins, after pickling and bating, were strained biaxially during chrome tanning. The strain ranged from 2 to 15% of the initial sample length, either uniformly in both directions by 10% or with 3% in one direction and 15% in the other. Once tanned, the leather tear strengths were measured and the collagen fibril orientation was measured using synchrotron-based small-angle X-ray scattering. The OI increased as a result of strain during tanning from 0.48 to 0.79 (P = 0.001) measured edge-on and the thickness-normalized tear strength increased from 27 to 43 N mm -1 (P leather was strained 10% in two orthogonal directions. This is evidence to support a causal relationship between high OI (measured edge-on), highly influenced by thickness, and tear strength. It also provides a method to produce stronger leather. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Is sonography performed by the rheumatologist as useful as arthrography executed by the radiologist for the assessment of full thickness rotator cuff tears?

NARCIS (Netherlands)

Swen, W. A.; Jacobs, J. W.; Neve, W. C.; Bal, D.; Bijlsma, J. W.

1998-01-01

Sonography and arthrography are techniques used to detect rotator cuff tears (RCT). The diagnostic value of sonography executed by a rheumatologist versus that of arthrography performed by a radiologist for assessment of RCT was investigated among patients with unilateral chronic shoulder complaints

Angled oblique sagittal MR imaging of rotator cuff tears: comparison with standard oblique sagittal images

International Nuclear Information System (INIS)

Tuite, M.J.; Asinger, D.; Orwin, J.F.

2001-01-01

Objective. To compare the accuracy for diagnosing rotator cuff tears of oblique coronal images supplemented with standard oblique sagittal images versus thinner-section angled oblique sagittal images.Design and patients. The study included 75 consecutive patients who had a shoulder MR scan followed by arthroscopy. MR images included oblique coronal, oblique sagittal (4 mm thick, 1 mm interslice gap), and angled oblique sagittal (3 mm/0.2 mm) images perpendicular to the lateral cuff. A musculoskeletal staff radiologist and fellow separately evaluated the cuff for tears on the oblique coronal images supplemented with either the oblique sagittal or the angled sagittal images.Results. For distinguishing a cuff tear from no tear, the staff radiologist had an accuracy of 0.76 (95% confidence interval: 0.67, 0.85) with the standard sagittal set, and 0.88 (0.80, 0.95) with the angled set (P=0.04). There was a nonsignificant improvement in accuracy for the fellow, calculated as 0.73 (0.63, 0.83) on the standard sagittal set and 0.76 (0.67, 0.85) on the angled set. Both readers also improved their diagnostic accuracy for partial-thickness tears with the angled set, although the improvement was statistically significant only for the staff radiologist.Conclusion. There is a slight improvement in accuracy for diagnosing rotator cuff tears, particularly partial-thickness tears, for the more experienced radiologist using thinner-section angled oblique sagittal images. These images may be useful as a supplemental sequence in patients where it is important to identify partial-thickness tears accurately. (orig.)

Angled oblique sagittal MR imaging of rotator cuff tears: comparison with standard oblique sagittal images

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Tuite, M J; Asinger, D; Orwin, J F [Dept. of Radiology, Univ. of Wisconsin Hospital and Clinics, Madison, WI (United States)

2001-05-01

Objective. To compare the accuracy for diagnosing rotator cuff tears of oblique coronal images supplemented with standard oblique sagittal images versus thinner-section angled oblique sagittal images.Design and patients. The study included 75 consecutive patients who had a shoulder MR scan followed by arthroscopy. MR images included oblique coronal, oblique sagittal (4 mm thick, 1 mm interslice gap), and angled oblique sagittal (3 mm/0.2 mm) images perpendicular to the lateral cuff. A musculoskeletal staff radiologist and fellow separately evaluated the cuff for tears on the oblique coronal images supplemented with either the oblique sagittal or the angled sagittal images.Results. For distinguishing a cuff tear from no tear, the staff radiologist had an accuracy of 0.76 (95% confidence interval: 0.67, 0.85) with the standard sagittal set, and 0.88 (0.80, 0.95) with the angled set (P=0.04). There was a nonsignificant improvement in accuracy for the fellow, calculated as 0.73 (0.63, 0.83) on the standard sagittal set and 0.76 (0.67, 0.85) on the angled set. Both readers also improved their diagnostic accuracy for partial-thickness tears with the angled set, although the improvement was statistically significant only for the staff radiologist.Conclusion. There is a slight improvement in accuracy for diagnosing rotator cuff tears, particularly partial-thickness tears, for the more experienced radiologist using thinner-section angled oblique sagittal images. These images may be useful as a supplemental sequence in patients where it is important to identify partial-thickness tears accurately. (orig.)

Synovial Chondromatosis of the Subacromial Bursa Causing a Bursal-Sided Rotator Cuff Tear

Directory of Open Access Journals (Sweden)

Julie A. Neumann

2015-01-01

Full Text Available Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up.

Progression from calcifying tendinitis to rotator cuff tear

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Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke [Department of Orthopaedic Surgery, Medical Center of Kurume University, 155-1 Kokubu-machi, Kurume City, Fukuoka 839-0862 (Japan)

2003-02-01

This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

Progression from calcifying tendinitis to rotator cuff tear

International Nuclear Information System (INIS)

Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke

2003-01-01

This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

Trabecular microstructure and surface changes in the greater tuberosity in rotator cuff tears

International Nuclear Information System (INIS)

Jiang, Yebin; Zhao, Jenny; Ouyang, Xiaolong; Genant, Harry K.; Holsbeeck, Marnix T. van; Flynn, Michael J.

2002-01-01

Abstract Objective. When planning surgery in patients with rotator cuff tear, strength of bone at the tendon insertion and trabecular bone structure in the greater tuberosity are usually taken into consideration. We investigated radiographic changes in bone structure of the greater tuberosity in rotator cuff tears.Design. Twenty-two human cadaveric shoulders from subjects ranging from 55 to 75 years of age were obtained. The integrity of the rotator cuff was examined by sonography to determine if it is intact without any tear, or torn partially or completely. The humeral head was sectioned in 3 mm thick coronal slab sections and microradiographed. After digitization of the microradiographs and imaging processing with in-house semi-automated image processing software tools developed using software interfaces on a Sun workstation, the trabecular histomorphometrical structural parameters and connectivity in the greater tuberosity were quantified. The degenerative changes on the surface of the greater tuberosity were interpreted blindly by 2 independent readers.Results. Among the 22 shoulder specimens, the rotator cuff was found intact in 10 shoulders, partially in 7 and fully torn in 5. Statistically significant loss in apparent trabecular bone volume fraction, number of trabecular nodes, and number of trabecular branches, and a statistically significant increase in apparent trabecular separation and number of trabecular free ends were found in the greater tuberosity of the shoulders with tears. The loss was greater in association with full tear than in partial tear. Thickening of the cortical margin of the enthesis, irregularity of its surface, and calcification beyond the tidemark were observed in 2 (20%) shoulders with intact rotator cuff, in 6 (86%) shoulders with partial tear, and in 5 (100%) shoulders with full tear.Conclusions. Rotator cuff tears are associated with degenerative changes on the bone surface and with disuse osteopenia of the greater tuberosity

Simultaneous acute rotator cuff tear and distal biceps rupture in a strongman competitor.

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George, Michael S

2010-04-01

Acute rotator cuff tear is commonly associated with tearing of the proximal biceps tendon, but has never been reported to occur simultaneously with a distal biceps tendon rupture. A 38-year-old right-hand-dominant strongman competitor attempted a 300-pound overhead axle press and experienced immediate pain in the right shoulder and elbow. He had no known systemic risk factors for tendon ruptures including hyperparathyroidism, hemodialysis, alcoholism, rheumatoid arthritis, statin medications, fluoroquinolones, and steroid use.Right shoulder magnetic resonance imaging (MRI) showed a full-thickness supraspinatus tear with 3 cm of retraction. There was minimal fatty infiltration of the supraspinatus on the sagittal cuts consistent with acute rupture. The subscapularis was intact. The long head of the biceps tendon had mild medial subluxation but was completely within the bicipital groove. Right elbow MRI showed a complete distal biceps tendon rupture. Thirteen days after his injury, the patient underwent arthroscopic supraspinatus repair and proximal biceps tenodesis. Distal biceps tendon repair was performed using the modified 2-incision muscle-splitting technique. At 24-month follow-up, the patient was pain free and had returned to full activity including weightlifting but had not returned to strongman competition.This is the first report of simultaneous acute full thickness ruptures of the rotator cuff and distal biceps tendon. This case report underscores the importance of a complete physical examination and a high index of suspicion for additional concomitant injuries, particularly in athletes with unusually high stresses to the body. Copyright 2010, SLACK Incorporated.

Rotator cuff tears: should abduction and external rotation (ABER) positioning be performed before image acquisition? A CT arthrography study

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Cochet, Hubert [Hopital Cardiologique du Haut-Leveque, CHU Bordeaux, Unite d' Imagerie Thoracique et Cardiovasculaire, Pessac (France); Couderc, Stephane; Pele, Eric; Moreau-Durieux, Marie-Helene; Hauger, Olivier [Hopital Pellegrin, CHU Bordeaux, Unite d' Imagerie Osteo-articulaire, Bordeaux (France); Amoretti, Nicolas [CHU Archet, Unite d' Imagerie Osteo-articulaire, Nice (France)

2010-05-15

To evaluate the impact of abduction and external rotation (ABER) positioning performed before image acquisition on the assessment of rotator cuff tears. Twenty-seven consecutive patients with clinically suspected rotator cuff tears underwent an initial CT arthrogram of the shoulder in neutral position, immediately followed by temporary ABER positioning, before a second CT acquisition in neutral position. Two observers blinded to potential pre-procedure ABER positioning independently analysed the randomly distributed images. Lesions were classified into partial-thickness (PT) and full-thickness (FT) tear subtypes. Lesion detection and measurements of pre- and post-ABER studies were compared. We found no influence of pre-test ABER positioning on FT detection or measurements. Every PT detected on pre-ABER study was also detected on post-ABER study (28/28 for reader 1, and 32/32 for reader 2). Seven and eight additional PT were found by readers 1 and 2, respectively, on post-ABER study. Lesion size increased after ABER in terms of area (P < 0.001 for both readers) and Ellman's grade (P = 0.02 and 0.002 for reader 1 and 2, respectively). ABER positioning before CT is associated with improved delineation of partial tears, a higher number of detected tears and modification of treatment planning. (orig.)

MR imaging of rotator cuff tears

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Kumagai, Hideo

1992-01-01

A total of 115 patients with clinical symptoms and signs suggesting rotator cuff tears underwent MR imaging with a 1.5-Tesla system. The body coil was used as the receiver coil in 24 patients and a single 10 cm surface coil in 91. Arthrography or MR imaging with intra-articular Gd-DTPA (MR arthrography) was performed in 95 of the 115. T2-weighted images with the body coil showed high signal intensity lesions in rotator cuffs in only seven of the 10 patients who had tears demonstrated by arthrography or MR arthrography. On the other hand, T2-weighted images with the surface coil demonstrated high signal intensity lesions in cuffs in all 27 patients who were diagnosed to have tears by arthrography or MR arthrography. In 12 patietns, T2-wighted images with the surface coil showed high signal intensity lesions in cuffs, while arthrography and MR arthrography did not show tears. Surgery was performed in four of the 12 patients and partial tears were confirmed. A single 10 cm surface coil, 3 mm slice thickness and 2.5 second repetition time seem to account for the fine visualization of cuff tears by the T2-weighted images. These results suggest that T2-weighted images obtained with the surface coil are superior to arthrography and MR arthrography. (author)

Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?

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Watson, Scott; Allen, Benjamin; Robbins, Chris; Bedi, Asheesh; Gagnier, Joel J; Miller, Bruce

2018-03-01

Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Cohort study; Level of evidence, 3. Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC ( P = .96), ASES ( P = .71), or VAS ( P = .86). Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair.

Automated Measurement of Tear Film Dynamics and Lipid Layer Thickness for Assessment of Non-Sjögren Dry Eye Syndrome With Meibomian Gland Dysfunction.

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Ji, Yong Woo; Lee, Jeihoon; Lee, Hun; Seo, Kyoung Yul; Kim, Eung Kweon; Kim, Tae-Im

2017-02-01

To investigate automated values from an advanced corneal topographer with a built-in real keratometer, color camera, and ocular surface interferometer for the evaluation of non-Sjögren dry eye syndrome (NSDES) with meibomian gland dysfunction (MGD). Sixty-four patients (64 eyes) diagnosed with NSDES with MGD were enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), fluorescence staining score, tear film breakup time (TBUT), Schirmer test, and MGD grade. Noninvasive Keratograph average tear film breakup time (NIKBUTav), tear meniscus height (TMHk), meibomian gland (MG) dropout grade, and lipid layer thickness (LLT) using interferometry were measured. Among automated indexes, NIKBUTav (mean 7.68 ± 4.07 s) and the MG dropout grade (mean 1.0 ± 0.5) significantly correlated with the OSDI (mean 40.6 ± 22.9) (r = -0.337, P = 0.006; and r = 0.201, P = 0.023, respectively), as did all conventional indicators, except the Schirmer score (mean 9.1 ± 5.9 mm). TMHk (mean 0.21 ± 0.18 mm) had significant correlation with the Schirmer score, the staining score (mean 1.2 ± 0.7), TBUT (mean 3.8 ± 1.8 s), and NIKBUTav (r = 0.298, P = 0.007; r = -0.268, P = 0.016; r = 0.459, P < 0.001; and r = 0.439, P < 0.001, respectively), but not any MGD indicator, even the MG dropout grade. NIKBUTav showed significant correlations with all clinical parameters and other automated values, except the Schirmer score and LLT (mean 83.94 ± 20.82 nm) (all (Equation is included in full-text article.)≥ 0.25 and P < 0.01). The MG dropout grade highly correlated with all indexes except TMHk (all (Equation is included in full-text article.)≥ 0.25 and P < 0.05). LLT was significantly associated with TBUT, MGD grade (mean 2.0 ± 0.7), and MG dropout grade (r = 0.219, P = 0.047; r = -0.221, P = 0.039; and r = 0.433, P < 0.001, respectively), although it was not related to patient symptoms. Automated noninvasive measurements using an advanced corneal topographer and LLT

Analysis of Factors Associated With the Tear Film Lipid Layer Thickness in Normal Eyes and Patients With Dry Eye Syndrome.

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Jung, Ji Won; Park, Si Yoon; Kim, Jin Sun; Kim, Eung Kweon; Seo, Kyoung Yul; Kim, Tae-Im

2016-08-01

To determine the effects of clinical variables, including age, sex, history of refractive or cataract surgery, contact lens use, and ocular surface and meibomian gland parameters on the lipid layer thickness (LLT) in normal subjects and patients with dry eye syndrome (DES). A total of 64 normal subjects and 326 patients with DES were enrolled, and they underwent measurements of LLT with a LipiView interferometer and tear meniscus height using optical coherence tomography, tear film break-up time (TBUT) determination, ocular surface staining, Schirmer's test, examination of the lid margins and meibomian glands, and assessment using the Ocular Surface Disease Index (OSDI). In normal subjects, the median (range) LLT was 67 (33-100) nm, and age was the only factor that was significantly associated with LLT (β = 0.678, P = 0.028). In patients with DES, the median (range) LLT was 84 (20-100) nm, and 79.0% of the participants fulfilled the diagnostic criteria for meibomian gland dysfunction (MGD). In a multivariate analysis, increased age and female sex were significantly related to increased LLT (β = 0.282, P = 0.005 and β = 11.493, P < 0.001), and hypersecretory MGD and lid margin inflammation were independently associated with increased LLT (β = 11.299, P = 0.001 and β = 12.747, P = 0.001). Lipid layer thickness measurements using a new interferometer are significantly affected by demographic factors such as age, sex, ocular surgical history, and MGD type. Therefore, all of these factors must be considered in the diagnosis of ocular surface diseases.

Aging-associated exacerbation in fatty degeneration and infiltration following rotator cuff tear

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Gumucio, Jonathan P; Korn, Michael A; Saripalli, Anjali L; Flood, Michael D; Phan, Anthony C; Roche, Stuart M; Lynch, Evan B; Claflin, Dennis R; Bedi, Asheesh; Mendias, Christopher L

2013-01-01

Background Rotator cuff tears are one of the most common musculoskeletal complaints and a substantial source of morbidity in elderly patients. Chronic cuff tears are associated with muscle atrophy and an infiltration of fat to the area, a condition known as “fatty degeneration.” To improve the treatment of cuff tears in elderly patients, a greater understanding of the changes in the contractile properties of muscle fibers and the molecular regulation of fatty degeneration is essential. Methods Using a full-thickness, massive supraspinatus and infraspinatus tear model in elderly rats, we measured fiber contractility and determined changes in fiber type distribution that develop 30 days after tear. We also measured the expression of mRNA and miRNA transcripts involved in muscle atrophy, lipid accumulation, and matrix synthesis. We hypothesized that a decrease in specific force of muscle fibers, an accumulation of type IIb fibers, and an upregulation in atrophic, fibrogenic, and inflammatory gene expression would occur in torn cuff muscles. Results Thirty days following tear, we observed a reduction in muscle fiber force and an induction of RNA molecules that regulate atrophy, fibrosis, lipid accumulation, inflammation and macrophage recruitment. A marked accumulation of advanced glycation end products, and a significant accretion of macrophages in areas of fat accumulation were observed. Conclusions The extent of degenerative changes in old rats was greater than that observed in adults. Additionally, we identified that the ectopic fat accumulation that occurs in chronic cuff tears does not occur by activation of canonical intramyocellular lipid storage and synthesis pathways. PMID:23790676

Tearing stability analysis of an axial surface flaw in thick-walled pressure vessels

International Nuclear Information System (INIS)

Zahoor, A.; Ghassemi, B.B.

1991-01-01

This paper presents two fracture mechanics models for evaluation of an axial surface flaw in pressure vessels. The surface flaw is located on the outside surface of the vessel. The first model assumes yielding of the remaining ligament directly ahead of the flaw. The second model assumes contained yielding ahead of the flaw and uses a linear elastic fracture mechanics solution. The former model is suitable for cases where the combination of material toughness, flaw size, and load is such that initiation of flaw growth follows ligament yielding. The latter model is suitable for low-toughness materials where initiation of crack growth and potential tearing instability may occur prior to the yielding of the ligament. Both models are suitable for thick-walled vessels. The paper discusses the applicability regime for both models. The models are then applied to a test vessel and the predicted failure pressure is compared against the pressure attained in the test. Results show that both models can be applied successfully. In particular, the contained yielding model when used with the plane-stress assumption can give reasonable predictions even for cases that involve yielding of the ligament. (orig.)

Tearing stability analysis of an axial surface flaw in thick-walled pressure vessels

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Zahoor, A.; Ghassemi, B.B. (NOVETECH Corp., Rockville, MD (USA))

1991-04-01

This paper presents two fracture mechanics models for evaluation of an axial surface flaw in pressure vessels. The surface flaw is located on the outside surface of the vessel. The first model assumes yielding of the remaining ligament directly ahead of the flaw. The second model assumes contained yielding ahead of the flaw and uses a linear elastic fracture mechanics solution. The former model is suitable for cases where the combination of material toughness, flaw size, and load is such that initiation of flaw growth follows ligament yielding. The latter model is suitable for low-toughness materials where initiation of crack growth and potential tearing instability may occur prior to the yielding of the ligament. Both models are suitable for thick-walled vessels. The paper discusses the applicability regime for both models. The models are then applied to a test vessel and the predicted failure pressure is compared against the pressure attained in the test. Results show that both models can be applied successfully. In particular, the contained yielding model when used with the plane-stress assumption can give reasonable predictions even for cases that involve yielding of the ligament. (orig.).

Evaporation-driven instability of the precorneal tear film.

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Peng, Cheng-Chun; Cerretani, Colin; Braun, Richard J; Radke, C J

2014-04-01

Tear-film instability is widely believed to be a signature of eye health. When an interblink is prolonged, randomly distributed ruptures occur in the tear film. "Black spots" and/or "black streaks" appear in 15 to 40 s for normal individuals. For people who suffer from dry eye, tear-film breakup time (BUT) is typically less than a few seconds. To date, however, there is no satisfactory quantitative explanation for the origin of tear rupture. Recently, it was proposed that tear-film breakup is related to locally high evaporative thinning. A spatial variation in the thickness of the tear-film lipid layer (TFLL) may lead to locally elevated evaporation and subsequent tear-film breakup. We examine the local-evaporation-driven tear-film-rupture hypothesis in a one-dimensional (1-D) model for the evolution of a thin aqueous tear film overriding the cornea subject to locally elevated evaporation at its anterior surface and osmotic water influx at its posterior surface. Evaporation rate depends on mass transfer both through the coating lipid layer and through ambient air. We establish that evaporation-driven tear-film breakup can occur under normal conditions but only for higher aqueous evaporation rates. Predicted roles of environmental conditions, such as wind speed and relative humidity, on tear-film stability agree with clinical observations. More importantly, locally elevated evaporation leads to hyperosmolar spots in the tear film and, hence, vulnerability to epithelial irritation. In addition to evaporation rate, tear-film instability depends on the strength of healing flow from the neighboring region outside the breakup region, which is determined by the surface tension at the tear-film surface and by the repulsive thin-film disjoining pressure. This study provides a physically consistent and quantitative explanation for the formation of black streaks and spots in the human tear film during an interblink. Copyright © 2013 Elsevier B.V. All rights reserved.

Muscle architectural changes after massive human rotator cuff tear.

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Gibbons, Michael C; Sato, Eugene J; Bachasson, Damien; Cheng, Timothy; Azimi, Hassan; Schenk, Simon; Engler, Adam J; Singh, Anshuman; Ward, Samuel R

2016-12-01

Rotator cuff (RC) tendon tears lead to negative structural and functional changes in the associated musculature. The structural features of muscle that predict function are termed "muscle architecture." Although the architectural features of "normal" rotator cuff muscles are known, they are poorly understood in the context of cuff pathology. The purpose of this study was to investigate the effects of tear and repair on RC muscle architecture. To this end thirty cadaveric shoulders were grouped into one of four categories based on tear magnitude: Intact, Full-thickness tear (FTT), Massive tear (MT), or Intervention if sutures or hardware were present, and key parameters of muscle architecture were measured. We found that muscle mass and fiber length decreased proportionally with tear size, with significant differences between all groups. Conversely, sarcomere number was reduced in both FTT and MT with no significant difference between these two groups, in large part because sarcomere length was significantly reduced in MT but not FTT. The loss of muscle mass in FTT is due, in part, to subtraction of serial sarcomeres, which may help preserve sarcomere length. This indicates that function in FTT may be impaired, but there is some remaining mechanical loading to maintain "normal" sarcomere length-tension relationships. However, the changes resulting from MT suggest more severe limitations in force-generating capacity because sarcomere length-tension relationships are no longer normal. The architectural deficits observed in MT muscles may indicate deeper deficiencies in muscle adaptability to length change, which could negatively impact RC function despite successful anatomical repair. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2089-2095, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Collisionless tearing mode reconnection at the dayside magnetopause of the earth's magnetosphere

International Nuclear Information System (INIS)

Quest, K.B.

1982-01-01

The purpose of this thesis was to determine if the collisionless tearing mode, a plasma instability, is a viable mechanism for interconnecting field lines at the dayside magnetopause. More generally, it was wished to test theoretically the assertion that collisionless tearing is a probable first step in cosmical reconnection. The procedure was to model the magnetopause as a local one-dimensional Vlasov equilibrium, and then calculate the linear and nonlinear stability properties of tearing and tearing-like oscillations. Quantitative estimates of the range of plasma parameter space over which significant growth occurs were obtained. Assuming that significant tearing mode growth implies significant reconnection, conditions were determined for which tearing will be important to dayside reconnection. Linearly it was found that the growth rate is relatively insensitive to the temperature of the species, but depends sensitively on (1) the thickness of the magnetopause current, (2) the number density at the location of the singular layer, and (3) the magnitude of the magnetic shear. For significant linear growth the magnetopause half-sheet thickness was required to be on the order of or less than a thermal ion gyroradius, the number density was required to be no more than 100 cm - 3 , and the magnetosheath field was required to be locally antialigned with the magnetospheric field. If the above conditions are met, which are stringent but not impossible, the mode will linearly amplify. Another topic examined is the question of the structure of the tearing eigenmodes at the dayside magnetopause. By considering finite transit time effects on electron Landau resonance it was concluded that magnetopause tearing turbulence probably occurs in spatially bounded wave packets

Simvastatin reduces fibrosis and protects against muscle weakness after massive rotator cuff tear.

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Davis, Max E; Korn, Michael A; Gumucio, Jonathan P; Harning, Julie A; Saripalli, Anjali L; Bedi, Asheesh; Mendias, Christopher L

2015-02-01

Chronic rotator cuff tears are a common source of shoulder pain and disability, and patients with chronic cuff tears often have substantial weakness, fibrosis, inflammation, and fat accumulation. Identifying therapies to prevent the development of these pathologic processes will likely have a positive impact on clinical outcomes. Simvastatin is a drug with demonstrated anti-inflammatory and antifibrotic effects in many tissues but had not previously been studied in the context of rotator cuff tears. We hypothesized that after the induction of a massive supraspinatus tear, simvastatin would protect muscles from a loss of force production and fibrosis. We measured changes in muscle fiber contractility, histology, and biochemical markers of fibrosis and fatty infiltration in rats that received a full-thickness supraspinatus tear and were treated with either carrier alone or simvastatin. Compared with vehicle-treated controls, simvastatin did not have an appreciable effect on muscle fiber size, but treatment did increase muscle fiber specific force by 20%. Simvastatin also reduced collagen accumulation by 50% but did not affect triglyceride content of muscles. Several favorable changes in the expression of genes and other markers of inflammation, fibrosis, and regeneration were also observed. Simvastatin partially protected muscles from the weakness that occurs as a result of chronic rotator cuff tear. Fibrosis was also markedly reduced in simvastatin-treated animals. Whereas further studies are necessary, statin medication could potentially help improve outcomes for patients with rotator cuff tears. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The tear turnover and tear clearance tests - a review.

Science.gov (United States)

Garaszczuk, Izabela K; Montes Mico, Robert; Iskander, D Robert; Expósito, Alejandro Cerviño

2018-03-01

The aim is to provide a summary of methods available for the assessment of tear turnover and tear clearance rates. The review defines tear clearance and tear turnover and describes their implication for ocular surface health. Additionally, it describes main types of techniques for measuring tear turnover, including fluorescein tear clearance tests, techniques utilizing electromagnetic spectrum and tracer molecule and novel experimental techniques utilizing optical coherence tomography and fluorescein profilometry. Areas covered: Internet databases (PubMed, Science Direct, Google Scholar) and most frequently cited references were used as a principal resource of information on tear turnover rate and tear clearance rate, presenting methodologies and equipment, as well as their definition and implications for the anterior eye surface health and function. Keywords used for data-search were as follows: tear turnover, tear clearance, fluorescein clearance, scintigraphy, fluorophotometry, tear flow, drainage, tear meniscus dynamics, Krehbiel flow and lacrimal functional unit. Expert commentary: After decades, the topic of tear turnover assessment has been reintroduced. Recently, new techniques have been developed to propose less invasive, less time consuming and simpler methodologies for the assessment of tear dynamics that have the potential to be utilized in clinical practice.

Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta-analysis.

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Lee, Sun Hwa; Yun, Seong Jong; Jin, Wook; Park, So Young; Park, Ji Seon; Ryu, Kyung Nam

2018-03-30

Although 3D-isotropic MR arthrography has been characterized as a substitute imaging tool for rotator cuff tear (RCT) and labral lesions, it has not been commonly used in clinical practice because of controversy related to image blurring and indistinctness of structural edges. To perform a comparison of the diagnostic performance of 3D-isotropic MR arthrography and 2D-conventional MR arthrography for diagnosis of RCT (solely RCT, full/partial-thickness supraspinatus [SST]-infraspinatus [IST] tear, or subscapularis [SSc] tear) and labral lesions. Meta-analysis. Patients with shoulder pain. 3D-isotropic and 2D-conventional MR arthrography at 3.0T or 1.5T. PubMed and EMBASE were searched following the PRISMA guidelines. Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the overall diagnostic performance of 3D-isotropic and 2D-conventional MR arthrography. Multiple-subgroup analyses were performed for diagnosing RCT, full/partial-thickness SST-IST tear, SSc tear, and labral lesions. Meta-regression analyses were performed according to subject, study, and MR arthrography characteristics including 3D-isotropic sequences (turbo spine echo [TSE] vs. gradient echo [GRE]). Eleven studies (825 patients) were included. Overall, 3D-isotropic MR arthrography had similar pooled sensitivity (0.90 [95% CI, 0.87-0.93]) (P = 0.95) and specificity (0.92 [95% CI, 0.87-0.95]) (P = 0.99), relative to 2D-conventional MR arthrography (sensitivity, 0.91 [95% CI, 0.86-0.94]); specificity, 0.92 [95% CI, 0.87-0.95]). Multiple-subgroup analyses showed that sensitivities (P = 0.13-0.91) and specificities (P = 0.26-0.99) on 3D-isotropic MR arthrography for diagnosing RCT, full/partial-thickness SST-IST tear, SSC tear, and labral lesions were not significantly different from 2D-conventional MR arthrography. On meta-regression analysis, 3D-TSE sequence demonstrated higher sensitivity (P 3D-GRE for RCT and labral

Idiopathic Bilateral Bloody Tearing

Directory of Open Access Journals (Sweden)

Emrullah Beyazyıldız

2015-01-01

Full Text Available Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon.

A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients

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Iman M. Eissa

2016-01-01

Full Text Available Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P=0.002, with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series.

Science.gov (United States)

Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; von Renteln, Daniel; Muehleisen, Helmut; Caca, Karel

2015-02-01

Endoscopic full-thickness resection of gastric subepithelial tumors with a full-thickness suturing device has been described as feasible in two small case series. The aim of this study was to evaluate the efficacy, safety, and clinical outcome of this resection technique. After 31 patients underwent endoscopic full-thickness resection, the data were analyzed retrospectively. Before snare resection, 1 to 3 full-thickness sutures were placed underneath each tumor with a device originally designed for endoscopic anti-reflux therapy. All tumors were resected successfully. Bleeding occurred in 12 patients (38.7 %); endoscopic hemostasis could be achieved in all cases. Perforation occurred in 3 patients (9.6 %), and all perforations could be managed endoscopically. Complete resection was histologically confirmed in 28 of 31 patients (90.3 %). Mean follow-up was 213 days (range, 1 - 1737), and no tumor recurrences were observed. Endoscopic full-thickness resection of gastric subepithelial tumors with the suturing technique described above is feasible and effective. After the resection of gastrointestinal stromal tumors (GISTs), we did not observe any recurrences during follow-up, indicating that endoscopic full-thickness resection may be an alternative to surgical resection for selected patients. © Georg Thieme Verlag KG Stuttgart · New York.

Tearing instabilities in turbulence

International Nuclear Information System (INIS)

Ishizawa, A.; Nakajima, N.

2009-01-01

Full text: Effects of micro-turbulence on tearing instabilities are investigated by numerically solving a reduced set of two-fluid equations. Micro-turbulence excites both large-scale and small-scale Fourier modes through energy transfer due to nonlinear mode coupling. The energy transfer to large scale mode does not directly excite tearing instability but it gives an initiation of tearing instability. When tearing instability starts to grow, the excited small scale mode plays an important role. The mixing of magnetic flux by micro-turbulence is the dominant factor of non-ideal MHD effect at the resonant surface and it gives rise to magnetic reconnection which causes tearing instability. Tearing instabilities were investigated against static equilibrium or flowing equilibrium so far. On the other hand, the recent progress of computer power allows us to investigate interactions between turbulence and coherent modes such as tearing instabilities in magnetically confined plasmas by means of direct numerical simulations. In order to investigate effects of turbulence on tearing instabilities we consider a situation that tearing mode is destabilized in a quasi-equilibrium including micro-turbulence. We choose an initial equilibrium that is unstable against kinetic ballooning modes and tearing instabilities. Tearing instabilities are current driven modes and thus they are unstable for large scale Fourier modes. On the other hand kinetic ballooning modes are unstable for poloidal Fourier modes that are characterized by ion Larmor radius. The energy of kinetic ballooning modes spreads over wave number space through nonlinear Fourier mode coupling. We present that micro-turbulence affects tearing instabilities in two different ways by three-dimensional numerical simulation of a reduced set of two-fluid equations. One is caused by energy transfer to large scale modes, the other is caused by energy transfer to small scale modes. The former is the excitation of initial

Vascular endothelial growth factor levels in tears of patients with retinal vein occlusion.

Science.gov (United States)

Kasza, M; Balogh, Z; Biro, L; Ujhelyi, B; Damjanovich, J; Csutak, A; Várdai, J; Berta, A; Nagy, V

2015-09-01

We measured vascular endothelial growth factor (VEGF) levels in tear fluid and serum in patients with retinal vein occlusion (RVO). Eight patients with RVO due to secondary macular oedema were examined. VEGF levels were measured by enzyme-linked immunosorbent assay. All patients had a full ophthalmic examination (visual acuity, slit lamp biomicroscopy, perimetry, and fluorescein angiography). Central retinal thickness (CRT) was examined using optical coherence tomography (OCT). Tear and serum samples were collected and examinations were performed at diagnosis and 1 and 4 weeks later. VEGF levels in the tears of RVO eyes were significantly higher than in fellow eyes at diagnosis and after both 1 and 4 weeks (paired t test, p1 = 0.01, p2 = 0.02, p3 = 0.006). We found a weak but significant positive correlation between VEGF levels in tear fluid and serum of patients with RVO (r = 0.21), while this correlation tended to be stronger between the fellow eyes and serum levels (r = 0.33). To the best of our knowledge, we are the first to report an increased level of VEGF in the tear fluid of patients with RVO. Alterations of VEGF levels in tears may be useful for determining stages of RVO. This non-invasive and objective method may also be helpful for estimating the severity of macular oedema and efficacy of treatment.

A review on hot tearing of magnesium alloys

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Jiangfeng Song

2016-09-01

Full Text Available Hot tearing is often a major casting defect in magnesium alloys and has a significant impact on the quality of their casting products. Hot tearing of magnesium alloys is a complex solidification phenomenon which is still not fully understood, it is of great importance to investigate the hot tearing behaviour of magnesium alloys. This review attempts to summarize the investigations on hot tearing of magnesium alloys over the past decades. The hot tearing criteria including recently developed Kou's criterion are summarized and compared. The numeric simulation and assessing methods of hot tearing, factors influencing hot tearing, and hot tearing susceptibility (HTS of magnesium alloys are discussed.

Full-thickness endometriosis of the bladder

DEFF Research Database (Denmark)

Kjer, Jens Jørgen; Kristensen, Jens; Hartwell, Dorthe

2014-01-01

referral centres in Denmark for surgical treatment of stage III and IV endometriosis. POPULATION: Thirty-one women with deep infiltrating bladder endometriosis. METHODS: All women presenting in the Department of Obstetrics and Gynaecology with deep infiltrating bladder endometriosis between March 2002...... and March 2011. We included only patients with symptomatic full-thickness bladder detrusor endometriosis and mucosal involvement. All patients had had bladder symptoms for two to seven years. MAIN OUTCOME MEASURES: Symptoms after surgery and recurrence rate. RESULTS: The main preoperative symptom...

Preauricular full-thickness skin grafting in medial canthal reconstruction

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Rafael Corredor-Osorio

2018-02-01

Full Text Available Basal cell carcinoma in medial canthal is a surgical challenge to oculoplastic surgeon. We report a case an 80 –year-old woman who presented with a vegetative tumor in the right inferior medial canthus that increased slowly in size over the past two years. An excisional biopsy from the tumor was suggestive of a basal cell carcinoma. A full-thickness excision of the tumor within the oncologic safety limits, was performed. A wide range of reconstruction techniques should be customized to the individual patient. In this case, the use of a preauricular full. Thickness skin graft was a favorable option, without complications, and with acceptable functional and cosmetic results. The aim of the treatment is to restore anatomy, functional and cosmetic of the patients.

Endoscopic full-thickness resection: Current status.

Science.gov (United States)

Schmidt, Arthur; Meier, Benjamin; Caca, Karel

2015-08-21

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.

On tear film breakup (TBU): dynamics and imaging.

Science.gov (United States)

Braun, Richard J; Driscoll, Tobin A; Begley, Carolyn G; King-Smith, P Ewen; Siddique, Javed I

2018-06-13

We report the results of some recent experiments to visualize tear film dynamics. We then study a mathematical model for tear film thinning and tear film breakup (TBU), a term from the ocular surface literature. The thinning is driven by an imposed tear film thinning rate which is input from in vivo measurements. Solutes representing osmolarity and fluorescein are included in the model. Osmolarity causes osmosis from the model ocular surface, and the fluorescein is used to compute the intensity corresponding closely to in vivo observations. The imposed thinning can be either one-dimensional or axisymmetric, leading to streaks or spots of TBU, respectively. For a spatially-uniform (flat) film, osmosis would cease thinning and balance mass lost due to evaporation; for these space-dependent evaporation profiles TBU does occur because osmolarity diffuses out of the TBU into the surrounding tear film, in agreement with previous results. The intensity pattern predicted based on the fluorescein concentration is compared with the computed thickness profiles; this comparison is important for interpreting in vivo observations. The non-dimensionalization introduced leads to insight about the relative importance of the competing processes; it leads to a classification of large vs small TBU regions in which different physical effects are dominant. Many regions of TBU may be considered small, revealing that the flow inside the film has an appreciable influence on fluorescence imaging of the tear film.

Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder

International Nuclear Information System (INIS)

Schaeffeler, Christoph; Mueller, Dirk; Rummeny, Ernst J.; Woertler, Klaus; Kirchhoff, Chlodwig; Wolf, Petra

2011-01-01

To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint with MR arthrography (MR-A) of the shoulder. MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon insertion were depicted. Anatomical locations were determined and depths of tears were classified. 112/305 patients showed RC tears, including 63 patients with 68 footprint tears. 34 PASTA lesions were detected with 20/34 involving the anterior supraspinatus (SSP) tendon and 17/34 PASTA lesions were grade I lesions. Most CID lesions (14/23) occurred at the posterior SSP and 20/23 were classified as grade I or II. 9 FT and 2 reverse PASTA lesions were found. Statistical analysis revealed no difference in anatomical location (p = 0.903) and no correlation with overhead sports activity (p = 0.300) or history of trauma (p=0.928). There were significantly more PASTA lesions in patients <40 years of age (p = 0.029). Most RC tears detected with MR-A involve the SSP footprint and are articular-sided with predominance in younger patients, but concealed lesions are not as uncommon as previously thought. (orig.)

Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder

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Schaeffeler, Christoph; Mueller, Dirk; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Orthopedics and Traumatology, Munich (Germany); Wolf, Petra [Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Munich (Germany)

2011-07-15

To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint with MR arthrography (MR-A) of the shoulder. MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon insertion were depicted. Anatomical locations were determined and depths of tears were classified. 112/305 patients showed RC tears, including 63 patients with 68 footprint tears. 34 PASTA lesions were detected with 20/34 involving the anterior supraspinatus (SSP) tendon and 17/34 PASTA lesions were grade I lesions. Most CID lesions (14/23) occurred at the posterior SSP and 20/23 were classified as grade I or II. 9 FT and 2 reverse PASTA lesions were found. Statistical analysis revealed no difference in anatomical location (p = 0.903) and no correlation with overhead sports activity (p = 0.300) or history of trauma (p=0.928). There were significantly more PASTA lesions in patients <40 years of age (p = 0.029). Most RC tears detected with MR-A involve the SSP footprint and are articular-sided with predominance in younger patients, but concealed lesions are not as uncommon as previously thought. (orig.)

Differences in muscle activities during shoulder elevation in patients with symptomatic and asymptomatic rotator cuff tears: analysis by positron emission tomography.

Science.gov (United States)

Shinozaki, Nobuhisa; Sano, Hirotaka; Omi, Rei; Kishimoto, Koshi N; Yamamoto, Nobuyuki; Tashiro, Manabu; Itoi, Eiji

2014-03-01

Differences in muscle activity patterns between patients with symptomatic and asymptomatic full-thickness rotator cuff tears have not yet been fully clarified. The purpose of this study was to investigate the muscle activity pattern by use of positron emission tomography (PET) in patients with symptomatic and asymptomatic rotator cuff tears. Ten shoulders of 9 patients with full-thickness rotator cuff tears were divided into 2 groups by a numerical pain rating scale (0-10), symptomatic (≥2) and asymptomatic (0 or 1), with 5 shoulders each. Scaption exercise of bilateral arms (200 repetitions in 10 minutes) with a weight of 0.25 kg each was performed before and after injection of fluorodeoxyglucose. After PET examination, the standardized uptake value of each muscle was calculated to quantify its activity and compared between the two groups. The activity of the anterior and middle deltoid was significantly decreased in the symptomatic group compared with the asymptomatic group (anterior deltoid, P = .02; middle deltoid, P = .03). In contrast, the activity of the superior trapezius was significantly increased in the symptomatic group compared with the asymptomatic group (P = .02). In patients with a symptomatic tear, the deltoid activity was decreased and the trapezius activity was increased. It is likely that they might have moved the painful glenohumeral joint less and instead moved the painless scapulothoracic joint more during the prescribed exercise. We conclude that patients with painful rotator cuff tears use the parascapular muscles more than those without pain do during arm elevation. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Linear stability of tearing modes

International Nuclear Information System (INIS)

Cowley, S.C.; Kulsrud, R.M.; Hahm, T.S.

1986-05-01

This paper examines the stability of tearing modes in a sheared slab when the width of the tearing layer is much smaller than the ion Larmor radius. The ion response is nonlocal, and the quasineutrality retains its full integal form. An expansion procedure is introduced to solve the quasineutrality equation in powers of the width of the tearing layer over the ion Larmor radius. The expansion procedure is applied to the collisionless and semi-collisional tearing modes. The first order terms in the expansion we find to be strongly stabilizing. The physics of the mode and of the stabilization is discussed. Tearing modes are observed in experiments even though the slab theory predicts stability. It is proposed that these modes grow from an equilibrium with islands at the rational surfaces. If the equilibrium islands are wider than the ion Larmor radius, the mode is unstable when Δ' is positive

The Effect of Polar Lipids on Tear Film Dynamics

KAUST Repository

Aydemir, E.

2010-06-17

In this paper, we present a mathematical model describing the effect of polar lipids, excreted by glands in the eyelid and present on the surface of the tear film, on the evolution of a pre-corneal tear film. We aim to explain the interesting experimentally observed phenomenon that the tear film continues to move upward even after the upper eyelid has become stationary. The polar lipid is an insoluble surface species that locally alters the surface tension of the tear film. In the lubrication limit, the model reduces to two coupled non-linear partial differential equations for the film thickness and the concentration of lipid. We solve the system numerically and observe that increasing the concentration of the lipid increases the flow of liquid up the eye. We further exploit the size of the parameters in the problem to explain the initial evolution of the system. © 2010 Society for Mathematical Biology.

Assessment of Corneal and Tear Film Parameters in Rheumatoid Arthritis Patients Using Anterior Segment Spectral Domain Optical Coherence Tomography.

Science.gov (United States)

El-Fayoumi, Dina; Youssef, Maha Mohamed; Khafagy, Mohamed Mahmoud; Badr El Dine, Nashwa; Gaber, Wafaa

2018-01-01

To study the corneal changes in rheumatoid arthritis (RA) patients in vivo, using spectral domain anterior segment optical coherence tomography (AS-OCT). A case-control study was done on 43 RA patients and 40 controls. The disease activity score (DAS28-ESR) was calculated and all participants had lower tear meniscus, corneal thickness, and epithelial thickness evaluation using AS-OCT. The lower tear meniscus height (LTMH) and the lower tear meniscus area (LTMA) were significantly lower in the RA patients than in controls (p < 0.001). RA patients also had a significantly thinner central corneal thickness (p = 0.02) and their epithelium was found to be thinner in the superotemporal peripheral sector. The LTMH and LTMA are significantly reduced in RA patients, despite the absence of clinical diagnosis of dry eye. RA patients have thinner corneal thickness and epithelial thickness than controls, which did not correlate with either disease duration or activity.

Percentage Level of Tannin fur Rabbit for Leather Concerning Stitch Tearing Strength, Tearing Strength and Flexibility

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Mustakim Mustakim

2012-02-01

Full Text Available The purpose of this study was to find out the appropriate of tannin level for rabbit fur leather concerning stitch tearing strength, tearing strength, and flexibility. The result were expected to contribute good information for the society, leather craftsman, and further researchers about fur leather tanning especially rabbit fur leather with tannin concerning stitch tearing strength, tearing strength and flexibility. The material that used were 12 pieces of four months of rabbit skin. The research method was Completely Randomized Design, consist of three treatments of tannin, they were: M1 (mimosa 15%, M2 (mimosa 20%, and M3 (mimosa 25%. Each of treatment hold on four repetition, the variables which measured were stitch tearing strength, tearing strength, and flexibility of fur leather. Data were  analysed by analysis variance followed by Duncan’s Multiple Range Test. The result of this research indicate that the use level of tannin give significant influence (P<0.05 among stitch tearing strength, tearing strength. It gave a very significant influence (P<0.01 for flexibility of rabbit fur leather. Based on the result, can be concluded that 25 % of tannin (mimosa, produce the best  result on stitch tearing strength and tearing strength. The increase of tannin offer will decrease the flexibility of fur leather but the lowest tannin produced the best flexibility of fur leather (15 percent. The best quality of rabbit fur leather produced by 25 % of tannin.   Keywords : leather, tannin, quality

′Switch flap′ for full thickness upper eyelid reconstruction

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Arvind Krishnamurthy

2011-01-01

Full Text Available Sebaceous gland carcinoma is an aggressive, uncommon, cutaneous malignancy. This tumour can arise anywhere in the body; approximately 75% of these tumours arise in the periocular region. The diagnosis and management of these malignancies often tend to get delayed because they are frequently mistaken for more common benign entities. Surgery has been and remains the primary treatment modality for sebaceous gland carcinomas. The resultant surgical defects following tumour excision generally tend to be full thickness and reconstructions of such defects pose significant challenges. These defects are conventionally reconstructed by the traditional bridging (eyelid sharing procedures, that is, the Cutler-Beard flap and its modifications. The ′Switch flap′ is an alternative eyelid sharing procedure; however, it is not very widely practiced. We recently used this procedure to reconstruct a large full-thickness upper eyelid defect with a satisfactory cosmetic and functional outcome.

The influence of simulated rotator cuff tears on the risk for impingement in handbike and handrim wheelchair propulsion.

Science.gov (United States)

van Drongelen, Stefan; Schlüssel, Matthias; Arnet, Ursina; Veeger, Dirkjan

2013-06-01

Rotator cuff tears strongly affect the biomechanics of the shoulder joint in their role to regulate the joint contact force needed to prevent the joint from dislocation. The aim of this study was to investigate the influence of simulated progressed rotator cuff tears on the (in)stability of the glenohumeral joint and the risk for impingement during wheelchair and handbike propulsion. The Delft Shoulder and Elbow Model was used to calculate the magnitude of the glenohumeral joint reaction force and the objective function J, which is an indication of the effort needed to complete the task. Full-thickness tears were simulated by virtually removing muscles from the model. With larger cuff tears the joint reaction force was higher and more superiorly directed. Also extra muscle force was necessary to balance the external force such that the glenohumeral joint did not dislocate. A tear of only the supraspinatus leads only to a minor increase in muscle forces and a minor shift of the force on the glenoid, indicating that it is possible to function well with a torn supraspinatus muscle. A massive tear shifts the direction of the joint reaction force to the superior border of the glenoid, increasing the risk for impingement. Copyright © 2013 Elsevier Ltd. All rights reserved.

As tears go by : Baby tears trigger more brain activity than adult tears in nulliparous women

NARCIS (Netherlands)

Hendricx-Riem, M.M.E.; De Carli, P.; van IJzendoorn, M.H.; Vingerhoets, A.J.J.M.; Bakermans-Kranenburg, M.J.

2017-01-01

The current functional magnetic resonance imaging study examines brain activity during the perception of infant and adult tears. Infant tears evoke stronger responses in the visual cortex than adult tears, indicating that infant tears are highly salient. In addition, our study shows that infant

Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video).

Science.gov (United States)

von Renteln, Daniel; Schmidt, Arthur; Riecken, Bettina; Caca, Karel

2008-04-01

The endoscopic full-thickness Plicator device was initially developed to provide an endoscopic treatment option for patients with GERD. Because the endoscopic full-thickness Plicator enables rapid and easy placement of transmural sutures, comparable with surgical sutures, we used the Plicator device for endoscopic treatment or prevention of GI-wall defects. To describe the outcomes and complications of endoscopic full-thickness suturing during EMR and for the treatment of gastric-wall defects. A report of 4 cases treated with the endoscopic full-thickness suturing between June 2006 and April 2007. A large tertiary-referral center. Four subjects received endoscopic full-thickness suturing. The subjects were women, with a mean age of 67 years. Of the 4 subjects, 3 received endoscopic full-thickness suturing during or after an EMR. One subject received endoscopic full-thickness suturing for treatment of a fistula. Primary outcome measurements were clinical procedural success and procedure-related adverse events. The mean time for endoscopic full-thickness suturing was 15 minutes. In all cases, GI-wall patency was restored or ensured, and no procedure-related complications occurred. All subjects responded well to endoscopic full-thickness suturing. The resection of one GI stromal tumor was incomplete. Because of the Plicator's 60F distal-end diameter, endoscopic full-thickness suturing could only be performed with the patient under midazolam and propofol sedation. The durable Plicator suture might compromise the endoscopic follow-up after EMR. The endoscopic full-thickness Plicator permits rapid and easy placement of transmural sutures and seems to be a safe and effective alternative to surgical intervention to restore GI-wall defects or to ensure GI-wall patency during EMR procedures.

Artificial tears potpourri: a literature review

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Moshirfar M

2014-07-01

Full Text Available Majid Moshirfar,1 Kasey Pierson,2,* Kamalani Hanamaikai,3,* Luis Santiago-Caban,1 Valliammai Muthappan,1 Samuel F Passi11Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA; 3A T Still University, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA *These authors contributed equally to this work Abstract: Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. Keywords: dry eye, tear film, dysfunctional tear syndrome, ophthalmic lubricant, artificial tears, lipid layer, tear osmolarity, TBUT, Systane®, Refresh®, Blink®, GenTeal®, Soothe®, Lacrisert®, ocular surface inflammatory disease, Sjogren�

Effect of piracetam and nimodipine on full-thickness skin burns in rabbits.

Science.gov (United States)

Sari, Elif; Dincel, Gungor C

2016-08-01

The potential of several drugs for full-thickness skin burns has been investigated, but the treatment of such burns remains a challenge in plastic surgery. The present study was designed to determine the effect of systemic and topical administration of piracetam and nimodipine on full-thickness skin burn wound healing. A total of 36 New Zealand male rabbits were divided into six groups. Full-thickness skin burns were produced in all the groups, except the control group. Piracetam was administered systemically (piracetam-IV) and topically (piracetam-C) for 14 days, and nimodipine was administered systemically (nimodipine-IV) and topically (nimodipine-C) over the burn wounds for 14 days. The sham group underwent burn injury but was not administered any drug. After 21 days, gross examination and histopathological analysis were performed and the results were compared statistically. Nimodipine-C and nimodipine-IV had no effect on burn wound healing. However, both piracetam-IV and piracetam-C significantly enhanced the healing of the full-thickness skin burn wounds, although the latter was more effective, useful and practical in burn wound healing. The histopathological features of the wounds in the piracetam-C group were closer to those of the control group than those of the other groups. Piracetam-C rather than piracetam-IV may promote full-thickness burn wound healing in rabbits. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Comparative study of lubricating properties of tear substitutes Systane® Ultra and Visine® Clear Tears

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Yu. A. Pavlova

2014-07-01

Full Text Available Purpose: To compare tear substitutive properties of Systane® Ultra and Visine® Clear Tears in dry eye therapy.Methods: 20 patients with dry eye due to chronic blepharoconjunctivitis and 20 patients with neurotrophic dry eye following corneal refractive surgery were examined. Treatment schedule was the following: in the first 7 days, Systane® Ultra was instilled in the right eye and Visine® Clear Tears was instilled in the left eye, while from day 8 to day 30, only one medicine selected by the patient was applied. Their efficacy was measured by tear film stability and patients’ subjective sensations.Results: Norn test results improved to day 7 in patients with dry eye following corneal refractive surgery and to day 30 in patients with dry eye due to blepharoconjunctivitis regardless of eye drops used. As to patients’ comfort, Systane® Ultra is preferable to Visine® Clear Tears.Conclusion: Systane® Ultra is therapeutically similar to but preferable to Visine® Clear Tears due to good tolerability.

Comparative study of lubricating properties of tear substitutes Systane® Ultra and Visine® Clear Tears

Directory of Open Access Journals (Sweden)

Yu. A. Pavlova

2013-01-01

Full Text Available Purpose: To compare tear substitutive properties of Systane® Ultra and Visine® Clear Tears in dry eye therapy.Methods: 20 patients with dry eye due to chronic blepharoconjunctivitis and 20 patients with neurotrophic dry eye following corneal refractive surgery were examined. Treatment schedule was the following: in the first 7 days, Systane® Ultra was instilled in the right eye and Visine® Clear Tears was instilled in the left eye, while from day 8 to day 30, only one medicine selected by the patient was applied. Their efficacy was measured by tear film stability and patients’ subjective sensations.Results: Norn test results improved to day 7 in patients with dry eye following corneal refractive surgery and to day 30 in patients with dry eye due to blepharoconjunctivitis regardless of eye drops used. As to patients’ comfort, Systane® Ultra is preferable to Visine® Clear Tears.Conclusion: Systane® Ultra is therapeutically similar to but preferable to Visine® Clear Tears due to good tolerability.

Can MRI distinguish between acute partial and complete anterior cruciate ligament tear?

International Nuclear Information System (INIS)

Yamato, Minoru; Yamagishi, Tsuneo.

1996-01-01

A study to elucidate the title problem was done. Subjects were 8 patients with partial anterior cruciate ligament (ACL) tear diagnosed by both MRI and arthroscopy within 6 weeks after trauma, 14 patients with complete ACL tear diagnosed similarly and 10 control patients with arthroscopically intact ACL. Proton density-and T2-weighted MRI imaging of the sagittal section of the knee was performed with 1.5 T magnets (Siemens Magnetom H15, Shimadzu SMT150GUX) by using a dedicated knee coil, with slice thickness of 4-5 mm and 14-16 cm field of view. The examination was done on the primary (discontinuity of low signal band, abnormal axis of the ligament and focal or diffuse increased signal intensity) and secondary (bone bruise, anterior translocation of the tibia and PCL curvature value) signs of ACL tear. In proton density-weighted sagittal images, it was found easy to distinguish acute partial ACL tear from normal ligament but not from complete ACL tear. In T2-weighted images, partial ACL tear was suggested to keep continuity of the ligament. (H.O.)

MRI diagnosis of ACL bundle tears: value of oblique axial imaging

Energy Technology Data Exchange (ETDEWEB)

Ng, Alex W.H.; Griffith, James F.; Hung, Esther H.Y. [Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China); Law, Kan Yip; Yung, Patrick S.H. [Chinese University of Hong Kong, Department of Orthopedics and Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China)

2013-02-15

To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears. The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance. Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05). The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL. (orig.)

Porcine cholecyst–derived scaffold promotes full-thickness wound healing in rabbit

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Deepa Revi

2013-12-01

Full Text Available Graft-assisted healing is an important strategy for treating full-thickness skin wounds. This study evaluated the properties of porcine cholecyst–derived scaffold and its use for treating full-thickness skin wound in rabbit. The physical properties of cholecyst-derived scaffold were congenial for skin-graft application. Compared to a commercially available skin-graft substitute made of porcine small intestinal submucosa, the cholecyst-derived scaffold was rich in natural biomolecules like elastin and glycosaminoglycans. When used as a xenograft, it promoted healing with excess cell proliferation at early phases and acceptable collagen deposition in the later remodelling phases.

Surgical correction of cryptotia combined with an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap.

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Yu, Xiaobo; Yang, Qinghua; Jiang, Haiyue; Pan, Bo; Zhao, Yanyong; Lin, Lin

2017-11-01

Cryptotia is a common congenital ear deformity in Asian populations. In cryptotia, a portion of the upper ear is hidden and fixed in a pocket of the skin of the mastoid. Here we describe our method for cryptotia correction by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. We developed a new method for correcting cryptotia by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. Following ear release, the full-thickness skin rotation flap is rotated into the defect, and the donor site is covered with an ultra-delicate split-thickness skin graft raised in continuity with the flap. All patients exhibited satisfactory release of cryptotia. No cases involved partial or total flap necrosis, and post-operative outcomes using this new technique for cryptotia correction have been more than satisfactory. Our method of using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap to correct cryptotia is simple and reliable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Rotator cuff tear: A detailed update

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Vivek Pandey

2015-01-01

Full Text Available Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

Tear ferning in normal dogs and dogs with keratoconjunctivitis sicca ...

African Journals Online (AJOL)

This study evaluates tear ferning as an ancillary technique for the evaluation of the canine tear film in normal eyes and eyes affected by keratoconjunctivitis sicca (KCS). Thirty dogs with KCS and 50 control dogs with normal tear film were evaluated with a full ophthalmoscopic examination and a Schirmer tear test type 1 ...

Anterior cruciate ligament tear: comparison of MR features between complete and partial tear

International Nuclear Information System (INIS)

Song, Ki Young; Lee, Joo Hyuk; Park, Jin Hee; Lee, Yu Jin; Rho, Eun Jin; Kim, Young Hoon; Yi, Jeong Geun; Ahn, Joong Mo

1997-01-01

To determine the MRI features which distinguish complete and partial tear of the anterior cruciate ligament(ACL) and to thus improve MRI interpretation. In 80 patients, we analyzed MR findings of direct and indirect signs of ACL tear (complete tear, 61 cases, partial tear, 19 cases) confirmed by arthroscopy or surgery, and compared the relative incidence of each sign in cases of complete and partial tear. Direct and indirect signs were found in 61 (100%) and 60 cases (98.4%), respectively, in complete tears, but in 16 (84.2%) and 15 cases (78.9%), respectively, in partial tears. Poor visualization, discontinuity and hyperintensity were seen in all complete tears but in only nine cases (47.4%) of partial tear. A wavy or abnormal contour was seen in 53 cases (86.9%) of complete tear and 14 (73.7%) of partial tear. A wavy contour without other direct signs was seen in only five cases (26.3%) of partial tear. Three cases (15.8%) of partial tear showed normal MR finding. Indirect signs, i.e. abnormal ACL angle, abnormal ACL-Blumensaat line angle, abnormal posterior cruciate ligament (PCL) line, abnormal PCL angle, PCL buckling, anterior displacement of tibia, posterior displacement of lateral meniscus, bone bruise, Segond fracture, tear of collateral ligaments, PCL, and tear of meniscus were commoner in complete than in partial tears. Two cases of O'Donoghue's triad and two of popliteus injury were seen only in complete tears. Direct and indirect signs of ACL tear were more commonly noted in complete than in partial tears. The latter showed MR features varying from normal to almost complete tear. We suggest that a wavy contour without other direct signs is indicative of a partial tear, and that O'Donoghue's triad and popliteus muscle injury are indirect signs of a complete tear

Streaming tearing mode

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Shigeta, M.; Sato, T.; Dasgupta, B.

1985-01-01

The magnetohydrodynamic stability of streaming tearing mode is investigated numerically. A bulk plasma flow parallel to the antiparallel magnetic field lines and localized in the neutral sheet excites a streaming tearing mode more strongly than the usual tearing mode, particularly for the wavelength of the order of the neutral sheet width (or smaller), which is stable for the usual tearing mode. Interestingly, examination of the eigenfunctions of the velocity perturbation and the magnetic field perturbation indicates that the streaming tearing mode carries more energy in terms of the kinetic energy rather than the magnetic energy. This suggests that the streaming tearing mode instability can be a more feasible mechanism of plasma acceleration than the usual tearing mode instability.

Mass spectrometric identification of phospholipids in human tears and tear lipocalin.

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Dean, Austin W; Glasgow, Ben J

2012-04-02

The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490-540) accounted for about 80% of the total integrated ion count. The [M+H](+) compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin-bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin.

Reduced muscle fiber force production and disrupted myofibril architecture in patients with chronic rotator cuff tears.

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Mendias, Christopher L; Roche, Stuart M; Harning, Julie A; Davis, Max E; Lynch, Evan B; Sibilsky Enselman, Elizabeth R; Jacobson, Jon A; Claflin, Dennis R; Calve, Sarah; Bedi, Asheesh

2015-01-01

A persistent atrophy of muscle fibers and an accumulation of fat, collectively referred to as fatty degeneration, commonly occur in patients with chronic rotator cuff tears. The etiology of fatty degeneration and function of the residual rotator cuff musculature have not been well characterized in humans. We hypothesized that muscles from patients with chronic rotator cuff tears have reduced muscle fiber force production, disordered myofibrils, and an accumulation of fat vacuoles. The contractility of muscle fibers from biopsy specimens of supraspinatus muscles of 13 patients with chronic full-thickness posterosuperior rotator cuff tears was measured and compared with data from healthy vastus lateralis muscle fibers. Correlations between muscle fiber contractility, American Shoulder and Elbow Surgeons (ASES) scores, and tear size were analyzed. Histology and electron microscopy were also performed. Torn supraspinatus muscles had a 30% reduction in maximum isometric force production and a 29% reduction in normalized force compared with controls. Normalized supraspinatus fiber force positively correlated with ASES score and negatively correlated with tear size. Disordered sarcomeres were noted, along with an accumulation of lipid-laden macrophages in the extracellular matrix surrounding supraspinatus muscle fibers. Patients with chronic supraspinatus tears have significant reductions in muscle fiber force production. Force production also correlates with ASES scores and tear size. The structural and functional muscle dysfunction of the residual muscle fibers is independent of the additional area taken up by fibrotic tissue. This work may help establish future therapies to restore muscle function after the repair of chronically torn rotator cuff muscles. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The influence of non-polar lipids on tear film dynamics

KAUST Repository

Bruna, M.; Breward, C.  J.  W.

2014-01-01

© 2014 Cambridge University Press. In this paper we examine the effect that physiological non-polar lipids, residing on the surface of an aqueous tear film, have on the film evolution. In our model we track the evolution of the thickness of the non

Influence of helical external driven current on nonlinear resistive tearing mode evolution and saturation in tokamaks

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Zhang, W.; Wang, S.; Ma, Z. W.

2017-06-01

The influences of helical driven currents on nonlinear resistive tearing mode evolution and saturation are studied by using a three-dimensional toroidal resistive magnetohydrodynamic code (CLT). We carried out three types of helical driven currents: stationary, time-dependent amplitude, and thickness. It is found that the helical driven current is much more efficient than the Gaussian driven current used in our previous study [S. Wang et al., Phys. Plasmas 23(5), 052503 (2016)]. The stationary helical driven current cannot persistently control tearing mode instabilities. For the time-dependent helical driven current with f c d = 0.01 and δ c d < 0.04 , the island size can be reduced to its saturated level that is about one third of the initial island size. However, if the total driven current increases to about 7% of the total plasma current, tearing mode instabilities will rebound again due to the excitation of the triple tearing mode. For the helical driven current with time dependent strength and thickness, the reduction speed of the radial perturbation component of the magnetic field increases with an increase in the driven current and then saturates at a quite low level. The tearing mode is always controlled even for a large driven current.

The role of resveratrol on full - Thickness uterine wound healing in rats.

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Sayin, Oya; Micili, Serap Cilaker; Goker, Asli; Kamaci, Gonca; Ergur, Bekir Ugur; Yilmaz, Osman; Guner Akdogan, Gul

2017-10-01

Healing of the uterus after cesarean section and myomectomy operation is clinically important. In this study, we aimed to investigate the effects of resveratrol (3,5,4'-o-trihydroxystilbene) on the wound healing process of the uterus in rats treated with resveratrol following full thickness injury of the uterus. Twenty-one female wistar albino rats were divided randomly into three groups (1) control group with no intervention (2) injury group with uterine full thickness injury (3) resveratrol group with uterine full thickness injury and treated with resveratrol. Resveratrol was injected by oral gavage at the doses of 0.5 mg/kg/day for 30 days following uterine full thickness injury. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) distributions were assessed using the immunohistochemical methods in tissue and ELISA methods in the tissue homogenate. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were evaluated with colorimetric method and malondialdehyde (MDA) levels also were measured using high performance liquid chromatography in the tissue homogenate. The effects of resveratrol on the uterine histology also were evaluated histologically with the light microscopy. Histological evaluation and immunohistochemical evaluations showed that treatment with a resveratrol significantly increased the thickness of the uterine wall and VEGF expression and decreased expression PDGF during wound healing. Biochemically, GPx and SOD activities were increased significantly after treatment with resveratrol. Additionally, resveratrol administration decreased MDA levels. These results showed that the antioxidant effects of resveratrol has been shown to have a positive influence on wound healing of the uterus. Copyright © 2017. Published by Elsevier B.V.

A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear.

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Zheng, Jiapeng; Zhai, Wenliang; Li, Qiang; Jia, Qianxin; Lin, Dasheng

2017-01-01

We describe a special, interesting phenomenon found in the anterior horn of the lateral meniscus (AHLM): most tear patterns in the AHLM are distinctive, with loose fibers in injured region and circumferential fiber bundles were separated. We name it as macerated tear. The goal of this study was to bring forward a new type of meniscal tear in the AHLM and investigate its clinical value. AHLM tears underwent arthroscopic surgery from January 2012 to December 2014 were included. Data regarding the integrity of AHLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos. A total of 60 AHLM tears in 60 patients (mean age 27.1 years) were grouped into horizontal tears (n = 15, 25%), vertical tears (n = 14, 23%), complex tears (n = 6, 10%), and macerated tears (n = 25, 42%). There were 6 patients with AHLM cysts in macerated tear group and one patient in vertical tear group. 60 patients were performed arthroscopic meniscus repairs and were followed-up with averaged 18.7 months. Each group had significant postoperative improvement in Lysholm and IKDC scores (p 0.05). This study demonstrated that the macerated tear is common in the tear pattern of AHLM. However, feasibility of the treatment of this type of meniscal tear, especially the meniscus repairs still requires further study.

Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness burn, excision and grafting.

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Carlsson, Anders H; Rose, Lloyd F; Fletcher, John L; Wu, Jesse C; Leung, Kai P; Chan, Rodney K

2017-02-01

Current standard of care for full-thickness burn is excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact burns (100°C, 30s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, burn eschar was tangentially excised and covered with 12/1000th inch (300μm) split-thickness skin graft. For comparison, unburned wounds were created by sharp excision to fat before graft application. From 7 to 120days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (pskin graft quality, likely by multiple mechanisms including burn-related inflammation, microscopically inadequate excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness burn, excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete excision. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Rotator cuff tears noncontrast MRI compared to MR arthrography

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Lee, Ji Hyun; Yoon, Young Cheol [Sungkyunkwan University, School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of); Jung, Jee Young [Chungang University School of Medicine, Department of Radiology, Chungang University Hospital, Seoul (Korea, Republic of); Yoo, Jae Chul [Sungkyunkwan University, School of Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

2015-12-15

To compare the accuracy of indirect magnetic resonance arthrography and noncontrast magnetic resonance imaging for diagnosing rotator cuff tears. In total, 333 patients who underwent noncontrast magnetic resonance imaging or indirect magnetic resonance arthrography were included retrospectively. Two musculoskeletal radiologists evaluated the images for the presence of supraspinatus-infraspinatus and subscapularis tendon tears. The overall diagnostic performance was calculated using the arthroscopic findings as the reference standard. Statistical differences between the diagnostic performances of the two methods were analyzed. Ninety-six and 237 patients who underwent noncontrast magnetic resonance imaging and indirect magnetic resonance arthrography were assigned into groups A and B, respectively. Sensitivity for diagnosing articular-surface partial-thickness supraspinatus-infraspinatus tendon tear was slightly higher in group B than in group A. Statistical significance was confirmed by multivariate analysis using the generalized estimating equation (p = 0.046). The specificity for diagnosing subscapularis tendon tear (85 % vs. 68 %, p = 0.012) and grading accuracy (57 % vs. 40 %, p = 0.005) was higher in group B than in group A; the differences were statistically significant for one out of two readers. Univariate analysis using the generalized estimating equation showed that the accuracy for diagnosing subscapularis tendon tear in group B was higher than in group A (p = 0.042). There were no statistically significant differences between the diagnostic performances of both methods for any other parameters. Indirect magnetic resonance arthrography may facilitate more accurate diagnosis and grading of subscapularis tendon tears compared with noncontrast magnetic resonance imaging. (orig.)

Rotator cuff tears noncontrast MRI compared to MR arthrography

International Nuclear Information System (INIS)

Lee, Ji Hyun; Yoon, Young Cheol; Jung, Jee Young; Yoo, Jae Chul

2015-01-01

To compare the accuracy of indirect magnetic resonance arthrography and noncontrast magnetic resonance imaging for diagnosing rotator cuff tears. In total, 333 patients who underwent noncontrast magnetic resonance imaging or indirect magnetic resonance arthrography were included retrospectively. Two musculoskeletal radiologists evaluated the images for the presence of supraspinatus-infraspinatus and subscapularis tendon tears. The overall diagnostic performance was calculated using the arthroscopic findings as the reference standard. Statistical differences between the diagnostic performances of the two methods were analyzed. Ninety-six and 237 patients who underwent noncontrast magnetic resonance imaging and indirect magnetic resonance arthrography were assigned into groups A and B, respectively. Sensitivity for diagnosing articular-surface partial-thickness supraspinatus-infraspinatus tendon tear was slightly higher in group B than in group A. Statistical significance was confirmed by multivariate analysis using the generalized estimating equation (p = 0.046). The specificity for diagnosing subscapularis tendon tear (85 % vs. 68 %, p = 0.012) and grading accuracy (57 % vs. 40 %, p = 0.005) was higher in group B than in group A; the differences were statistically significant for one out of two readers. Univariate analysis using the generalized estimating equation showed that the accuracy for diagnosing subscapularis tendon tear in group B was higher than in group A (p = 0.042). There were no statistically significant differences between the diagnostic performances of both methods for any other parameters. Indirect magnetic resonance arthrography may facilitate more accurate diagnosis and grading of subscapularis tendon tears compared with noncontrast magnetic resonance imaging. (orig.)

T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear

Science.gov (United States)

Gumucio, J.; Flood, M.; Harning, J.; Phan, A.; Roche, S.; Lynch, E.; Bedi, A.; Mendias, C.

2014-01-01

Objectives Rotator cuff tears are among the most common and debilitating upper extremity injuries. Chronic cuff tears result in atrophy and an infiltration of fat into the muscle, a condition commonly referred to as ‘fatty degeneration’. While stem cell therapies hold promise for the treatment of cuff tears, a suitable immunodeficient animal model that could be used to study human or other xenograft-based therapies for the treatment of rotator cuff injuries had not previously been identified. Methods A full-thickness, massive supraspinatus and infraspinatus tear was induced in adult T-cell deficient rats. We hypothesised that, compared with controls, 28 days after inducing a tear we would observe a decrease in muscle force production, an accumulation of type IIB fibres, and an upregulation in the expression of genes involved with muscle atrophy, fibrosis and inflammation. Results Chronic cuff tears in nude rats resulted in a 30% to 40% decrease in muscle mass, a 23% reduction in production of muscle force, and an induction of genes that regulate atrophy, fibrosis, lipid accumulation, inflammation and macrophage recruitment. Marked large lipid droplet accumulation was also present. Conclusions The extent of degenerative changes in nude rats was similar to what was observed in T-cell competent rats. T cells may not play an important role in regulating muscle degeneration following chronic muscle unloading. The general similarities between nude and T-cell competent rats suggest the nude rat is likely an appropriate preclinical model for the study of xenografts that have the potential to enhance the treatment of chronically torn rotator cuff muscles. Cite this article: Bone Joint Res 2014;3:262–72. PMID:25185444

Effect of castor oil emulsion eyedrops on tear film composition and stability.

Science.gov (United States)

Maïssa, Cécile; Guillon, Michel; Simmons, Peter; Vehige, Joseph

2010-04-01

An emulsion eyedrop containing castor oil has been shown to modify the tear film lipid layer and increase tear film stability. The primary objectives of this investigation were to measure the prevalence of castor oil in the tear fluid over time and quantify the effects on the lipid layer. A secondary objective was to quantify the initial effects on ocular symptomatology. The investigation was an open label pilot study on 5 normal and 10 dry eye subjects. A single eyedrop (Castor oil emulsion, Allergan) was instilled in each eye; the tear film appearance and composition were monitored for 4h via in vivo visualisation using the Tearscope and post in vivo tear samples analysis by HPLC. Combined results for both normal and dry eye subjects showed that castor oil was detected up to 4h after a single eyedrop instillation and associated with an increase in the level of tear film lipid. The relative amount of various lipid families was also changed. An increase in tear lipid layer thickness was significant up to one hour post-instillation for the symptomatic sub-population. The changes in tear film characteristics were associated with significantly lower symptoms up to four hours post-instillation for the symptomatic sub-population. This pilot investigation showed that castor oil eyedrops achieved a residence time of at least four hours post-instillation, producing a more stable tear film and an associated significant decrease in ocular symptoms over the entire follow-up period for the symptomatic subjects. 2009 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Repair mechanism of retinal pigment epithelial tears in age-related macular degeneration.

Science.gov (United States)

Mukai, Ryo; Sato, Taku; Kishi, Shoji

2015-03-01

To investigate repair mechanisms of retinal pigment epithelial (RPE) tears in age-related macular degeneration. The authors retrospectively studied 10 eyes with age-related macular degeneration that developed RPE tears during follow-up or after treatment with an anti-vascular endothelial growth factor drug or photodynamic therapy combined with ranibizumab. After development of the RPE tears, all follow-ups exceeded 13 months. Spectral domain or swept-source optical coherence tomography have been used to examine consecutive retinal changes where the RPE tears developed and attempted to determine the repair mechanisms. Retinal pigment epithelial tears developed during the natural course (n = 4) after ranibizumab treatment (n = 2) and after photodynamic therapy and ranibizumab (n = 4). Subretinal fluid persisted for more than 6 months after the RPE tears developed (n = 4), with the area where the RPE was lost found to be covered with thickened proliferative tissue. In 6 eyes where the subretinal fluid was absorbed within 2 months, optical coherence tomography showed the outer retina appeared to be directly attached to Bruch membrane, and there was attenuation of the normal hyperreflective band attributable to normal RPE during follow-up. Results suggest that two repair processes may be present in the area where RPE tears developed. Persistent subretinal fluid may lead to repair with thick proliferative tissue, while the outer retina appears to attach to Bruch membrane when there is early subretinal fluid resolution after RPE tear development.

Influence of preoperative artificial tears on tear film after phacoemulsification on dry eye of diabetes patients

Directory of Open Access Journals (Sweden)

Rui Su

2015-05-01

Full Text Available AIM: To discuss the artificial tears on the tear film of diabetic patients with dry eye preoperatively, and the influence on the tear film's fuctional after phacoemulsification.METHODS: Fifty-four diabetic patients with dry eye(60 eyeswere followed up before phacoemulsification. Preoperatively, group A(30 eyes in 28 caseswas treated with Hydroxyl Indican eye drops and group B(30 eyes in 26 caseswas not treated. Postoperatively, both group A and B were treated with Tobramycin Dexamethasone eye drops, Oprah Winfrey Ibuprofen eye drops and Hydroxyl Indican eye drops. Dry eye symptoms, break up time(BUT, Schirmer Ⅰ test(S Ⅰ t, fluorescein stain test(FIwere measured at 3d preoperatively, and 1, 7, 30, 90d postoperatively.RESULTS: At 3d preoperatively, there was no statistical differences between the two groups for dry eye symptoms, BUT, SⅠt, FI(P>0.05. At 1 and 7d postoperatively, there were significant statistical differents between the two groups for dry eye symptoms(PPP>0.05.CONCLUSION: Using artificial tears before phacoemulsification can improve symptoms of the diabetic patients with dry eye and accelerate the recovery of the tear film.

Tear secretion and tear stability of women on hormonal contraceptives

Directory of Open Access Journals (Sweden)

Faustina Kemdinum Idu

2013-01-01

Conclusions: Injectable hormonal contraceptives had no significant effects on tear secretion and tear stability of healthy women of childbearing age. Further studies may be required to determine the effects of hormonal contraceptives on tear volume and stability of women with dry eyes.

Application of indocyanine green-fluorescence imaging to full-thickness cholecystectomy.

Science.gov (United States)

Morita, Kiyomi; Ishizawa, Takeaki; Tani, Keigo; Harada, Nobuhiro; Shimizu, Atsushi; Yamamoto, Satoshi; Takemura, Nobuyuki; Kaneko, Junichi; Aoki, Taku; Sakamoto, Yoshihiro; Sugawara, Yasuhiko; Hasegawa, Kiyoshi; Kokudo, Norihiro

2014-05-01

Fluorescence imaging using indocyanine green (ICG) has recently been applied to laparoscopic surgery to identify cancerous tissues, lymph nodes, and vascular anatomy. Here we report the application of ICG-fluorescence imaging to visualize the boundary between the liver and subserosal tissues of the gallbladder during laparoscopic full-thickness cholecystectomy. A patient with a potentially malignant gallbladder lesion was administered 2.5-mg intravenous ICG just before laparoscopic full-thickness cholecystectomy. Intraoperative fluorescence imaging enabled the real-time delineation of both extrahepatic bile duct anatomy and hepatic parenchyma throughout the procedure, which resulted in complete removal of subserosal tissues between liver and gallbladder. Safe and feasible ICG-fluorescence imaging can be widely applied to laparoscopic hepatobiliary surgery by utilizing a biliary excretion property of ICG. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Full-Thickness Retinochoroidal Incision in the Management of Central Retinal Vein Occlusion

Directory of Open Access Journals (Sweden)

San-Ni Chen

2015-01-01

Full Text Available Purpose. To evaluate the clinical outcomes in patients with central retinal vein occlusion (CRVO treated with full-thickness retinochoroidal incisions and to compare whether there is difference in treatment response in ischemic and nonischemic CRVO. Methods. Retrospective study of patients of CRVO receiving full-thickness retinochoroidal incisions in Changhua Christian Hospital. Fluorescein angiography (FA, slit-lamp biomicroscopy, indirect funduscopy, best corrected visual acuity, and central macular thickness (CMT measured by optical coherence tomography were performed pre- and postoperatively. Patients were divided into an ischemic and nonischemic group according to the findings of FA. Patients were followed up for at least 1 year. Results. Twenty-eight eyes (14 ischemic and 14 nonischemic CRVO were included. Functional retinochoroidal venous anastomosis (RCVA was achieved in 48 of the 65 retinochoroidal incisions (73.8%. Central macular thickness (CMT and retinal hemorrhage decreased significantly after the surgery. Significant visual gain was observed postoperatively in the nonischemic group, but not in the ischemic group. Postoperative complications included vitreous hemorrhage (17.8%, neovascular glaucoma (7.1%, and preretinal fibrovasular membrane (10.7%, all of which were in the ischemic group. Conclusions. RCVA formation induced by retinochoroidal incisions could improve venous flow, and decrease CMT and retinal hemorrhage. However, only eyes with nonischemic CRVO showed visual improvement.

Operative management of partial-thickness tears of the proximal hamstring muscles in athletes.

Science.gov (United States)

Bowman, Karl F; Cohen, Steven B; Bradley, James P

2013-06-01

Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population. To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes. Case series; Level of evidence, 4. The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded. There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in

Application of tearing modulus stability concepts to nuclear piping. Final report

International Nuclear Information System (INIS)

Cotter, K.H.; Chang, H.Y.; Zahoor, A.

1982-02-01

The recently developed tearing modulus stability concept was successfully applied to several boiling water reactor (BWR) and pressurized water reactor (PWR) piping systems. Circumferentially oriented through-the-thickness cracks were postulated at numerous locations in each system. For each location, the simplified tearing stability methods developed in USNRC Report NUREG/CR-0838 were used to determine crack stability. The J-T diagram was used to present the results of the computations. The piping systems considered included Type 304 stainless steel as well as A106 carbon steel materials. These systems were analyzed using the piping analysis computer code MINK

Comparison of three dimensional isotropic and two dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears

Energy Technology Data Exchange (ETDEWEB)

Lee, Ji Hyun; Yoon, Young Cheol; Kwon, Jong Won; Yoo, Jae Chul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Cha, Jang Kyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jee, Suk Kyoung [Joeun Madi Hospital, Seoul (Korea, Republic of)

2014-12-15

To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

Comparison of three dimensional isotropic and two dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears

International Nuclear Information System (INIS)

Lee, Ji Hyun; Yoon, Young Cheol; Kwon, Jong Won; Yoo, Jae Chul; Cha, Jang Kyu; Jee, Suk Kyoung

2014-01-01

To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

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Yang Seo Park

2012-09-01

Full Text Available BackgroundPediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG in pediatric hand burns, based on long-term observation periods and existing studies.MethodsFrom January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed.ResultsThe mean age of the patients was 24.4 months (range, 8 to 94 months, consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%. During the observation, 25 cases underwent corrective operations with an average period of 40.6 months.ConclusionsIn the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

Changes of tear film after trabeculectomy in glaucoma

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Xue-Jun Li

2015-07-01

Full Text Available AIM: To learn the changes of the tear film before and after the trabeculectomy of glaucoma and explore the incidence of dry eye and the prevention and control measures.METHODS: The 36 patients(60 eyesof glaucoma were examined in detail before 3d of trabeculectomy and after the surgery at 3, 7, 14 and 30d. The examinations include lower eyelid central river of tears, break-up time(BUT, Schirmer Ⅰ test(SⅠtand staining scores of corneal fluorescein under slit lamp microscope.RESULTS:The tear meniscus height of central lower eyelid was increased and the tear film BUT was shortened at the same time, the scores of SⅠt was reduced and corneal fluorescein staining score was increased at postoperative 3 and 7d compared with that of preoperation. The tear meniscus height of central lower eyelid, tear film BUT and SIt and score of corneal fluorescein staining began to recover in most of the affected eyes after surgery 14d. At 30d after surgery, 22% of patients tear film failed to recover to the preoperative level; dry eye occured in 18% preoperative eyes with normal tear film.CONCLUSION:Trabeculectomy of glaucoma may affect the stability of the tear film and some patients showeing obvious dry eye and should be intervened and treatmented timely.

A comparison of basal and eye-flush tears for the analysis of cat tear proteins.

Science.gov (United States)

Petznick, Andrea; Evans, Margaret D M; Madigan, Michele C; Markoulli, Maria; Garrett, Qian; Sweeney, Deborah F

2011-02-01

To identify a rapid and effective tear collection method providing sufficient tear volume and total protein content (TPC) for analysis of individual proteins in cats. Domestic adult short-haired cats (12-37 months; 2.7-6.6 kg) were used in the study. Basal tears without stimulation and eye-flush tears after instillation of saline (10 μl) were collected using microcapillary tubes from animal eyes either unwounded control or wounded with 9-mm central epithelial debridement giving four groups with n = 3. Tear comparisons were based on total time and rate for tear collection, TPC using micro bicinchoninic acid (BCA), tear immunoglobulin A (IgA), total matrix-metalloproteinase (MMP)-9 concentration using sandwich enzyme-linked immunosorbent assay (ELISA) and MMP-9 activity. Eye-flush tears were collected significantly faster than basal tears in wounded eyes with higher rates for tear collection in unwounded control and wounded eyes. TPC was significantly lower in eye-flush tears compared to basal tears. The relative proportion of tear IgA normalized to TPC (% IgA of TPC) was not significantly different between basal and eye-flush tears. In unwounded control eyes, MMP-9 was slightly higher in eye-flush than in basal tears; activity of MMP-9 in both tear types was similar. In wounded eyes, eye-flush tears showed highest MMP-9 levels and activity on Day 1, which subsequently decreased to Day 7. MMP-9 activity in basal tears from wounded eyes did not display changes in expression. Eye-flush tears can be collected rapidly providing sufficient tear volume and TPC. This study also indicates that eye-flush tears may be more suitable than basal tears for the analysis of MMPs following corneal wounding. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Relationship between full-thickness macular hole and retinal break/lattice degeneration.

Science.gov (United States)

Zhang, Jinglin; Li, Yonghao; Zhao, Xiujuan; Cai, Yu; Yu, Xiling; Lu, Lin

2015-12-01

The purpose is to investigate the relationship between full-thickness macular hole (MH) and retinal break (RB) and/or lattice degeneration. Patients diagnosed as full-thickness MH and referred to Dr. Lin Lu from January 2009 to December 2013 were evaluated. All patients underwent general ophthalmologic examinations, fundus examination and optical coherence tomography (OCT). The RB and/or lattice degeneration were recorded. Totally 183 eyes of 167 patients were included. The sex ratio of men to women was 1:2.88. A total of 17 eyes were pseudophakic and 166 eyes were phakic. RB and/or lattice degeneration were found in 62 eyes (33.88%). The prevalence of RB and/or lattice degeneration was similar between men and women (P = 0.344 > 0.05). There was no statistical difference between the pseudophakic eyes and phakic eyes (P = 0.138 > 0.05). All of the RB and/or lattice degeneration were located near or anterior to the equator. The inferior quadrants and the vertical meridian were affected more often than the superior quadrants and the horizontal meridian. We identified a high incidence of RB/lattice degeneration in cases of full-thickness MH. Carefully examination of the peripheral retina and prophylactic treatment of RB and/or lattice degeneration are critical.

Blocked Tear Duct

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... of the nose (lacrimal sac). From there tears travel down a duct (the nasolacrimal duct) draining into your nose. Once in the nose, tears are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta ...

Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity

Science.gov (United States)

Dunn, Warren R.; Kuhn, John E.; Sanders, Rosemary; An, Qi; Baumgarten, Keith M.; Bishop, Julie Y.; Brophy, Robert H.; Carey, James L.; Holloway, G. Brian; Jones, Grant L.; Ma, C. Benjamin; Marx, Robert G.; McCarty, Eric C.; Poddar, Sourav K.; Smith, Matthew V.; Spencer, Edwin E.; Vidal, Armando F.; Wolf, Brian R.; Wright, Rick W.

2014-01-01

Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders. Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4. Results: Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25). Conclusions

The role of an axial MR scan on the diagnosis a meniscal tear of the knee joint

International Nuclear Information System (INIS)

Yeom, Suk Keu; Kim, Baek Hyun; Hong, Suk Joo; Seol, Hae Young

2007-01-01

To evaluate the role of standard axial MR images for the diagnosis for meniscal tears of the knee. Forty-five patients with a prior MRI examination that underwent arthroscopic surgery of the knee due to clinical impression of a meniscal tear were included in the study group. The sequence for meniscal evaluation was an axial fat-saturated proton density-weighted image with a 4 mm slice thickness. Axial MR images were independently reviewed by two radiologists and were compared with findings of arthroscopy. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the axial MR scan for the diagnosis of the meniscal tear were calculated. A total 90 menisci of 45 patients were evaluated in the axial MR scans. Forty-two patients had meniscal tears, and two of the patients had tears in both menisci; thus, a total of 44 meniscal tears were found by arthroscopy. For meniscal tears, the sensitivity of the axial plane was 76.2%, the specificity was 89.1% and the accuracy was 81.1%. False negative meniscal tears were seen in 12 cases and false positive meniscal tears were seen in 5 cases on the axial MR images. In standard knee MRI examinations, axial images may be valuable for the detection and localization of meniscal tears

Full thickness burn caused by exposure to giant hogweed: delayed presentation, histological features and surgical management.

LENUS (Irish Health Repository)

Chan, Jeffrey C Y

2012-02-01

We report the case of a 10-year-old boy with a full thickness chemical burn on his right pretibial area due to phytophotodermatitis (PPD) following contact with giant hogweed (Heracleum mantegazzianum). Although cutaneous burns due to plants are a well-established cause of chemical burn, previous reports described partial thickness burns that healed with conservative measures. This patient presented to our unit two weeks after the initial injury with an established full thickness burn. Debridement and split thickness skin grafting was required. We presented the histological features of the debrided skin specimen and discussed potential factors leading to this unexpected full thickness injury.

Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.

Science.gov (United States)

Boyce, Steven T; Simpson, Peggy S; Rieman, Mary T; Warner, Petra M; Yakuboff, Kevin P; Bailey, J Kevin; Nelson, Judith K; Fowler, Laura A; Kagan, Richard J

Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository, correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7 ± 9.7 for ESS compared with a maximum of 4.0 ± 0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the National Burn Repository (P burn generated an R value of 0.65 (P burns of greater than 50% TBSA.

Efficacy of artificial tears for children xerophthalmia

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Jie Yang

2016-03-01

Full Text Available AIM:To observe the efficacy and safety of artificial tears for children xerophthalmia.METHODS:Fifty-eight cases with 116 eyes were diagnosed as xerophthalmia by tear break-up time(BUT, Schirmer Ⅰ test(SⅠt, tear meniscus height, corneal staining, meibomian gland function test and were given artificial tears therapy for 1mo. Then the aforementioned tests were conducted again for statistical analysis.RESULTS:The mean BUT of all the children before treatments was 6.03±1.19s, SⅠt was 7.67±2.32mm/5min, tear meniscus height was 0.20±0.02mm, corneal staining was 1.02±0.13 scores and meibomian gland function was 2.45±0.86 scores. Sixty-two eyes in 31 cases were the lipid-deficient type, 40 eyes in 20 cases were aqueous-deficient type, and 14 eyes in 7 cases were other types. According to their types, corresponding artificial tears therapy was given. At 1mo after treatments, the clinical symptoms were improved significantly. BUT was 13.72±1.83s, SⅠt was 12.38±3.64mm/5min, tear meniscus height was 0.36±0.08mm, corneal fluorescein staining was 0.03±0.24 scores and meibomian gland function was 1.57±0.93 scores. Compared with those before treatments, the difference of each observed indicators was statistically significant(PCONCLUSION:Artificial tears treatment for children xerophthalmia is safe and effective.

One-sheet spiraling full thickness skin graft for penile resurfacing after paraffinoma excision

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Theddeus O.H. Prasetyono

2011-08-01

Full Text Available In the midst of on-going non-illicit practice of silicone or paraffin injection to enlarge penis, the author reported 3 cases of surgical treatment to resurface the body of the penis after excision of the destructed penile skin using full thickness skin graft. The skin excision was performed technically through penile body degloving procedure. Full thickness skin graft was then applied as a single sheet donor tissue to cover the denuded penile body spirally. The full thickness graft, which is relatively easy to be performed, is no doubt much thinner than a skin flap, while it also bears a smaller degree of secondary contraction than split skin graft. The color of the skin is considerably matched as it comes from the groin, which is a nearby area of penis. The size and skin sensitization of the penis looks to be natural. The only disadvantage is the common possibility of either spiral or circular junctional scar in between graft edges and between the graft and the penile mucosa and skin to develop hypertrophic scar. However, this possible scar problem applies also to any other surgical scar with any donor tissue. Fortunately, the 3 cases posed no scar problem and normal appearance. All the patients have also regained their normal sexual function. (Med J Indones 2011; 20:222-5Keywords: full thickness skin graft, paraffinoma, siliconoma, sexual function

Skin resurfacing in a circumferential full thickness burn to the penis: lessons learnt.

Science.gov (United States)

Jabir, Shehab; Frew, Quentin; Thompson, Richard; Dziewulski, Peter

2013-08-13

A circumferential full-thickness burn to the penis is a rarely encountered injury. However, when it does occur, it proves a management challenge to the plastic and burns surgeon in terms of reconstruction. This is due to the need of not only regaining adequate function of the organ, but also because of the need for a pleasing aesthetic outcome. Split-skin grafts have been utilised successfully to resurface full thickness burns of the penis and have given good results. Yet the success of split-skin grafts, especially those applied to an anatomically challenging region of the body such as the penis, depends on a number of carefully thought-out steps. We discuss the case of a circumferential full-thickness burn to the penis which was treated with split-skin grafting and highlight important pitfalls that the plastic and burns surgeon need to be aware of to ensure a successful outcome.

MRI on the tear of the triangular fibrocartilage of the wrist

Energy Technology Data Exchange (ETDEWEB)

Saito, Yoko; Sasaki, Taisuke; Sasaki, Yukio; Nishi, Naoko; Yodono, Hiraku; Takekawa, Shoichi; Toh, Satoshi; Harata, Seikou (Hirosaki Univ., Aomori (Japan). School of Medicine)

1992-07-01

MRI of the wrist joints in the normal volunteers and patients with triangular fibrocartilage (TFC) injury was performed and usefulness of MRI of TFC injury was discussed. Small FOV and thin slice thickness were selected. Normal TFCs were shown as low signal intensity areas. Injury of TFC was demonstrated as increased signal intensity areas. Diagnosis of TFC injury should be made after considering their ages and symptoms because TFC shows degenerative change with aging. The sensitivity, specificity and accuracy of MRI in the detection of TFC tears were 80.0%, 81.8% and 81.0% respectively. MRI is considered to be a non-invasive good modality to demonstrate TFC tears. (author).

Tear Mediators in Corneal Ectatic Disorders.

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Dorottya Pásztor

Full Text Available To compare the concentrations of 11 tear mediators in order to reveal the biochemical difference between pellucid marginal degeneration (PMD and keratoconus (KC.We have designed a cross-sectional study in which patients with corneal ectasia based on slit-lamp biomicroscopy and Pentacam HR (keratometry values (K1, K2, Kmax, astigmatism, minimal radius of curvature (Rmin, corneal thickness (Apex and Min, indices (surface variation, vertical asymmetry, keratoconus, central keratoconus, height asymmetry and decentration were enrolled. Eyes of keratoconic patients were similar to the PMD patients in age and severity (K2, Kmax and Rmin. Non-stimulated tear samples were collected from nine eyes of seven PMD patients, 55 eyes of 55 KC patients and 24 eyes of 24 healthy controls. The mediators' (interleukin -6, -10, chemokine ligand 5, -8, -10, matrix metalloproteinase (MMP -9, -13, tissue inhibitor of metalloproteinases (TIMP-1, tissue plasminogen activator, plasminogen activator inhibitor, nerve growth factor concentrations were measured using Cytometric Bead Array.MMP-9 was the only mediator which presented relevant variances between the two patient groups (p = 0.005. The ratios of MMP-9 and TIMP-1 were 2.45, 0.40 and 0.23 in PMD, KC and the controls, respectively.As far as we are aware, this is the first study that aims to reveal the biochemical differences between PMD and KC. Further studies of biomarkers to investigate the precise role of these mediators need to be defined, and it is important to confirm the observed changes in a larger study to gain further insights into the molecular alterations in PMD.

Deformation behavior of curling strips on tearing tubes

Energy Technology Data Exchange (ETDEWEB)

Choi, Ji Won; Kwon, Tae Soo; Jung, Hyun Seung; Kim, Jin Sung [Dept. of Robotics and Virtual Engineering, Korea University of Science and Technology, Seoul (Korea, Republic of)

2015-10-15

This paper discusses the analysis of the curl deformation behavior when a dynamic force is applied to a tearing tube installed on a flat die to predict the energy absorption capacity and deformation behavior. The deformation of the tips of the curling strips was obtained when the curl tips and tube body are in contact with each other, and a formula describing the energy dissipation rate caused by the deformation of the curl tips is proposed. To improve this formula, we focused on the variation of the curl radius and the reduced thickness of the tube. A formula describing the mean curl radius is proposed and verified using the curl radius measurement data of collision test specimens. These improved formulas are added to the theoretical model previously proposed by Huang et al. and verified from the collision test results of a tearing tube.

Evaluation of lesser metatarsophalangeal joint plantar plate tears with contrast-enhanced and fat-suppressed MRI

Energy Technology Data Exchange (ETDEWEB)

Dinoa, Vanessa; Ranke, Felipe von; Costa, Flavia; Marchiori, Edson [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)

2016-05-15

To present findings of plantar plate (PP) lesions from MRI with administration of gadolinium and to differentiate PP lesions from others causes of metatarsalgia. Two musculoskeletal radiologists reviewed 249 contrast-enhanced forefoot MRI scans from patients with metatarsalgia between June 2012 and June 2013. Evaluations focused on hyper-vascularized/fibrous tissue and other findings associated with PP tears. Fifty-nine patients had PP tears, 59 % were female. Most of these patients, 48/59 (81.4 %), had a single metatarsophalangeal (MTP) PP lesion in one foot, although 7/59 patients had one lesion in each foot, 3/59 (5.1 %) had two in one foot, and 1/59 (1.7 %) had three lesions in one foot. The second MTP joint was the most common location for PP tears (n = 56), followed by the third (n = 12) and fourth (n = 3) MTP joints. Lateral (n = 33) and full thickness (n = 28) PP lesions were the most frequent, and central (n = 3) and lateral/central (n = 7) tears were less prevalent. Fifty (70.5 %) PP lesions showed pericapsular fibrosis in pre-contrast sequences, and 21 (29.5 %) were visible only after administration of gadolinium. All PP lesions had collateral ligament involvement. Others findings included interosseous tendon lesions (n = 29), interosseous tendon rupture (n = 29), synovitis (n = 49), flexor tenosynovitis (n = 28), crossover toe (n = 2), hammertoe (n = 1), intermetatarsal space (IS) neuromas (n = 11), and third IS neuromas (n = 12). PP tears are a common cause of metatarsalgia, accounting for more than 20 % of cases in our sample. A substantial portion of the lesions (29.5 %) became visible only after the administration of gadolinium. (orig.)

Evaluation of lesser metatarsophalangeal joint plantar plate tears with contrast-enhanced and fat-suppressed MRI

International Nuclear Information System (INIS)

Dinoa, Vanessa; Ranke, Felipe von; Costa, Flavia; Marchiori, Edson

2016-01-01

To present findings of plantar plate (PP) lesions from MRI with administration of gadolinium and to differentiate PP lesions from others causes of metatarsalgia. Two musculoskeletal radiologists reviewed 249 contrast-enhanced forefoot MRI scans from patients with metatarsalgia between June 2012 and June 2013. Evaluations focused on hyper-vascularized/fibrous tissue and other findings associated with PP tears. Fifty-nine patients had PP tears, 59 % were female. Most of these patients, 48/59 (81.4 %), had a single metatarsophalangeal (MTP) PP lesion in one foot, although 7/59 patients had one lesion in each foot, 3/59 (5.1 %) had two in one foot, and 1/59 (1.7 %) had three lesions in one foot. The second MTP joint was the most common location for PP tears (n = 56), followed by the third (n = 12) and fourth (n = 3) MTP joints. Lateral (n = 33) and full thickness (n = 28) PP lesions were the most frequent, and central (n = 3) and lateral/central (n = 7) tears were less prevalent. Fifty (70.5 %) PP lesions showed pericapsular fibrosis in pre-contrast sequences, and 21 (29.5 %) were visible only after administration of gadolinium. All PP lesions had collateral ligament involvement. Others findings included interosseous tendon lesions (n = 29), interosseous tendon rupture (n = 29), synovitis (n = 49), flexor tenosynovitis (n = 28), crossover toe (n = 2), hammertoe (n = 1), intermetatarsal space (IS) neuromas (n = 11), and third IS neuromas (n = 12). PP tears are a common cause of metatarsalgia, accounting for more than 20 % of cases in our sample. A substantial portion of the lesions (29.5 %) became visible only after the administration of gadolinium. (orig.)

Tearing instability in cylindrical plasma configuration

International Nuclear Information System (INIS)

Zelenyj, L.M.

1979-01-01

The effect of the neutral-layer cylindrical geometry on the development of the tearing instability has been investigated in detail. The increments of the instability for all the regimes have been found. The influence of cylindrical effects becomes manifesting itself at small, as compared to the layer characteristic thickness, distances from the axis, and, finally, the electron regime of the instability development transforms into an ion one. The results obtained are of interest for studying the plasma stability in the devices of the ''Astron'' type and in magnetospheres of cosmic objects

Pele's tears and spheres

Science.gov (United States)

Porritt, L. A.; Quane, S.; Russell, K.

2011-12-01

Pele's tears are a well known curiosity commonly associated with low viscosity basaltic explosive eruptions. However, these pyroclasts are rarely studied in detail and there is no full explanation for their formation. These intriguing pyroclasts have smooth glassy surfaces, vesiculated interiors, and fluidal morphologies tending towards droplets and then spheres as they decrease in size to Pele's tears from the 1959 fire-fountaining eruption of Kilauea Iki involving size and density measurements. Using thin section and SEM analysis we also consider their internal and external morphologies, porosity and bubble size distributions, and surface textures. Finally we consider the mechanisms of magma fragmentation, timescales of relaxation, and cooling rates that are responsible for their formation.

The ocular surface and tear film and their dysfunction in dry eye disease.

Science.gov (United States)

Rolando, M; Zierhut, M

2001-03-01

The ocular surface, tear film, lacrimal glands, and eyelids act as a functional unit to preserve the quality of the refractive surface of the eye and to resist injury and protect the eye against changing bodily and environmental conditions. Events that disturb the homeostasis of this functional unit can result in a vicious cycle of ocular surface disease. The tear film is the most dynamic structure of the functional unit, and its production and turnover is essential to maintaining the health of the ocular surface. Classically, the tear film is reported to be composed of three layers: the mucin, aqueous, and lipid layers. The boundaries and real thickness of such layers is still under discussion. A dysfunction of any of these layers can result in dry eye disease.

Divalent cations in tears, and their influence on tear film stability in humans and rabbits.

Science.gov (United States)

Wei, Xiaojia Eric; Markoulli, Maria; Millar, Thomas J; Willcox, Mark D P; Zhao, Zhenjun

2012-06-05

Reduced tear film stability is reported to contribute to dry eye. Rabbits are known to have a more stable tear film than humans. Thus, we sought to examine the tears of rabbits and humans for metal cations, and to test how they influence tear film stability. Tears were collected from 10 healthy humans and 6 rabbits. Tear osmolality was measured by vapor pressure osmometer, and metals analyzed using inductively coupled plasma (ICP) mass spectrometry or ICP atomic emission spectroscopy. The influence of divalent cations on tears was analyzed by measuring surface tension using the Langmuir trough in vitro, using different concentrations of cations in the subphase, and grading the tear break-up in rabbits in vivo after instillation of chelating agents. Rabbit tears had a higher osmolality compared to humans. Major metals did not differ between species; however, rabbits had higher levels of Mg(2+) (1.13 vs. 0.39 mM) and Ca(2+) (0.75 vs. 0.36 mM). In rabbit tears in vitro, diminishing divalent cations resulted in a decrease in the maximum surface pressure from 37 to 30 mN/m. In vivo, an increase in the amount of tear film that was broken-up was found. In contrast, when changing divalent cation concentrations in human tears, the maximum surface pressure remained at 26 mN/m. The normal osmolality of rabbit tears is significantly higher than that in humans. While divalent cations had little influence on human tears, they appear to have an important role in maintaining tear film stability in rabbits.

Surface Chemistry Interactions of Cationorm with Films by Human Meibum and Tear Film Compounds

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Georgi As. Georgiev

2017-07-01

Full Text Available Cationorm® (CN cationic nanoemulsion was demonstrated to enhance tear film (TF stability in vivo possibly via effects on tear film lipid layer (TFLL. Therefore the interactions of CN with human meibum (MGS and TFLL in vitro and in vivo deserve special study. MGS and CN were spread at the air/water interface of a Langmuir surface balance to ensure a range of MGS/CN oil phase ratios: 20/1, 10/1, 5/1, 3/1, 2/1 and 1/1. The films capability to reorganize during dynamic area changes was evaluated via the surface pressure-area compression isotherms and step/relaxation dilatational rheology studies. Films structure was monitored with Brewster angle microscopy. CN/TFLL interactions at the ocular surface were monitored with non-contact specular microscopy. The in vitro studies of MGS/CN layers showed that (i CN inclusion (at fixed MGS content increased film elasticity and thickness and that (ii CN can compensate for moderate meibum deficiency in MGS/CN films. In vivo CN mixed with TFLL in a manner similar to CN/MGS interactions in vitro, and resulted in enhanced thickness of TFLL. In vitro and in vivo data complement each other and facilitated the study of the composition-structure-function relationship that determines the impact of cationic nanoemulsions on TF.

Innovative usage of accessory auricles as full-thickness skin graft

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Elankumar Subbarayan

2017-01-01

Full Text Available Accessory auricles are relatively rare malformations arising from the first branchial arch which contains skin, fat and cartilage. The treatment is usually surgical removal for the cosmetic purpose. We are sharing our experience of utilising the accessory auricle skin as full thickness graft for post.burn reconstruction of the fingers contracture of a child. Even though this type of association is rare, it is an innovative idea following Sir Harold Gilles’ principle ‘Never throw anything away’.

Effect of lipid-based dry eye supplements on the tear film in wearers of eye cosmetics.

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Wang, Michael T M; Cho, Irene Sung Hee; Jung, Soo Hee; Craig, Jennifer P

2017-08-01

To compare the effects on tear film parameters and contamination in cosmetic eyeliner wearers, after single application of two lipid-based dry eye treatments: a lipid-containing lubricant eye drop and a phospholipid liposomal spray. Fifty participants were enrolled in a prospective, randomised, paired-eye, investigator-masked trial. Pencil eyeliner (Body Shop ® Crayon Eye Definer) was applied to the upper eyelid periocular skin of both eyes, anterior to the lash line. Baseline tear film quality was assessed fifteen minutes after eyeliner application. A lubricant drop (Systane ® Balance) was then applied to one eye (randomised), and liposomal spray (Tears Again ® ) to the contralateral eye. Tear film contamination, lipid layer grade, non-invasive tear film break-up time and tear evaporation rate were evaluated fifteen minutes post-treatment and compared to pre-treatment values. Pre-treatment measurements did not differ between eyes assigned to lubricant drop and liposomal spray. Tear film contamination was observed in a greater proportion of eyes following both treatments (both p0.05). Changes in tear film parameters did not differ between treatments (all p>0.05). Both the lipid-containing lubricant eye drop and phospholipid liposomal spray result in clinically apparent tear film contamination in eyeliner cosmetic wearers. Although both treatments effected an increase in lipid layer thickness, neither displayed clinical efficacy in improving tear film stability. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Single-leaf partial meniscectomy in extensive horizontal tears of the discoid lateral meniscus: Does decreased peripheral meniscal thickness affect outcomes? (Mean four-year follow-up).

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Lee, Se-Won; Chun, Yong-Min; Choi, Chong-Hyuk; Kim, Sung-Jae; Jung, Min; Han, Joon-Woo; Kim, Sung-Hwan

2016-06-01

To evaluate whether single-leaf partial meniscectomy in horizontal tears along the entire discoid lateral meniscus has any advantages in clinical and radiological results compared with other meniscectomies in discoid lateral meniscus. A total of 145 patients with a horizontal tear pattern in symptomatic lateral discoid meniscus were retrospectively reviewed. Twenty-seven patients had undergone full-extent single-leaf partial meniscectomy (group A), 60 had undergone conventional partial meniscectomy (saucerization) maintaining peripheral meniscal height (group B), and 58 patients had undergone total meniscectomy (group C). Each patient was evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective grading, and modified Kellgren-Lawrence grade in plain radiography at their last follow-up. Group C had inferior functional results to groups A and B on the Lysholm knee score and IKDC subjective score. There was no significant difference between groups A and B. Group C fared significantly worse than groups A and B (p=0.003, pmeniscus tears, the full-extent single-leaf partial meniscectomy group had no adverse results compared with the total meniscectomy group and was not significantly different compared to the conventional partial meniscectomy group. Cohort study. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Copyright © 2015 Elsevier B.V. All rights reserved.

Nonlinear tearing mode and vortex chains

International Nuclear Information System (INIS)

Jovanovic, D.; Vranjes, J.

1996-01-01

We study the nonlinear stage of a tearing mode, whose island width exceeds the tearing layer thickness, and the wavelength is of the order of collisionless skin depth. A coherent solution is found in the form of a moving vortex chain. It is the result of a self-organization process, which adjusts the profile of the sheared poloidal magnetic field and excites a localized perpendicular sheared plasma flow, consisting of three counterstreaming jets. A numerical solution shows a twin chain of plasma vortices, coupled with a single chain of magnetic islands, whose width is of the order of collisionless skin depth. Adiabatic evolution of the vortex chain in the presence of small viscosity reveals its finite lifetime. The chain destruction may occur either directly, or through a sequence of bifurcations (corresponding to abrupt changes of the vortex chain parameters) to magnetic field stochastization within a layer of the collisionless skin depth scale, which occurs before the magnetic island overlapping takes place. This provides a new mechanism for the anomalous transport. (orig.)

Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

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Yang Seo Park

2012-09-01

Full Text Available Background Pediatric hand burns are a difficult problem because they lead to serious handdeformities with functional impairment due to rapid growth during childhood. Therefore,adequate management is required beginning in the acute stage. Our study aims to establishsurgical guidelines for a primary full-thickness skin graft (FTSG in pediatric hand burns, basedon long-term observation periods and existing studies.Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. Weretrospectively studied the clinical course and treatment outcomes based on the patients’medical records. The patients’ demographics, age, sex, injury site of the fingers, presence ofweb space involvement, the incidence of postoperative late deformities, and the duration ofrevision were critically analyzed.Results The mean age of the patients was 24.4 months (range, 8 to 94 months, consisting of141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 yearson average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 tothree fingers, and 22 to more than three. Among these cases, 70 were burns that included aweb space (33.3%. During the observation, 25 cases underwent corrective operations withan average period of 40.6 months.Conclusions In the volar area, primary full-thickness skin grafting can be a good indicationfor an isolated injured finger, excluding the web spaces, and injuries of less than three fingersincluding the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a goodindication. However, if the donor site is insufficient and the wound is large, split-thicknessskin grafting can be considered.

[Arthroscopic double-row reconstruction of high-grade subscapularis tendon tears].

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Plachel, F; Pauly, S; Moroder, P; Scheibel, M

2018-04-01

Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain. Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head. Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head. After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair. The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months. While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.

Effect of Robusta coffee beans ointment on full thickness wound healing

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Yorinta Putri Kenisa

2012-03-01

Full Text Available Background: Traumatic lesions, whether chemical, physical, or thermal in nature, are among the most common lesion in the mouth. Wound healing is essential for the maintenance of normal structure, function, and survival of organisms. Experiments of Robusta coffee powder on rat-induced alloxan incision wound, clinically demonstrated similar healing rate with the povidone iodine 10%. No studies that look directly the effect of coffee extract in ointment form when viewed in terms of histopathology. Robusta coffee bean (Coffea canephora consists of chlorogenic acid (CGA and caffeic acid which are belived to act as antioxidant and take part in wound healing process. Purpose: The aim of this study was to identify the enhancement of healing process of full-thickness skin wound after Robusta coffee beans extract ointment application. Methods: Sample consisted of 20 Cavia cabaya treated with full-thickness with wounds and was given Robusta coffee beans extract ointment concentration range of 22.5%, 45%, and 90% except the control group which was given ointment base material. Animals were then harvested on the fourth day and made for histopathological preparations. Data were calculated and compared by one-way ANOVA test and LSD test. Results: The study showed that Robusta coffee bean extract ointment can increase the number of lymphocytes, plasma cells, macrophages, fibroblasts, and blood vessels by the presence of chlorogenic acid (CGA and Caffeic acid. Conclusion: In conclusion Robusta coffee bean extract ointment enhance the healing process of fullthickness skin wound of Cavia cabaya.Latar belakang: Lesi traumatik, baik akibat rangsang kimia, fisik, atau termal, merupakan lesi yang paling umum terjadi di dalam rongga mulut. Penyembuhan luka yang terjadi ini penting untuk pemeliharaan struktur normal, fungsi, dan kelangsungan hidup organisme. Percobaan pemberian bubuk kopi Robusta terhadap luka sayatan pada tikus yang diinduksi aloksan, secara klinis

Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring.

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von Renteln, Daniel; Schmidt, Arthur; Riecken, Bettina; Caca, Karel

2010-05-01

Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication. In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication. The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008). Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered.

Application of tearing modulus stability concepts to nuclear piping. Final report. [PWR; BWR

Energy Technology Data Exchange (ETDEWEB)

Cotter, K.H.; Chang, H.Y.; Zahoor, A.

1982-02-01

The recently developed tearing modulus stability concept was successfully applied to several boiling water reactor (BWR) and pressurized water reactor (PWR) piping systems. Circumferentially oriented through-the-thickness cracks were postulated at numerous locations in each system. For each location, the simplified tearing stability methods developed in USNRC Report NUREG/CR-0838 were used to determine crack stability. The J-T diagram was used to present the results of the computations. The piping systems considered included Type 304 stainless steel as well as A106 carbon steel materials. These systems were analyzed using the piping analysis computer code MINK.

A case of recurrent bloody tears

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Karslıoğlu Ş

2011-07-01

Full Text Available Şafak Karslioğlu1, Ilke Bahçeci Şimşek2, Müslime Akbaba11Ìstanbul Oculoplastic and Orbital Surgery and Ocular Oncology Center, 2Ophthalmology Department, Medicine Hospital, Ìstanbul, TurkeyAbstract: Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an erythema multiforme-like drug eruption. He experienced chronic conjunctivitis which resulted in a few minor symblephara. One year later, the patient developed attacks of bloody tearing. All clinical, radiologic, and laboratory investigations related to bloody epiphora were within normal limits except for a mild, nonspecific chronic inflammatory reaction in the perivascular tissues of the lacrimal gland and orbital soft tissues. Also, an increase in vascular permeability and contrast extravasation on carotid angiography was detected. High-dose vitamin C was administered. The patient continued to have unilateral bloody tears intermittently for two years, but the episodes became much less frequent and had resolved by three years. It is conceivable that increased vascular permeability following the systemic inflammatory process could have played a role in the etiology of recurrent bloody tears in this atypical patient.Keywords: bloody tears, erythema multiforme, drug eruption, vitamin C

Meniscus Tears (For Teens)

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... Safe Videos for Educators Search English Español Meniscus Tears KidsHealth / For Teens / Meniscus Tears What's in this ... surgery to fix it. What Is a Meniscus Tear? Your knee is made up of three bones: ...

[Rotator cuff tear athropathy prevalence].

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Guerra-Soriano, F; Encalada-Díaz, M I; Ruiz-Suárez, M; Valero-González, F S

2017-01-01

Glenohumeral arthritis secondary to massive rotator cuff tear presents with a superior displacement and femoralization of the humeral head with coracoacromial arch acetabularization. The purpose of this study was to establish prevalence of rotator cuff tear artropathy (CTA) at our institution. Four hundred electronic records were reviewed from which we identified 136 patients with rotator cuff tears. A second group was composed with patients with massive cuff tears that were analized and staged by the Seebauer cuff tear arthropathy classification. Thirty four patients with massive rotator cuff tears were identified, 8 male and 26 female (age 60.1 ± 10.26 years). Massive rotator cuff tear prevalence was 25%. CTA prevalence found in the rotator cuff group was 19 and 76% in the massive cuff tears group. Patients were staged according to the classification with 32% in stage 1a, 11% 1b, 32% 2a and 0% 2b. CTA prevalence in patients with rotator cuff tears and massive cuff tears is higher than the one reported in American population. We consider that a revision of the Seebauer classification to be appropriate to determine its reliability.

Effects of wearing a daily disposable lens on tear film: a randomised controlled trial.

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Chong, Pamela Qin Yi; Yeo, Sharon; Too, Cheah Loon; Boo, Cynthia; Tong, Louis

2016-05-01

Contact lens-induced dry eye is commonly encountered, although its extent is not well documented with daily disposable lenses. A novel type of contact lens system incorporating moisturising agent (alginic acid) has been developed. The aim of this study was to evaluate the effect of wearing daily 2-hydroxyethyl methacrylate disposable contact lenses for seven days on tear stability, conjunctival and limbal redness and dry eye symptoms. Then, we aimed to determine whether lens solutions containing alginic acid had any influence on tear parameters. This was a seven-day parallel group double-masked clinical trial of previous contact lens wearers, where participants were randomly assigned to wearing SEED 1dayPure moisture contact lenses with (n = 15) or without alginic acid (n = 15). Tear lipid layer thickness (LLT), non-invasive tear break-up time (NIBUT), conjunctival redness, corneal fluorescein staining, tear break-up time and Schirmer I readings were measured. Symptom severity and frequency were evaluated and combined using a global score from visual analogue scales. The mean age and standard deviation of the participants was 25 ± 3.8 years. There were 24 females and six males. After reintroduction of contact lens wear for one week, there was significant improvement in the global symptom score; however, this may not be clinically significant. There were small and clinically insignificant changes in limbal and conjunctival hyperaemia but no significant changes in lipid layer thickness, Schirmer I and NIBUT in overall participants. The use of alginic acid in lens solutions did not affect these parameters compared to control lenses (p > 0.05). After seven days of wearing a modern daily disposable lens, there was no significant deterioration of tear function in a group of young contact lens wearers. In this short-term study, there was no evidence of significant benefit of lens solutions containing alginic acid used with HEMA lenses. © 2016 The Authors Clinical and

Prospective randomized comparison of scar appearances between cograft of acellular dermal matrix with autologous split-thickness skin and autologous split-thickness skin graft alone for full-thickness skin defects of the extremities.

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Yi, Ju Won; Kim, Jae Kwang

2015-03-01

The purpose of this study was to evaluate the clinical outcomes of cografting of acellular dermal matrix with autologous split-thickness skin and autologous split-thickness skin graft alone for full-thickness skin defects on the extremities. In this prospective randomized study, 19 consecutive patients with full-thickness skin defects on the extremities following trauma underwent grafting using either cograft of acellular dermal matrix with autologous split-thickness skin graft (nine patients, group A) or autologous split-thickness skin graft alone (10 patients, group B) from June of 2011 to December of 2012. The postoperative evaluations included observation of complications (including graft necrosis, graft detachment, or seroma formation) and Vancouver Scar Scale score. No statistically significant difference was found regarding complications, including graft necrosis, graft detachment, or seroma formation. At week 8, significantly lower Vancouver Scar Scale scores for vascularity, pliability, height, and total score were found in group A compared with group B. At week 12, lower scores for pliability and height and total scores were identified in group A compared with group B. For cases with traumatic full-thickness skin defects on the extremities, a statistically significant better result was achieved with cograft of acellular dermal matrix with autologous split-thickness skin graft than with autologous split-thickness skin graft alone in terms of Vancouver Scar Scale score. Therapeutic, II.

Use of autologous tissue engineered skin to treat porcine full-thickness skin defects

Institute of Scientific and Technical Information of China (English)

CAI Xia; CAO Yi-lin; CUI Lei; LIU Wei; GUAN Wen-xiang

2005-01-01

Objective: To explore a feasible method to repair full-thickness skin defects utilizing tissue engineered techniques. Methods: The Changfeng hybrid swines were used and the skin specimens were cut from the posterior limb girdle region, from which the keratinocytes and fibroblasts were isolated and harvested by trypsin, EDTA, and type II collagenase. The cells were seeded in Petri dishes for primary culture. When the cells were in logarithmic growth phase, they were treated with trypsin to separate them from the floor of the tissue culture dishes. A biodegradable material, Pluronic F-127, was prefabricated and mixed with these cells, and then the cell-Pluronic compounds were seeded evenly into a polyglycolic acid (PGA). Then the constructs were replanted to the autologous animals to repair the full-thickness skin defects. Histology and immunohistochemistry of the neotissue were observed in 1, 2, 4, and 8 postoperative weeks. Results: The cell-Pluronic F-127-PGA compounds repaired autologous full-thickness skin defects 1 week after implantation. Histologically, the tissue engineered skin was similar to the normal skin with stratified epidermis overlying a moderately thick collageneous dermis. Three of the structural proteins in the epidermal basement membrane zone, type IV collagen, laminin, and type VII collagen were detected using immunohistochemical methods. Conclusions: By studying the histology and immunohistochemistry of the neotissue, the bioengineered skin graft holds great promise for improving healing of the skin defects.

Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique.

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Shin, Sang-Jin; Jeong, Jae-Hoon; Jeon, Yoon Sang; Kim, Rag Gyu

2016-12-01

The purpose of this study was to introduce a novel arthroscopic transtendon anatomic repair technique that spares the intact bursal-sided tendon in articular-sided partial-thickness rotator cuff tears (PTRCT) and to present shoulder functional outcomes in patients with symptomatic articular-sided PCRCT that involves more than 50 % of its thickness after arthroscopic repair using a novel technique. Eighteen patients with symptomatic articular-sided PCRCT involving more than 50 % of the tendon's thickness underwent arthroscopic repair using a devised technique. The devised technique restores only the torn articular portion of the rotator cuff at the anatomical footprint using a suture anchor, and preserves the integrity of the corresponding bursal-sided tendon by tying knots at the most lateral bursal side on the subacromial space. Clinical and functional outcome using ASES and Constant scores were evaluated. The structural integrity of the rotator cuff was evaluated by MRI at 6 months postoperatively. Pain relief and shoulder functional outcomes were encouraging during the recovery phase after operation. ASES (preoperative 54.0 ± 10.3 to postoperative 92.6 ± 8.0), Constant score (61.2 ± 8.5-88.0 ± 5.3), VAS for pain (4.9 ± 2.6-0.6 ± 0.7) improved significantly after arthroscopic transtendon anatomic repair (p rotator cuff retears on 6-month MRI. No complications related to surgical procedures had occurred. The devised technique of arthroscopic transtendon repair provided satisfactory functional outcomes without postoperative discomforts. This technique minimizes over-tightening of the articular layer and reduces tension mismatches between the articular and bursal layers, which are considered as important factors for improvement of postoperative shoulder motion.

Human tears contain a chemosignal.

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Gelstein, Shani; Yeshurun, Yaara; Rozenkrantz, Liron; Shushan, Sagit; Frumin, Idan; Roth, Yehudah; Sobel, Noam

2011-01-14

Emotional tearing is a poorly understood behavior that is considered uniquely human. In mice, tears serve as a chemosignal. We therefore hypothesized that human tears may similarly serve a chemosignaling function. We found that merely sniffing negative-emotion-related odorless tears obtained from women donors induced reductions in sexual appeal attributed by men to pictures of women's faces. Moreover, after sniffing such tears, men experienced reduced self-rated sexual arousal, reduced physiological measures of arousal, and reduced levels of testosterone. Finally, functional magnetic resonance imaging revealed that sniffing women's tears selectively reduced activity in brain substrates of sexual arousal in men.

Deltoid muscle shape analysis with magnetic resonance imaging in patients with chronic rotator cuff tears.

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Meyer, Dominik C; Rahm, Stefan; Farshad, Mazda; Lajtai, Georg; Wieser, Karl

2013-08-19

It seems appropriate to assume, that for a full and strong global shoulder function a normally innervated and active deltoid muscle is indispensable. We set out to analyse the size and shape of the deltoid muscle on MR-arthrographies, and analyse its influence on shoulder function and its adaption (i.e. atrophy) for reduced shoulder function. The fatty infiltration (Goutallier stages), atrophy (tangent sign) and selective myotendinous retraction of the rotator cuff, as well as the thickness and the area of seven anatomically defined segments of the deltoid muscle were measured on MR-arthrographies and correlated with shoulder function (i.e. active abduction). Included were 116 patients, suffering of a rotator cuff tear with shoulder mobility ranging from pseudoparalysis to free mobility. Kolmogorov-Smirnov test was used to determine the distribution of the data before either Spearman or Pearson correlation and a multiple regression was applied to reveal the correlations. Our developed method for measuring deltoid area and thickness showed to be reproducible with excellent interobserver correlations (r = 0.814-0.982).The analysis of influencing factors on active abduction revealed a weak influence of the amount of SSP tendon (r = -0.25; p muscle retraction (r = -0.27; p muscle infiltration (GFDI: r = -0.36; p muscle shape with the degree of active glenohumeral abduction. Furthermore, long-standing rotator cuff tears did not appear to influence the deltoid shape, i.e. did not lead to muscle atrophy. Our data support that in chronic rotator cuff tears, there seems to be no disadvantage to exhausting conservative treatment and to delay implantation of reverse total shoulder arthroplasty, as the shape of deltoid muscle seems only to be influenced by natural aging, but to be independent of reduced shoulder motion.

Antimicrobial compounds in tears.

Science.gov (United States)

McDermott, Alison M

2013-12-01

The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cemental tear: To know what we have neglected in dental practice

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Po-Yuan Jeng

2018-04-01

Full Text Available Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction. Keywords: Cemental tear, Clinical characteristics, Surface root fracture, Periodontal/periapical breakdown, Recurrence, Predisposing factors

Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand.

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Weeks, Dexter; Kasdan, Morton L; Wilhelmi, Bradon J

2016-01-01

The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury.

Complex descemet′s membrane tears and detachment during phacoemulsification

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Faik Orucoglu

2015-01-01

Full Text Available Purpose: To report a case of complex Descemet′s membrane detachment (DMD and tears during phacoemulsification cataract surgery. Case Report: A 64-year-old woman underwent phacoemulsification surgery in her right eye and developed tears and partial loss of Descemet′s membrane (DM while the aspiration port was inserted through the main incision. Massive corneal edema obscured the view and the anterior chamber was barely visible the following day. Scheimpflug imaging was used to complement slit lamp examination in the postoperative period. Frequent topical corticosteroid drops were initiated. After 5 days of treatment, multiple tears and detachment of DM were visible and the anterior chamber was filled with air. After 5 weeks, the cornea regained much of its clarity despite large DM tears and focal loss of DM. Conclusion: Despite partial loss of DM, the corneal edema mostly disappeared after 5 weeks of air bubble injection. Scheimpflug imaging was beneficial in the diagnosis and monitoring of DM tears and detachments.

Examination of rotator cuff re-tear

International Nuclear Information System (INIS)

Kitahara, Hiroyuki; Yabe, Yoshihiro; Norimatsu, Takahiro; Adachi, Shinji; Sera, Keisuke

2010-01-01

The six-month post-operative re-tear rate in 72 arthroscopic rotator cuff repair cases was 16.3% by MRI. The re-tear rate of massive tears was 50%. We investigated the details of the re-tears by MRI and arthroscopic findings. High re-tear rates were connected with cuff tear size and fatty degeneration of muscle belly. Cases with poor cuff quality in arthroscopically showed high re-tear rate. These results suggest that surgery operation should be performed as soon as possible after diagnosis of cuff tear to obtain good results. Cases with damage of long head of the biceps (LHB) are likely to develop impingement causes of re-tears. Some type of rehabilitation is required to avoid impingement in such cases. (author)

What emotional tears convey : Tearful individuals are seen as warmer, but also as less competent

NARCIS (Netherlands)

van de Ven, Niels; Meijs, Maartje; Vingerhoets, A.J.J.M.

Earlier research found that the mere sight of tears promotes the willingness to provide support to the person shedding the tears. Other research, however, found that deliberate responses towards tearful persons could be more negative as well. We think this is because tears have ambivalent effects on

Daytime Variations of Tear Osmolarity Measurement in Dry Eye Patients

Directory of Open Access Journals (Sweden)

Ulviye Yiğit

2013-12-01

Full Text Available Purpose: We have targeted primarily to show the variations of tear osmolarity during the daytime period in subjects with dry eyes and non-dry eyes and, secondarily, to evaluate the relationship of these variations with Schirmer’s test and break-up time (BUT. Material and Method: Twenty newly diagnosed dry eye patients and 20 healthy voluntary subjects with similar age and gender were included in this prospective study. In addition to the full ophthalmic examination, Schirmer’s test and BUT test were applied to all participants. Tear osmolarity measurements were done after pre-examination but in different day. The measurements were registered with TearLab Osmolarity System (TearLab Corporation, San Diego, CA, USA every 3 hours within 8:00 AM and 5:00 PM. The results were evaluated statistically. Results: No statistically significant difference was found between the mean age and gender of dry eye syndrome (DES and control groups (p>0.05. The mean measurements of Schirmer’s test and BUT in the DES group were statistically significantly lower than those in the control group (p=0.0001. The mean measurements of tear osmolarity at 8:00 AM, 11:00 AM, 2:00 PM, and 5:00 PM in the DES group were statistically significantly higher than those in the control group (p=0.001, p=0.0001. No statistically significant difference in tear osmolarity at 8:00 AM, 11: 00 AM, 2:00 PM, and 5:00 PM was found between the groups, and within DES and control groups (p>0.05. Discussion: We did not determine significant change in daytime variations of the tear osmolarity in dry eye patients and healthy subjects. As a secondary result, we can conclude that there is no difference among tear osmolarity, Shirmer’s and BUT tests in the diagnosis of DES. (Turk J Ophthalmol 2013; 43: 437-41

Ten-year clinical and anatomic follow-up after repair of anterosuperior rotator cuff tears: influence of the subscapularis.

Science.gov (United States)

Nové-Josserand, Laurent; Collin, Philippe; Godenèche, Arnaud; Walch, Gilles; Meyer, Nicolas; Kempf, Jean-Francois

2017-10-01

Anterosuperior rotator cuff tears are more frequent than expected. We report the results of a 10-year follow-up study after repair. Our hypothesis was that the extent of the subscapularis tear influenced the prognosis. The study population consisted of all 138 patients who underwent surgery in 14 participating centers in 2003 for full-thickness tears of the rotator cuff with lesions in the subscapularis and supraspinatus tendons. The patients were divided into 2 groups, depending on whether the subscapularis lesion affected only the superior half of the tendon (group A) or extended into the lower half (group B). Ninety-two patients (56 ± 7 years; 71 in group A and 21 in group B) were available for follow-up after 10 years (127 ± 16 months) with magnetic resonance imaging to evaluate tendon healing and muscle condition. The mean Constant scores were 59 ± 16 before surgery and 77 ± 14 at follow-up (P = 1.7 × 10 -12 ). The retear rates were 25% for the supraspinatus and 13.5% for the subscapularis tendon. The clinical results for group A patients were better than those for group B. Severe fatty infiltration was observed more frequently in the subscapularis than in the supraspinatus muscle (27% vs. 12% of cases). Supraspinatus healing influenced subscapularis healing and fatty infiltration. Repair of anterosuperior rotator cuff tears is satisfactory at 10 years, particularly if the subscapularis tear is not extensive. An extensive subscapularis tear is a negative prognosis factor. Postoperatively, fatty infiltration of the subscapularis muscle was frequently observed despite tendon healing. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients.

Science.gov (United States)

Eissa, Iman M; Khalil, Noha M; El-Gendy, Heba A

2016-01-01

Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

TFOS DEWS II Tear Film Report.

Science.gov (United States)

Willcox, Mark D P; Argüeso, Pablo; Georgiev, Georgi A; Holopainen, Juha M; Laurie, Gordon W; Millar, Tom J; Papas, Eric B; Rolland, Jannick P; Schmidt, Tannin A; Stahl, Ulrike; Suarez, Tatiana; Subbaraman, Lakshman N; Uçakhan, Omür Ö; Jones, Lyndon

2017-07-01

The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect Of Weave Construction On Tear Strength Of Woven Fabrics

Directory of Open Access Journals (Sweden)

Eryuruk Selin Hanife

2015-09-01

Full Text Available The tear strength of a woven fabric is very important, since it is more closely related to serviceability of the fabric. Tearing strength of the fabrics depend on the mobility of the yarn within the fabric structure. In this study, the tearing strength of four types of fabrics warp rib, weft rib, ripstop and plain weave were analysed, which were produced in different densities and with filament and texturised polyester yarns.

Use of MR arthrography in detecting tears of the ligamentum teres with arthroscopic correlation

Energy Technology Data Exchange (ETDEWEB)

Chang, Connie Y.; Gill, Corey M.; Huang, Ambrose J.; Simeone, Frank J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); McCarthy, Joseph C. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

2014-12-20

To demonstrate the normal appearance of the ligamentum teres on MR arthrography (MRA) and evaluate the accuracy of MRA in detecting ligamentum teres tears with arthroscopic correlation. Institutional Review Board approval was obtained with a waiver for informed consent because of the retrospective study design. A total of 165 cases in 159 patients (111 females, 48 males; mean age 41 ± 12 years) who underwent both MRA and hip arthroscopy were evaluated for appearance of the ligamentum teres, including the size, number of bundles, and ligamentum teres tears. Marrow edema of the fovea capitis adjacent to the ligamentum teres insertion and the presence of hip plicae were also recorded. The mean thickness and length of the ligamentum teres were 3.5 ± 1.5 mm and 25.2 ± 3.8 mm, respectively. Sensitivity, specificity, positive and negative predictive value, and accuracy of MRA for the detection of ligamentum teres tears were 78, 97, 74, 97, and 95 %, respectively. MRA is an accurate method to evaluate the normal morphology and to detect tears of the ligamentum teres. (orig.)

Comparison of Medial and Lateral Meniscus Root Tears.

Directory of Open Access Journals (Sweden)

Ji Hyun Koo

Full Text Available The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs and twenty patients had lateral meniscus root tears (LMRTs. Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8 in the MMRT group and 0.9mm (range, -1.9 to 3.4 in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years and 30 years (range: 14-62 years in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001, and between an ACL tear and LMRT (p<0.0001. A history of trauma was significantly common in LMRT (p<0.0001. LMRT patients were significantly younger than MMRT patients (p<0.0001. Kellgren-Lawrence (K-L grade differed significantly between MMRT and LMRT group (p<0.0001. Meniscal extrusion is

Tear dynamics in healthy and dry eyes.

Science.gov (United States)

Cerretani, Colin F; Radke, C J

2014-06-01

Dry-eye disease, an increasingly prevalent ocular-surface disorder, significantly alters tear physiology. Understanding the basic physics of tear dynamics in healthy and dry eyes benefits both diagnosis and treatment of dry eye. We present a physiological-based model to describe tear dynamics during blinking. Tears are compartmentalized over the ocular surface; the blink cycle is divided into three repeating phases. Conservation laws quantify the tear volume and tear osmolarity of each compartment during each blink phase. Lacrimal-supply and tear-evaporation rates are varied to reveal the dependence of tear dynamics on dry-eye conditions, specifically tear osmolarity, tear volume, tear-turnover rate (TTR), and osmotic water flow. Predicted periodic-steady tear-meniscus osmolarity is 309 and 321 mOsM in normal and dry eyes, respectively. Tear osmolarity, volume, and TTR all match available clinical measurements. Osmotic water flow through the cornea and conjunctiva contribute 10 and 50% to the total tear supply in healthy and dry-eye conditions, respectively. TTR in aqueous-deficient dry eye (ADDE) is only half that in evaporative dry eye (EDE). The compartmental periodic-steady tear-dynamics model accurately predicts tear behavior in normal and dry eyes. Inclusion of osmotic water flow is crucial to match measured tear osmolarity. Tear-dynamics predictions corroborate the use of TTR as a clinical discriminator between ADDE and EDE. The proposed model is readily extended to predict the dynamics of aqueous solutes such as drugs or fluorescent tags.

Quantitative analysis of tear film fluorescence and discomfort during tear film instability and thinning.

Science.gov (United States)

Begley, Carolyn; Simpson, Trefford; Liu, Haixia; Salvo, Eliza; Wu, Ziwei; Bradley, Arthur; Situ, Ping

2013-04-12

The purpose of this study was to test the association between tear film fluorescence changes during tear break-up (TBU) or thinning and the concurrent ocular sensory response. Sixteen subjects kept one eye open as long as possible (MBI), indicated their discomfort level continuously, and rated ocular sensations of irritation, stinging, burning, pricking, and cooling using visual analog scales (VAS). Fluorescence of the tear film was quantified by a pixel-based analysis of the median pixel intensity (PI), TBU, and percentage of dark pixels (DarkPix) over time. A cutoff of 5% TBU was used to divide subjects into either break-up (BU) or minimal break-up (BUmin) groups. Tear film fluorescence decreased (median PI) and the percentage of TBU and DarkPix increased in all trials, with the rate significantly greater in the BU than the BUmin group (Mann-Whitney U test, P film thinning best explains decreasing tear film fluorescence during trials. This was highly correlated with increasing ocular discomfort, suggesting that both tear film thinning and TBU stimulate underlying corneal nerves, although TBU produced more rapid stimulation. Slow increases in tear film hyperosmolarity may cause the gradual increase in discomfort during slow tear film thinning, whereas the sharp increases in discomfort during TBU suggest a more complex stimulus.

Software Simulation of Hot Tearing

DEFF Research Database (Denmark)

Andersen, S.; Hansen, P.N.; Hattel, Jesper Henri

1999-01-01

The brittleness of a solidifying alloy in a temperature range near the solidus temperature has been recognised since the fifties as the mechanism responsible for hot tearing. Due to this brittlenes, the metal will crack under even small amounts of strain in that temperature range. We see these hot...... tears in castings close to hot centres, where the level of strain is often too high.Although the hot tearing mechanism is well understood, until now it has been difficult to do much to reduce the hot tearing tendency in a casting. In the seventies, good hot tearing criteria were developed by considering...... the solidification rate and the strain rate of the hot tear prone areas. But, until recently it was only possible to simulate the solidification rate, so that the criteria could not be used effectively.Today, with new software developments, it is possible to also simulate the strain rate in the hot tear prone areas...

Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.

Science.gov (United States)

Demiryay, Elvan; Yaylali, Volkan; Cetin, Ebru Nevin; Yildirim, Cem

2011-09-01

The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (Ptears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.

Science.gov (United States)

Atzei, A; Luchetti, R; Garagnani, L

2017-05-01

The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. II.

Not all ultrasounds are created equal: general sonography versus musculoskeletal sonography in the detection of rotator cuff tears

Science.gov (United States)

Cole, Brandi; Twibill, Kristen; Lam, Patrick; Hackett, Lisa

2016-01-01

Background This cross-sectional analytic diagnostic accuracy study was designed to compare the accuracy of ultrasound performed by general sonographers in local radiology practices with ultrasound performed by an experienced musculoskeletal sonographer for the detection of rotator cuff tears. Methods In total, 238 patients undergoing arthroscopy who had previously had an ultrasound performed by both a general sonographer and a specialist musculoskeletal sonographer made up the study cohort. Accuracy of diagnosis was compared with the findings at arthroscopy. Results When analyzed as all tears versus no tears, musculoskeletal sonography had an accuracy of 97%, a sensitivity of 97% and a specificity of 95%, whereas general sonography had an accuracy of 91%, a sensitivity of 91% and a specificity of 86%. When the partial tears were split with those ≥ 50% thickness in the tear group and those tear group, musculoskeletal sonography had an accuracy of 97%, a sensitivity of 97% and a specificity of 100% and general sonography had an accuracy of 85%, a sensitivity of 84% and a specificity of 87%. Conclusions Ultrasound in the hands of an experienced musculoskeletal sonographer is highly accurate for the diagnosis of rotator cuff tears. General sonography has improved subsequent to earlier studies but remains inferior to an ultrasound performed by a musculoskeletal sonographer. PMID:27660657

Meniscal Tear Film Fluid Dynamics Near Marx’s Line

KAUST Repository

Zubkov, V. S.

2013-07-03

Extensive studies have explored the dynamics of the ocular surface fluid, though theoretical investigations are typically limited to the use of the lubrication approximation, which is not guaranteed to be uniformly valid a-priori throughout the tear meniscus. However, resolving tear film behaviour within the meniscus and especially its apices is required to characterise the flow dynamics where the tear film is especially thin, and thus most susceptible to evaporatively induced hyperosmolarity and subsequent epithelial damage. Hence, we have explored the accuracy of the standard lubrication approximation for the tear film by explicit comparisons with the 2D Navier-Stokes model, considering both stationary and moving eyelids. Our results demonstrate that the lubrication model is qualitatively accurate except in the vicinity of the eyelids. In particular, and in contrast to lubrication theory, the solution of the full Navier-Stokes equations predict a distinct absence of fluid flow, and thus convective mixing in the region adjacent to the tear film contact line. These observations not only support emergent hypotheses concerning the formation of Marx\\'s line, a region of epithelial cell staining adjacent to the contact line on the eyelid, but also enhance our understanding of the pathophysiological consequences of the flow profile near the tear film contact line. © 2013 Society for Mathematical Biology.

An engineering interpretation of pop-in arrest and tearing arrest in terms of static crack arrest, Ksub(Ia)

International Nuclear Information System (INIS)

Witt, F.J.

1983-01-01

When fracture toughness specimens are tested under displacement controlled conditions, they are often observed to exhibit unstable cleavage fracture followed by arrest of the cleavage mode wherein a significant load remains on the specimen (pop-in arrest). This behavior carries over into the ductile tearing regime wherein tearing may occur rapidly identified by load reduction and then proceeds at a discernible less rate (tearing arrest). Both these behaviors represent an initiation condition followed by an arrest condition. In this paper it is demonstrated that from either of the arrest conditions an arrest value may be determined which, for available experimental data, is shown to be an engineering estimate for the static crack arrest toughness, Ksub(Ia). A data analysis procedure is outlined and Ksub(Ic) and Ksub(Ia) estimates from sixty-eight 1/2, 1 and 2 in. thick compact specimens from two steels (A533 Grade B Class 1 and AISI 1018) tested between -40 deg F and 200 deg F are summarized. The crack arrest estimates are seen to compare favorably with Ksub(Ia) results obtained by other investigators using 2 in. thick specimens. Also it is demonstrated that when failure is by fully ductile tearing, the crack arrest toughness is at least equal to the estimate for Ksub(Ic) for the specimen. (author)

Revision Vaginoplasty: A Comparison of Surgical Outcomes of Laparoscopic Intestinal versus Perineal Full-Thickness Skin Graft Vaginoplasty.

Science.gov (United States)

Van der Sluis, Wouter B; Bouman, Mark-Bram; Buncamper, Marlon E; Mullender, Margriet G; Meijerink, Wilhelmus J

2016-10-01

Vaginal (re)construction can greatly improve the quality of life of indicated patients. If primary vaginoplasty fails, multiple surgical approaches exist for revision. The authors compared surgical results of laparoscopic intestinal versus full-thickness skin graft revision vaginoplasty. A retrospective chart review of patients who underwent revision vaginoplasty at the authors' institution was conducted. Patient demographics, surgical characteristics, complications, hospitalization, reoperations, and neovaginal depth for both surgical techniques were recorded and compared. The authors studied a consecutive series of 50 transgender and three biological women who underwent revision vaginoplasty, of which 21 were laparoscopic intestinal and 32 were perineal full-thickness skin graft vaginoplasties, with a median clinical follow-up of 3.2 years (range, 0.5 to 19.7 years). Patient demographics did not differ significantly. There was no mortality. Two intraoperative rectal perforations (10 percent) occurred in the intestinal group versus six (19 percent) in the full-thickness skin graft group. Operative time was shorter for the full-thickness skin graft vaginoplasty group (131 ± 35 minutes versus 191 ± 45 minutes; p skin graft (81 percent) vaginoplasty procedures. A deeper neovagina was achieved with intestinal vaginoplasty (15.9 ± 1.4 cm versus 12.5 ± 2.8 cm; p skin graft vaginoplasty can be used as secondary vaginal reconstruction. Intraoperative and postoperative complications do not differ significantly, but rectal perforation was more prevalent in the full-thickness skin graft vaginoplasty group. Although the operative time of laparoscopic intestinal vaginoplasty is longer, adequate neovaginal depth was more frequently achieved than in secondary perineal full-thickness skin graft vaginoplasty. Therapeutic, III.

Bubaline Cholecyst Derived Extracellular Matrix for Reconstruction of Full Thickness Skin Wounds in Rats

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Poonam Shakya

2016-01-01

Full Text Available An acellular cholecyst derived extracellular matrix (b-CEM of bubaline origin was prepared using anionic biological detergent. Healing potential of b-CEM was compared with commercially available collagen sheet (b-CS and open wound (C in full thickness skin wounds in rats. Thirty-six clinically healthy adult Sprague Dawley rats of either sex were randomly divided into three equal groups. Under general anesthesia, a full thickness skin wound (20 × 20 mm2 was created on the dorsum of each rat. The defect in group I was kept as open wound and was taken as control. In group II, the defect was repaired with commercially available collagen sheet (b-CS. In group III, the defect was repaired with cholecyst derived extracellular matrix of bovine origin (b-CEM. Planimetry, wound contracture, and immunological and histological observations were carried out to evaluate healing process. Significantly (P<0.05 increased wound contraction was observed in b-CEM (III as compared to control (I and b-CS (II on day 21. Histologically, improved epithelization, neovascularization, fibroplasia, and best arranged collagen fibers were observed in b-CEM (III as early as on postimplantation day 21. These findings indicate that b-CEM have potential for biomedical applications for full thickness skin wound repair in rats.

Artificial tears potpourri: a literature review

Science.gov (United States)

Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F

2014-01-01

Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. PMID:25114502

Ultrasound determination of rotator cuff tear repairability

Science.gov (United States)

Tse, Andrew K; Lam, Patrick H; Walton, Judie R; Hackett, Lisa

2015-01-01

Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% (p tear size (p tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability. PMID:27582996

Uninduced adipose-derived stem cells repair the defect of full-thickness hyaline cartilage.

Science.gov (United States)

Zhang, Hai-Ning; Li, Lei; Leng, Ping; Wang, Ying-Zhen; Lv, Cheng-Yu

2009-04-01

To testify the effect of the stem cells derived from the widely distributed fat tissue on repairing full-thickness hyaline cartilage defects. Adipose-derived stem cells (ADSCs) were derived from adipose tissue and cultured in vitro. Twenty-seven New Zealand white rabbits were divided into three groups randomly. The cultured ADSCs mixed with calcium alginate gel were used to fill the full-thickness hyaline cartilage defects created at the patellafemoral joint, and the defects repaired with gel or without treatment served as control groups. After 4, 8 and 12 weeks, the reconstructed tissue was evaluated macroscopically and microscopically. Histological analysis and qualitative scoring were also performed to detect the outcome. Full thickness hyaline cartilage defects were repaired completely with ADSCs-derived tissue. The result was better in ADSCs group than the control ones. The microstructure of reconstructed tissue with ADSCs was similar to that of hyaline cartilage and contained more cells and regular matrix fibers, being better than other groups. Plenty of collagen fibers around cells could be seen under transmission electron microscopy. Statistical analysis revealed a significant difference in comparison with other groups at each time point (t equal to 4.360, P less than 0.01). These results indicate that stem cells derived from mature adipose without induction possess the ability to repair cartilage defects.

Iatrogenic tracheal tear.

LENUS (Irish Health Repository)

Dias, A

2010-10-01

Large post intubation tracheal tears are usually detected intra-operatively due to unstable signs namely impaired ventilation and mediastinal emphysema and often require surgical management. Smaller tracheal tears are often missed during anaesthesia and recognized during the postoperative period. Conservative management should be considered in these latter cases.

Water-evaporation reduction by duplex films: application to the human tear film.

Science.gov (United States)

Cerretani, Colin F; Ho, Nghia H; Radke, C J

2013-09-01

Water-evaporation reduction by duplex-oil films is especially important to understand the physiology of the human tear film. Secreted lipids, called meibum, form a duplex film that coats the aqueous tear film and purportedly reduces tear evaporation. Lipid-layer deficiency is correlated with the occurrence of dry-eye disease; however, in-vitro experiments fail to show water-evaporation reduction by tear-lipid duplex films. We review the available literature on water-evaporation reduction by duplex-oil films and outline the theoretical underpinnings of spreading and evaporation kinetics that govern behavior of these systems. A dissolution-diffusion model unifies the data reported in the literature and identifies dewetting of duplex films into lenses as a key challenge to obtaining significant evaporation reduction. We develop an improved apparatus for measuring evaporation reduction by duplex-oil films including simultaneous assessment of film coverage, stability, and temperature, all under controlled external mass transfer. New data reported in this study fit into the larger body of work conducted on water-evaporation reduction by duplex-oil films. Duplex-oil films of oxidized mineral oil/mucin (MOx/BSM), human meibum (HM), and bovine meibum (BM) reduce water evaporation by a dissolution-diffusion mechanism, as confirmed by agreement between measurement and theory. The water permeability of oxidized-mineral-oil duplex films agrees with those reported in the literature, after correction for the presence of mucin. We find that duplex-oil films of bovine and human meibum at physiologic temperature reduce water evaporation only 6-8% for a 100-nm film thickness pertinent to the human tear film. Comparison to in-vivo human tear-evaporation measurements is inconclusive because evaporation from a clean-water surface is not measured and because the mass-transfer resistance is not characterized. Copyright © 2013 Elsevier B.V. All rights reserved.

Platelet-rich plasma with keratinocytes and fibroblasts enhance healing of full-thickness wounds.

Science.gov (United States)

Law, Jia Xian; Chowdhury, Shiplu Roy; Saim, Aminuddin Bin; Idrus, Ruszymah Bt Hj

2017-08-01

Advances in tissue engineering led to the development of various tissue-engineered skin substitutes (TESS) for the treatment of skin injuries. The majority of the autologous TESS required lengthy and costly cell expansion process to fabricate. In this study, we determine the possibility of using a low density of human skin cells suspended in platelet-rich plasma (PRP)-enriched medium to promote the healing of full-thickness skin wounds. To achieve this, full-thickness wounds of size 1.767 cm 2 were created at the dorsum part of nude mice and treated with keratinocytes (2 × 10 4  cells/cm 2 ) and fibroblasts (3 × 10 4  cells/cm 2 ) suspended in 10% PRP-enriched medium. Wound examination was conducted weekly and the animals were euthanized after 2 weeks. Gross examination showed that re-epithelialization was fastest in the PRP+cells group at both day 7 and 14, followed by the PRP group and NT group receiving no treatment. Only the PRP+cells group achieved complete wound closure by 2 weeks. Epidermal layer was presence in the central region of the wound of the PRP+cells and PRP groups but absence in the NT group. Comparison between the PRP+cells and PRP groups showed that the PRP+cells-treated wound was more mature as indicated by the presence of thinner epidermis with single cell layer thick basal keratinocytes and less cellular dermis. In summary, the combination of low cell density and diluted PRP creates a synergistic effect which expedites the healing of full-thickness wounds. This combination has the potential to be developed as a rapid wound therapy via the direct application of freshly harvested skin cells in diluted PRP. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

Science.gov (United States)

Dhasmana, Renu; Nagpal, Ramesh Chander

2016-01-01

Introduction Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age ≤20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (μm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus

Evaluation of the Subscapularis Tendon Tears on 3T Magnetic Resonance Arthrography: Comparison of Diagnostic Performance of T1-Weighted Spectral Presaturation with Inversion-Recovery and T2-Weighted Turbo Spin-Echo Sequences.

Science.gov (United States)

Lee, Hoseok; Ahn, Joong Mo; Kang, Yusuhn; Oh, Joo Han; Lee, Eugene; Lee, Joon Woo; Kang, Heung Sik

2018-01-01

To compare the T1-weighted spectral presaturation with inversion-recovery sequences (T1 SPIR) with T2-weighted turbo spin-echo sequences (T2 TSE) on 3T magnetic resonance arthrography (MRA) in the evaluation of the subscapularis (SSC) tendon tear with arthroscopic findings as the reference standard. This retrospective study included 120 consecutive patients who had undergone MRA within 3 months between April and December 2015. Two musculoskeletal radiologists blinded to the arthroscopic results evaluated T1 SPIR and T2 TSE images in separate sessions for the integrity of the SSC tendon, examining normal/articular-surface partial-thickness tear (PTTa)/full-thickness tear (FTT). Diagnostic performance of T1 SPIR and T2 TSE was calculated with arthroscopic results as the reference standard, and sensitivity, specificity, and accuracy were compared using the McNemar test. Interobserver agreement was measured with kappa (κ) statistics. There were 74 SSC tendon tears (36 PTTa and 38 FTT) confirmed by arthroscopy. Significant differences were found in the sensitivity and accuracy between T1 SPIR and T2 TSE using the McNemar test, with respective rates of 95.9-94.6% vs. 71.6-75.7% and 90.8-91.7% vs. 79.2-83.3% for detecting tear; 55.3% vs. 31.6-34.2% and 85.8% vs. 78.3-79.2%, respectively, for FTT; and 91.7-97.2% vs. 58.3-61.1% and 89% vs. 78-79.3%, respectively, for PTTa. Interobserver agreement for T1 SPIR was almost perfect for T1 SPIR (κ = 0.839) and substantial for T2 TSE (κ = 0.769). T1-weighted spectral presaturation with inversion-recovery sequences is more sensitive and accurate compared to T2 TSE in detecting SSC tendon tear on 3T MRA.

Hot tearing studies in AA5182

Science.gov (United States)

van Haaften, W. M.; Kool, W. H.; Katgerman, L.

2002-10-01

One of the major problems during direct chill (DC) casting is hot tearing. These tears initiate during solidification of the alloy and may run through the entire ingot. To study the hot tearing mechanism, tensile tests were carried out in semisolid state and at low strain rates, and crack propagation was studied in situ by scanning electron microscopy (SEM). These experimentally induced cracks were compared with hot tears developed in an AA5182 ingot during a casting trial in an industrial research facility. Similarities in the microstructure of the tensile test specimens and the hot tears indicate that hot tearing can be simulated by performing tensile tests at semisolid temperatures. The experimental data were compared with existing hot tearing models and it was concluded that the latter are restricted to relatively high liquid fractions because they do not take into account the existence of solid bridges in the crack.

Classification and localization of acetabular labral tears

International Nuclear Information System (INIS)

Blankenbaker, D.G.; De Smet, A.A.; Keene, J.S.; Fine, J.P.

2007-01-01

The purpose of this study was to compare the findings on hip MR arthrography (MRA) with the published MRA and arthroscopic classifications of hip labral tears and to evaluate a clock-face method for localizing hip labral tears. We retrospectively reviewed 65 hip MRA studies with correlative hip arthroscopies. Each labrum was evaluated on MRA using the classification system of Czerny and an MRA modification of the Lage arthroscopic classification. In addition, each tear was localized on MRA by using a clock-face description where 6 o'clock was the transverse ligament and 3 o'clock was anterior. These MRA findings were then correlated with the arthroscopic findings using the clock-face method of localization and the Lage arthroscopic classification of labral tears. At MRA, there were 42 Czerny grade 2 and 23 grade 3 labral tears and 22 MRA Lage type 1, 11 type 2, 22 type 3 and 10 type 4 tears. At arthroscopy, there were 10 Lage type 1 flap tears, 20 Lage type 2 fibrillated tears, 18 Lage type 3 longitudinal peripheral tears and 17 Lage type 4 unstable tears. The Czerny MRA classification and the modified MRA Lage classification had borderline correlation with the arthroscopic Lage classification. Localization of the tears using a clock-face description was within 1 o'clock of the arthroscopic localization of the tears in 85% of the patients. The Lage classification, which is the only published arthroscopic classification system for hip labral tears, does not correlate well with the Czerny MRA or an MRA modification of the Lage classification. Using a clock-face description to localize tears provides a way to accurately localize a labral tear and define its extent. (orig.)

Tearing mode saturation with finite pressure

International Nuclear Information System (INIS)

Lee, J.K.

1988-01-01

With finite pressure, the saturation of the current-driven tearing mode is obtained in three-dimensional nonlinear resistive magnetohydrodynamic simulations for Tokamak plasmas. To effectively focus on the tearing modes, the perturbed pressure effects are excluded while the finite equilibrium pressure effects are retained. With this model, the linear growth rates of the tearing modes are found to be very insensitive to the equilibrium pressure increase. The nonlinear aspects of the tearing modes, however, are found to be very sensitive to the pressure increase in that the saturation level of the nonlinear harmonics of the tearing modes increases monotonically with the pressure rise. The increased level is associated with enhanced tearing island sizes or increased stochastic magnetic field region. (author)

[The correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK].

Science.gov (United States)

Zhang, Luyan; Sun, Xiyu; Yu, Ye; Xiong, Yan; Cui, Yuxin; Wang, Qinmei; Hu, Liang

2016-01-01

To investigate the correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK (FS-LASIK) surgery. In this prospective clinical study, 31 patients undergoing FS-LASIK for myopia were recruited. The upper and lower tear meniscus volumes (UTMV and LTMV) were measured by customized anterior segment optical coherence tomography, tear film osmolarity was measured by a TearLab Osmolarity test device, central corneal sensation was measured by a Cochet-Bonner esthesiometer preoperatively, at 1 week, 1 and 3 months postoperatively. Repeated measures analysis of variance was used to evaluate whether the tear film osmolarity, tear meniscus volume, and corneal sensation were changed after surgery. The correlations between these variables were analyzed by the Pearson correlation analysis. The tear film osmolarity was (310.03 ± 16.48) mOsms/L preoperatively, (323.51 ± 15.92) mOsms/L at 1 week, (319.93 ± 14.27) mOsms/L at 1 month, and (314.97±12.91) mOsms/L at 3 months. The UTMV was (0.42±0.15), (0.25± 0.09), (0.30±0.11), and (0.35±0.09) μL, respectively; the LTMV was (0.60±0.21),(0.37±0.08), (0.44± 0.14), and (0.52±0.17) μL, respectively. The tear film osmolarity was significantly higher at 1 week and 1 month postoperatively compared with the baseline (P=0.001, 0.004), and reduced to the preoperative level at 3 months (P=0.573). The UTMV, LTMV, and corneal sensation values presented significant decreases at all postoperative time points (all Psensation at 1 week after surgery (r=0.356,P=0.005). There were significant correlations between the preoperative LTMV and corneal sensation at 1 week, 1 and 3 months (respectively, r=0.422, 0.366, 0.352;P=0.001, 0.004, 0.006). No significant correlations were found between the tear film osmolarity, tear meniscus volume, and corneal sensation after surgery (all P>0.05). The tear film osmolarity, tear meniscus volume, and corneal sensation became aggravated due

The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up

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Ibrahim Khalid A

2007-12-01

Full Text Available Abstract Background To prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears. Methods Fifty-two patients underwent "mini-open" or all arthroscopic repair of a full thickness tear of the rotator cuff. Patients who complained of shoulder pain and/or weakness and who had failed a minimum of 6 weeks of physical therapy and had at least one sub-acromial injection were surgical candidates. Pre and post-operative clinical evaluations included the following: 1 demographics; 2 Simple Shoulder Test (SST; 3 University of California, Los Angeles (UCLA rating scale; 4 visual analog pain assessment (VAS; and 5 pre-op SF12 assessment. Descriptive analysis was performed for patient demographics and for all variables. Pre and post outcome scores, range of motion and pain scale were compared using paired t-tests. Analysis of variance (ANOVA was used to evaluate any effect between dependent and independent variables. Significance was set at p is less than or equal to 0.05. Results There were 31 females and 21 males. The average follow-up was 50.6 months (27 – 84 months. The average age was similar between the two groups [arthroscopic x = 55 years/mini-open x = 58 years, p = 0.7]. Twenty-seven patients underwent arthroscopic repair and 25 underwent repair with a mini-open incision. The average rotator cuff tear size was 3.1 cm (range: 1–5 centimeters. There was no significant difference in tear size between the two groups (arthroscopic group = 2.9 cm/mini-open group = 3.2 cm, p = 0.3. Overall, there was a significant improvement from pre-operative status in shoulder pain, shoulder function as measured on the Simple Shoulder test and UCLA Shoulder Form. Visual analog pain improved, on average, 4.4 points and the most recent Short Shoulder Form and UCLA scores were 8 and 26 respectively. Both active and passive glenohumeral joint range of motion improved

Percentage Level of Tannin fur Rabbit for Leather Concerning Stitch Tearing Strength, Tearing Strength and Flexibility

OpenAIRE

Mustakim Mustakim; Aris Sri Widati; Lisa Purnaningtyas

2012-01-01

The purpose of this study was to find out the appropriate of tannin level for rabbit fur leather concerning stitch tearing strength, tearing strength, and flexibility. The result were expected to contribute good information for the society, leather craftsman, and further researchers about fur leather tanning especially rabbit fur leather with tannin concerning stitch tearing strength, tearing strength and flexibility. The material that used were 12 pieces of four months of rabbit skin. The re...

Interaction of tearing modes

International Nuclear Information System (INIS)

Satya, Y.; Schmidt, G.

1979-01-01

A fully developed tearing mode modifies the magnetic field profile. The effect of this profile modification on the linear growth rate of a different tearing mode in a slab and cylindrical geometry is investigated

MRI diagnosis of meniscal tears

International Nuclear Information System (INIS)

Kuga, Naoyuki; Oh, Toshihiro

1996-01-01

We studied the accuracy of magnetic resonance imaging (MRI) of the knee in fifty-six patients who were also examined arthroscopically. The accuracy, sensitivity, and specificity were 96%, 100%, and 95% for medial meniscal tears, and 91%, 67%, and 100% for lateral meniscal tears respectively. Two MRIs of the medial meniscus were false-positives. These MRI findings were both meniscocapsular separation of the medial meniscus, but the arthroscopic findings were normal. One case was an ACL injury and the other PCL and MCL injury. Hemorrhage and edema of the medial capsule caused by valgus stress at injury may look like a meniscal pseudo-tear on MRI. Five MRIs of the lateral meniscus were false-negatives. All menisci showed normal signal and shape on MRI but traumatic and stable tears of the lateral meniscus were identified arthroscopically. All were associated with ACL tears and lateral condylar bone bruise. The traumatic and stable tear of the meniscus tended to be overlooked on MRI because a meniscus without degeneration shows a normal signal. (author)

Winging of scapula due to serratus anterior tear

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Varun Singh Kumar

2014-10-01

Full Text Available 【Abstract】Winging of scapula occurs most commonly due to injury to long thoracic nerve supplying serratus anterior muscle. Traumatic injury to serratus anterior muscle itself is very rare. We reported a case of traumatic winging of scapula due to tear of serratus anterior muscle in a 19-year-old male. Winging was present in neutral position and in extension of right shoulder joint but not on "push on wall" test. Patient was managed conservatively and achieved satisfactory result. Key words: Serratus anterior tear; Scapula; Wounds and injuries

The Hug-up Test: A New, Sensitive Diagnostic Test for Supraspinatus Tears

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Yu-Lei Liu

2016-01-01

Full Text Available Background: The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests. Methods: Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC test, full can (FC test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer. Results: The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%, with a low negative likelihood ratio (NLR, 0.08 and comparable specificity (76.6% compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075 or the FC test (z = 1.498, P = 0.067. The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ2 = 0.578, P = 0.898 and size (Fisher′s exact test, P > 0.999 compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823. Conclusions: The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional

Assessment of tear film osmolarity using the TearLab™ osmometer in normal dogs and dogs with keratoconjunctivitis sicca.

Science.gov (United States)

Sebbag, Lionel; Park, Shin Ae; Kass, Philip H; Maggs, David J; Attar, Mayssa; Murphy, Christopher J

2017-07-01

To evaluate repeatability and reproducibility of tear osmolarity measured using the TearLab ™ osmometer in normal dogs and to assess its diagnostic potential in dogs with keratoconjunctivitis sicca (KCS). Beagle dogs; six normal and five with KCS. Tear osmolarity and Schirmer tear test-1 (STT-1) values were obtained at various times. Normal dogs were assessed for diurnal variation and repeatability and reproducibility of measurements. Dogs with KCS were evaluated before and after 5 months' topical twice-daily therapy with 2% cyclosporine. Mean ± SD tear osmolarity (mOsm/L) was significantly higher in normal dogs (337.4 ± 16.2) than in dogs with KCS before therapy (306.2 ± 18.0; P dogs, tear osmolarity readings were stable during the daytime (P = 0.99). Repeated measurements revealed high variability and typically poor-to-moderate repeatability and reproducibility, although this was improved by taking three successive measurements at each session. Considering combined data from all dogs, a positive correlation existed between STT-1 and tear osmolarity measurements (Pearson's correlation test, P = 0.04, r = 0.62). Canine tear osmolarity as determined by TearLab ™ osmometer was variable, required multiple readings to be informative, and differed from values reported for humans. Dogs with KCS had a lower tear osmolarity than did normal dogs, and this increased following cyclosporine therapy. © 2016 American College of Veterinary Ophthalmologists.

Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System

DEFF Research Database (Denmark)

Skiveren, J; Bermark, S; LeBlanc, K

2015-01-01

OBJECTIVE: The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. METHOD: Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System......) and social and health-care assistants (non-RN) from both primary health care and a Danish university hospital in Copenhagen. Thirty photographs, with equal representation of the three types of skin tears, were selected to test validity. The photographs chosen were those originally used for internal...... and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. RESULTS: The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists...

Case Report of Acute Traumatic Rotator Cuff Tear Treatment in Traditional Korean Medicine

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Jeong-Hwan Lee

2011-12-01

Full Text Available Objectives: There is no report on treatment of acute traumatic rotator cuff tear in Traditional Korean Medicine. We reported Traditional Korean Treatment for pain relief and better movement of acute traumatic rotator cuff tear. Methods: Shoulder MRI was used to confirm the diagnosis of tear of rotator cuff. The patient was treated with Traditional Korean Methods (Acupuncture, Herbal medicine, Pharmacopuncture for 6 months. We evaluated the patient through VAS (Visual Analogue Scale, UCLA shoulder scale, ROM (Range of motion and Shoulder MRI. Results: After 6 months of treatment, the patient's VAS was decreased whereas UCLA score and Shoulder ROM were increased. Rotator cuff tear was repaired on Shoulder MRI images. Conclusions: In acute traumatic rotator cuff tear, Korean Traditional Treatment is good method for pain relief and better movement.

Posterior vitreous detachment - prevalence of and risk factors for retinal tears

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Bond-Taylor M

2017-09-01

Full Text Available Martin Bond-Taylor,1 Gunnar Jakobsson,1,2 Madeleine Zetterberg1,2 1Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, 2Department of Clinical Neuroscience/Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden Purpose: The present study aimed to describe clinical characteristics of patients with posterior vitreous detachment (PVD, to determine the prevalence of retinal tears in PVD patients, and to find predictors for retinal tears in this patient group. Methods: Retrospective analysis of medical records on patients diagnosed with PVD, retinal tears, or vitreous hemorrhage at the Department of Ophthalmology at Sahlgrenska University Hospital, a tertiary eye center. Results: Between February and July 2009, 365 patients consulted the Department of Ophthalmology for PVD-related symptoms. The incidence of retinal tears was 14.5% (n=53 and that of vitreous and/or retinal hemorrhage was 22.7% (n=83. For analysis of possible predictors for complications to PVD, patients diagnosed with retinal tears or vitreous hemorrhage between May and July 2009 were also included in the study, resulting in a total of 426 patients. Predictors of a retinal tear were symptoms of visual impairment (P=0.024, the presence of vitreous or retinal hemorrhage at examination (P<0.001, and a duration of symptoms for <24 hours (P=0.004. Symptoms of flashes did not constitute an extra risk of retinal tears (P=0.135. Subsequent retinal pathology (follow-up time 4.5 years, including vitreous detachment/hemorrhage or retinal tears/detachment, occurred more often in patients presenting with a retinal tear. For patients with a retinal tear, the relative risk of having a retinal detachment in the same eye during the follow-up time was 17.7 when compared to patients without a retinal tear (risk ratio 17.7, 95% confidence interval 2.2–145. Conclusion: Patients seeking care on the first day have a

Linear growth rates of resistive tearing modes with sub-Alfvénic streaming flow

International Nuclear Information System (INIS)

Wu, L. N.; Ma, Z. W.

2014-01-01

The tearing instability with sub-Alfvénic streaming flow along the external magnetic field is investigated using resistive MHD simulation. It is found that the growth rate of the tearing mode instability is larger than that without the streaming flow. With the streaming flow, there exist two Alfvén resonance layers near the central current sheet. The larger perturbation of the magnetic field in two closer Alfvén resonance layers could lead to formation of the observed cone structure and can largely enhance the development of the tearing mode for a narrower streaming flow. For a broader streaming flow, a larger separation of Alfvén resonance layers reduces the magnetic reconnection. The linear growth rate decreases with increase of the streaming flow thickness. The growth rate of the tearing instability also depends on the plasma beta (β). When the streaming flow is embedded in the current sheet, the growth rate increases with β if β  s , but decreases if β > β s . The existence of the specific value β s can be attributed to competition between the suppressing effect of β and the enhancing effect of the streaming flow on the magnetic reconnection. The critical value β s increases with increase of the streaming flow strength

Arthroscopic repair of large U-shaped rotator cuff tears without margin convergence versus repair of crescent- or L-shaped tears.

Science.gov (United States)

Park, Jin-Young; Jung, Seok Won; Jeon, Seung-Hyub; Cho, Hyoung-Weon; Choi, Jin-Ho; Oh, Kyung-Soo

2014-01-01

For large-sized tears of the rotator cuff, data according to the tear shape have not yet been reported for repair methodology, configuration, and subsequent integrity. The retear rate after the repair of large mobile tears, such as crescent- or L-shaped tears, is believed to be lower compared with retear rates after the repair of large U-shaped tears that are accompanied by anterior or posterior leaves of the rotator cuff. Cohort study; Level of evidence, 3. Data were collected and analyzed from 95 consecutive patients with a large-sized rotator cuff tear who underwent arthroscopic suture-bridge repair. Patients were divided into 2 groups: those having crescent- or L-shaped tears (mobile tear group, 53 patients) and those having U-shaped tears (U-shaped tear group, 42 patients). The integrity of the repaired constructs was determined by ultrasonography at 4.5, 12, and 24 months. Moreover, clinical evaluations were performed by using the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and muscle strength at intervals of 3, 6, 12, and 24 months postoperatively. On ultrasonography at 4.5, 12, and 24 months, a retear was detected in 6, 2, and 1 patients in the mobile tear group and in 5, 2, and 1 patients in the U-shaped tear group, respectively. Significant differences in retear rates were not detected between the groups overall or at each time point. Moreover, clinical scores were similar between groups, except for the presence of a temporarily higher Constant score at 12 months in the mobile tear group. With regard to shoulder strength, between-group comparisons indicated no statistically significant difference, either in abduction or external rotation, except for the presence of temporarily higher external rotation strength at 3 months in the mobile tear group. Arthroscopic repair of large-sized rotator cuff tears yielded substantial improvements in shoulder function, regardless of tear retraction, during midterm follow-up. Moreover, the

Pele's tears and spheres: Examples from Kilauea Iki

Science.gov (United States)

Porritt, L. A.; Russell, J. K.; Quane, S. L.

2012-06-01

Pele's tears are a well known curiosity commonly associated with low viscosity basaltic explosive eruptions. However, detailed studies of these pyroclasts are rare and, thus, there is no full explanation for their formation. These intriguing pyroclasts have smooth glassy surfaces, vesiculated interiors (∼30%), and fluidal morphologies trending towards teardrops and then spheres as they decrease in size to Pele's tears from the 1959 fire-fountaining eruption of Kilauea Iki has led to a reassessment of the mechanisms of magma disruption and fragmentation, timescales of relaxation, and cooling rates that are responsible for their formation. We conclude that the particle size distributions and vesicularities of Pele's tears are representative of the magma properties at the moment of explosive disruption. However, the morphology of these unique pyroclasts results from reshaping through viscous relaxation, driven by surface tension forces, on a time scale fast enough to compete with cooling times.

Tear osmolarity and dry eye symptoms in diabetics

Directory of Open Access Journals (Sweden)

Fuerst N

2014-03-01

Full Text Available Nicole Fuerst,1 Nicole Langelier,1 Mina Massaro-Giordano,1 Maxwell Pistilli,1 Kalliopi Stasi,1 Carrie Burns,2 Serena Cardillo,2 Vatinee Y Bunya1 1Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Purpose: To assess the relationship between tear osmolarity and dry eye symptoms in patients with diabetes. Patients and methods: Fifty patients with diabetes were enrolled. Demographic information and past medical history were recorded. Symptoms were assessed using the ocular surface disease index (OSDI. Tear osmolarity of each eye was measured with the TearLab® Osmolarity System. Results: The majority of the subjects were female (76%, African American (56%, and/or had a diagnosis of type 2 diabetes (82%. The mean ± standard deviation (SD for age was 54.6±13.4, and maximum tear osmolarity was 304.6±12.7 mOsm/L. Men had higher osmolarity than women (mean ± standard error (SE 311.8±4.0 mOsm/L versus 302.3±1.9 mOsm/L, P=0.02. Age, race, use of artificial tears, years of diabetes, and hemoglobin A1c did not have a statistically significant association with tear osmolarity. Longer duration of diabetes was associated with lower (less severe OSDI scores (r=-0.35, P=0.01. Higher tear osmolarity was associated with lower (less severe OSDI scores (r=-0.29, P=0.04. Conclusion: Approximately half of the diabetic subjects in our study had elevated tear osmolarity, and half of our population also reported symptoms consistent with dry eye disease. However, the two were slightly inversely related in that those with higher osmolarity reported fewer symptoms. Subjects with a longer duration of diabetes also reported fewer dry eye symptoms. Therefore, health care providers should be aware that patients who are most likely to have ocular surface disease, including those with

Solute Dynamics and Imaging in the Tear Film on an Eye-shaped Domain

Science.gov (United States)

Braun, R. J.; Li, Longfei; Henshaw, William; Driscoll, Tobin; King-Smith, P. E.

2015-11-01

The concentration of ions in the tear film (osmolarity) is a key variable in understanding dry eye symptoms and disease, yet its global distribution is not available; direct measurements are restricted to a region near the temporal canthus. It has been suggested that imaging methods that use solutes such as fluorescein can be used as a proxy for estimating the osmolarity. The concentration of fluorescein is not measured directly either but the intensity as a function of concentration and thickness of the film is well established. We derived a mathematical model that couples multiple solutes and fluid dynamics within the tear film on a 2D eye-shaped domain. The model includes the physical effects of evaporation, surface tension, viscosity, ocular surface wettability, osmolarity, osmosis, fluorescence and tear fluid supply and drainage. We solved the governing system of coupled nonlinear PDEs using the Overture computational framework developed at LLNL, together with a hybrid time stepping scheme (using variable step BDF and RKC). Results of our numerical simulations provide new insight about the osmolarity distribution and its connection with images obtained in vivo over the whole ocular surface and in local regions of tear thinning due to evaporation and other effects. This work was supported in part by NSF grants 1022706 and 1412085, and NIH grant 1R01EY021794.

MRI of meniscal bucket-handle tears

Energy Technology Data Exchange (ETDEWEB)

Magee, T.H.; Hinson, G.W. [Menorah Medical Center, Overland Park, KS (United States). Dept. of Radiology

1998-09-01

A meniscal bucket-handle tear is a tear with an attached fragment displaced from the meniscus of the knee joint. Low sensitivity of MRI for detection of bucket-handle tears (64% as compared with arthroscopy) has been reported previously. We report increased sensitivity for detecting bucket-handle tears with the use of coronal short tau inversion recovery (STIR) images. Results. By using four criteria for diagnosis of meniscal bucket-handle tears, our overall sensitivity compared with arthroscopy was 93% (28 of 30 meniscal bucket-handle tears seen at arthroscopy were detected by MRI). The meniscal fragment was well visualized in all 28 cases on coronal STIR images. The double posterior cruciate ligament sign was seen in 8 of 30 cases, the flipped meniscus was seen in 10 of 30 cases and a fragment in the intercondylar notch was seen in 18 of 30 cases. (orig.)

Feasibility and Advantages of Full Thickness Skin Graft from the Anterolateral Thigh.

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Shin, Seung-Han; Kim, Chulkyu; Lee, Yong-Suk; Kang, Jin-Woo; Chung, Yang-Guk

2017-12-01

Full thickness skin graft (FTSG) gives better outcomes than split thickness skin graft (STSG), but it has the drawback of limited donor sites. Anterolateral thigh (ALT), a popular donor site of STSG, is also a popular donor site of perforator flaps. This area has the advantage of large flap size available with primary closure. Based on this we harvested FTSG instead of STSG from the ALT. We retrospectively reviewed 10 cases of FTSG from the ALT, with the recipient site of foot in 3, ankle in 2, lower leg in 2, forearm in 2, and wrist in 1 patient. In all cases elliptical full thickness skin was harvested from the ALT, and the donor site was closed primarily. The skin was defatted and placed onto the defect with vacuum-assisted closure (VAC). The skin size ranged 7-30 cm in length and 3-12 cm in width. Mean follow up period was 7 months (range, 3-13). FTSG from the ALT provided durable wound coverage, with excellent color and texture matching. Partial (< 20%) graft failure was observed in 1 case, but no additional surgery was necessary. No patient reported donor site pain at postoperative 2 weeks. No donor site complications were encountered. No patient complained a feeling of tension in the thigh at final follow-up. FTSG from the ALT is feasible with the aid of VAC. Considering the skin quality, large skin size available, early pain relief, and little donor site morbidity, the ALT should be revisited as a donor site of FTSG.

Modulation of scar tissue formation using different dermal regeneration templates in the treatment of experimental full-thickness wounds.

NARCIS (Netherlands)

Druecke, D.; Lamme, E.N.; Hermann, S.; Pieper, J.S.; May, P.S.; Steinau, H.U.; Steinstraesser, L.

2004-01-01

The recovery of skin function is the goal of each burn surgeon. Split-skin graft treatment of full-thickness skin defects leads to scar formation, which is often vulnerable and instable. Therefore, the aim of this study was to analyze wound healing and scar tissue formation in acute full-thickness

The Tear Osmolarity Changes After Cataract Surgery

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Banu Öncel

2012-01-01

Full Text Available Pur po se: To determine the tear osmolarity changes in patients who had undergone phacoemulsification surgery. Ma te ri al and Met hod: Tear osmolarity measurements were performed in 30 eyes of 30 patients who had undergone cataract surgery without any complication. Measurements were performed before surgery and consecutively at 1st month, 3rd month, and 6th month after the surgery. TearLab osmometer (TearLab Corporation, San Diego, CA, USA device was used for the measurements and paired ttest was used for statistical analysis. Re sults: The mean age of the patients was 72.3±3.7 (67-78 years. Thirteen patients were men and 17 patients were women. The mean osmolarity values were 305.8±6.5 mOsm/L before the surgery and 312.3±6.4 mOsm/L at 1st month, 307.5±5.1 mOsm/L at 3rd month and 305.1±5.7 at 6th month after the surgery. The difference between the values before surgery and at 1st month was found statistically significant (p=0.001. Dis cus si on: The tear osmolarity increases at the first month after surgery but decreases to the levels measured before surgery at the 3rd month. The increase at the first month may be due to the corneal incisions and medication used after the surgery. We think that we have to take into account this similarity increase in all cataract patients, especially in those who also have dry eye disease. (Turk J Ophthalmol 2012; 42: 35-7

Comparison of low-abundance biomarker levels in capillary-collected nonstimulated tears and washout tears of aqueous-deficient and normal patients.

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Guyette, Nicole; Williams, Larezia; Tran, My-Tho; Than, Tammy; Bradley, John; Kehinde, Lucy; Edwards, Clara; Beasley, Mark; Fullard, Roderick

2013-05-01

Low tear volume limits the use of nonstimulated (NS) microcapillary tear collection in aqueous-deficient (AD) patients. Adding a small amount of "washout" fluid to the eye prior to tear collection is a potentially viable alternative method for abundant proteins, but is relatively untested for low-abundance biomarkers. This study determined the feasibility of the washout (WO) method as an NS alternative for low-abundance biomarkers. NS and WO biomarker profiles were compared between AD patients and non-AD controls to determine if the two methods identify the same intergroup differences. Matching NS and WO tears were collected from 48 patients by micropipette, the WO sample after instillation of 10 μL saline. Tear cytokine levels were measured by 27-Plex Bio-Rad assay. Bland-Altman analyses for each biomarker determined the agreement between tear sample types. Patients were grouped as AD or non-AD based on Schirmer score to determine if NS profile between-group differences were preserved in WO tears. Bland-Altman plots showed good biomarker level agreement between NS and WO tears for most cytokines. Five biomarkers, among those most often cited as differing in AD dry eye, differed significantly between non-AD and AD groups in both tear types. Additional biomarker differences were seen in NS tears only. The WO tear collection method is a viable alternative to NS tears for many low-abundance biomarkers and is able to replicate major NS tear differences between dry eye groups. More subtle intergroup differences are lost in WO samples because of reduced statistical power.

Anatomical and visual outcomes of ranibizumab injections in retinal pigment epithelium tears

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Muhammet Kazım Erol

2015-06-01

Full Text Available ABSTRACT Purpose: To report the anatomical and visual results in patients diagnosed as having retinal pigment epithelium (RPE tears after receiving ranibizumab injections. Methods: Eyes diagnosed as having RPE tears with a minimum 6-month follow-up were retrospectively evaluated. Each eye was treated with at least three doses of ranibizumab at monthly intervals. Best-corrected visual acuity (BCVA, anterior segment findings, intraocular pressure, and fundus examination results were evaluated during control visits. Color fundus photography, fundus fluorescein angiographies, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT images were obtained. The height of pigment epithelial detachment (PED was measured by SD-OCT. Results: Twelve eyes with RPE tears were studied. Nine eyes (75% developed RPE tears during ranibizumab injections for choroidal neovascularization (eight eyes with vascularized PED and one eye with choroidal osteoma, and tears occurred in three eyes before any injections. The median number of ranibizumab injections after diagnosis of RPE tears was 3 (min 2, max 5. In the most recent follow-up visit, there was no statistically significant correlation between the grade of RPE and logMAR of BCVA (p>0.05, r=0.112. Eight of twelve eyes had PED, and seven of these had irregular PED contours before injection therapy. The mean PED height was 447 ± 122 µm. Conclusions: In this series, RPE tears developed mostly after intravitreal anti-VEGF injections for vascularized PED. Increased vertical height and irregular contours of the PEDs can be risk factors for the formation of RPE tears. The continuation of anti-VEGF therapy after tear formation is beneficial for vision improvement in eyes with RPE tears.

Warm and touching tears: tearful individuals are perceived as warmer because we assume they feel moved and touched.

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Zickfeld, Janis H; Schubert, Thomas W

2018-01-31

Recent work investigated the inter-individual functions of emotional tears in depth. In one study (Van de Ven, N., Meijs, M. H. J., & Vingerhoets, A. (2017). What emotional tears convey: Tearful individuals are seen as warmer, but also as less competent. British Journal of Social Psychology, 56(1), 146-160. Https://doi.org/10.1111/bjso.12162) tearful individuals were rated as warmer, and participants expressed more intentions to approach and help such individuals. Simultaneously, tearful individuals were rated as less competent, and participants expressed less intention to work with the depicted targets. While tearful individuals were perceived as sadder, perceived sadness mediated only the effect on competence, but not on warmth. We argue that tearful individuals might be perceived as warm because they are perceived as feeling moved and touched. We ran a pre-registered extended replication of Van de Ven et al. Results replicate the warmth and helping findings, but not the competence and work effects. The increase in warmth ratings was completely mediated by perceiving feeling moved and touched. Possible functions of feeling moved and touched with regard to emotional tears are discussed.

Sonography of the painful shoulder: role of the operator's experience

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Corroller, Thomas Le; Cohen, Michel; Champsaur, Pierre [Hopital Sainte-Marguerite, Service d' Imagerie Medicale, Marseille (France); Aswad, Richard [Clinique Juge, Service de Chirurgie Orthopedique, Marseille (France); Pauly, Vanessa [Hopital Sainte-Marguerite, D.I.M., Marseille (France)

2008-11-15

The aim of our study was to determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7%for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears ({kappa}=0.90), supraspinatus tendinosis ({kappa} =0.80), abnormalities of the long head of biceps tendon ({kappa}=0.84), subacromial bursa abnormalities ({kappa}=0.89), and acromioclavicular osteoarthritis ({kappa}=0.81). The agreement was only moderate for partial-thickness tears ({kappa}=0.63) and intratendinous tears ({kappa}=0.57). Our results show that in moderately experienced hands as in experts' hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher. (orig.)

Sonography of the painful shoulder: role of the operator's experience

International Nuclear Information System (INIS)

Corroller, Thomas Le; Cohen, Michel; Champsaur, Pierre; Aswad, Richard; Pauly, Vanessa

2008-01-01

The aim of our study was to determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7%for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears (κ=0.90), supraspinatus tendinosis (κ =0.80), abnormalities of the long head of biceps tendon (κ=0.84), subacromial bursa abnormalities (κ=0.89), and acromioclavicular osteoarthritis (κ=0.81). The agreement was only moderate for partial-thickness tears (κ=0.63) and intratendinous tears (κ=0.57). Our results show that in moderately experienced hands as in experts' hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher. (orig.)

A new scale measuring translation of the humeral head as a prognostic factor for the treatment of large and massive rotator cuff tears.

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Taniguchi, Noboru; D'Lima, Darryl D; Suenaga, Naoki; Chosa, Etsuo

2018-02-01

Failure rates after rotator cuff repair remain high in patients with massive tears. Although superior translation of the humeral head has been used to assess the severity of rotator cuff tears, the relevance of anterior migration of the humeral head to clinical outcomes has not been established. The purpose of this study was to investigate the potential role of the T-scale, a measure of the anterolateral translation of the humeral head, as a prognostic factor for rotator cuff repair. One hundred twenty consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale and acromiohumeral interval (AHI) were measured preoperatively on axial computed tomography scans and radiographs, respectively. The correlations of the T-scale and AHI with previously published scores and active forward elevation (FE) were investigated. The outcome of rotator cuff repairs was compared between patients with positive and patients with negative preoperative T-scale values. The preoperative T-scale but not AHI correlated significantly with postoperative FE and clinical scores in patients with large to massive tears but not in those with small to medium tears. Postoperative FE and clinical scores were significantly higher in patients with positive T-scale values than in those with negative T-scale values. The relative risk of retear was 2.0 to 7.9 times greater in patients with negative T-scale values. Patients with large to massive tears and negative T-scale values had poorer clinical outcomes and higher retear rates. A negative T-scale value represents a useful prognostic factor for considering reverse shoulder arthroplasty in patients at greater risk of retear after rotator cuff repair. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Tear exchange and contact lenses: a review.

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Muntz, Alex; Subbaraman, Lakshman N; Sorbara, Luigina; Jones, Lyndon

2015-01-01

Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Full-thickness skin wound healing using autologous keratinocytes and dermal fibroblasts with fibrin: bilayered versus single-layered substitute.

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Idrus, Ruszymah Bt Hj; Rameli, Mohd Adha bin P; Low, Kiat Cheong; Law, Jia Xian; Chua, Kien Hui; Latiff, Mazlyzam Bin Abdul; Saim, Aminuddin Bin

2014-04-01

Split-skin grafting (SSG) is the gold standard treatment for full-thickness skin defects. For certain patients, however, an extensive skin lesion resulted in inadequacies of the donor site. Tissue engineering offers an alternative approach by using a very small portion of an individual's skin to harvest cells for propagation and biomaterials to support the cells for implantation. The objective of this study was to determine the effectiveness of autologous bilayered tissue-engineered skin (BTES) and single-layer tissue-engineered skin composed of only keratinocytes (SLTES-K) or fibroblasts (SLTES-F) as alternatives for full-thickness wound healing in a sheep model. Full-thickness skin biopsies were harvested from adult sheep. Isolated fibroblasts were cultured using medium Ham's F12: Dulbecco modified Eagle medium supplemented with 10% fetal bovine serum, whereas the keratinocytes were cultured using Define Keratinocytes Serum Free Medium. The BTES, SLTES-K, and SLTES-F were constructed using autologous fibrin as a biomaterial. Eight full-thickness wounds were created on the dorsum of the body of the sheep. On 4 wounds, polyvinyl chloride rings were used as chambers to prevent cell migration at the edge. The wounds were observed at days 7, 14, and 21. After 3 weeks of implantation, the sheep were euthanized and the skins were harvested. The excised tissues were fixed in formalin for histological examination via hematoxylin-eosin, Masson trichrome, and elastin van Gieson staining. The results showed that BTES, SLTES-K, and SLTES-F promote wound healing in nonchambered and chambered wounds, and BTES demonstrated the best healing potential. In conclusion, BTES proved to be an effective tissue-engineered construct that can promote the healing of full-thickness skin lesions. With the support of further clinical trials, this procedure could be an alternative to SSG for patients with partial- and full-thickness burns.

Preference direction study of Job’s-tears ice cream

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Wiwat Wangcharoen

2007-09-01

Full Text Available Job's-tears (Coix lachryma-jobi L. is a kind of cereal commonly used in Asia as food and medicine, but it is still not widely consumed in Thailand. Four prototype products of Job’s-tears ice cream were developed by varying 2 levels of glucose syrup (16 and 32% of Job's-tears used and coconut milk (50 and 100 % of Job's-tears used. Their sensory attribute profiles were evaluated by 3 groups of 10 selected panelists using Ratio profile test (RPT, and their acceptances, hedonic scores, were evaluated by 100 consumers. Results showed that there were significant effects of coconut milk quantity on several attributes, such as appearance (whiteness, texture (hardness, smoothness, and flavour (coconut milk aroma, sweetness, saltiness, but the effect of glucose syrup quantity was significant on hardness only. Acceptance data were analyzed by cluster analysis to find out the difference of preference directions and 3 clusters (n1 = 39, n2 = 25, n3 = 36 were found. The first cluster preferred Job's tears ice cream containing high glucose syrup and low coconut milk, whilst the second preferred high level of only one of these two ingredients, and the third preferred high level of both ingredients. External preference maps were created from RPT and acceptance data to express the preference direction of each cluster.

[Alterations in tears aqueous layer during cytostatics treatment].

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Wojciechowska, Katarzyna; Wieckowska-Szakiel, Marzena; Rózalska, Barbara; Jurowski, Piotr

2013-01-01

The aim of the study was to evaluate tears secretion, pH and lysozyme activity in tears aqueous layer during chemotherapy in lung, breast and bowel cancer. 36 patients were enrolled to the study. Depending on the type of cancer and type of chemotherapy patients were divided into three groups. Group I (12 patients) diagnosed with non-small-cell lung cancer treated with PE schema (cisplatin, etoposide), Group II (12 patients) with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), Group III (12 patients) with bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). In all the patients: Schirmer's I test, pH measurements and lysozyme test were performed. Patients were examined before chemotherapy, after 2nd, 4th, 6th cycle. In group I and II lowering of tears secretion (p tears secretion (p tears film in all groups (p tears aqueous layer causing alterations of tears secretions. PH alterations depending on type of chemotherapy was observed. Lowering of lysozyme activity in tears was observed. All the deteriorations aggravate with duration of chemotherapy. Alterations of tears film parameters during chemotherapy may influence upon eye surface homeostasis and infectious complication. tears aqueous layer, Schirmer's test, lysozyme activity, tears pH.

Magnetic resonance imaging of meniscal bucket-handle tears

International Nuclear Information System (INIS)

Dfouni, N.; Garcia, J.; Kindynis, Ph.; Bosson, D.

1997-01-01

To define MR signs of meniscal bucket-handle tears and evaluate the diagnostic efficiency of this technique. Retrospective study of 30 patients with a meniscal bucket-handle tear and 30 with a different type of tear, all proven by arthroscopy. The following MR signs of a bucket-handle tear were evaluated: 'separate meniscal fragment, 'double posterior cruciate ligament', 'snake sign' and 'double anterior horn'. A correct diagnosis of a bucket-handle tear was only made in 18/30 of patients. Several of the MR signs were seen in the same patient in 17 cases. A double posterior cruciate ligament was present only in cases of medial meniscus tears. The 12 menisci without these signs, and therefore not diagnosed as bucket-handle tears, were all classified as meniscal tears on the basis of signal extending to the meniscal surface. Nine of these were not displaced into the inter-condylar notch at arthroscopy. The interobserver agreement was excellent: kappa 0.88. The diagnosis of a bucket-handle meniscal tear, if it is displaced, can be made when one or more of the four MR evaluated signs are present. Other forms of meniscal tears are only exceptionally diagnosed as bucket-handle tears. (authors)

Quadriceps Strength and Endurance After Posterior Cruciate Ligament Tears Versus Matched Group With Anterior Cruciate Ligament Tears.

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Lee, Dae-Hee; Han, Seung-Beom; Lee, Jin-Hyuck; Lee, Seok-Joo; Suh, Dong-Won; Jeong, Hye-Jin

2015-06-01

This study was designed to compare the preoperative strengths and endurances of the quadriceps and hamstring muscles in patients with anterior cruciate ligament (ACL) versus posterior cruciate ligament (PCL) tears. Quadriceps and hamstring muscle strength and endurance were compared between 20 prospectively enrolled patients with isolated PCL tears and a retrospective, matched control group of 20 patients with isolated ACL tears. The maximal torque (60°/s) and total work (180°/s) of the quadriceps and hamstring were evaluated with an isokinetic testing device. Total work (1,094.4 ± 505.8 J v 797.5 ± 332.7 J, P = .035) and peak torque (129.9 ± 56.2 N ∙ m v 98.2 ± 37.4 N ∙ m, P = .046) of the quadriceps muscle on the involved side were higher in the PCL tear group than in the ACL tear group. However, there were no significant differences between the PCL tear group and ACL tear group in hamstring muscle strength (45.8 ± 42.3 N ∙ m and 46.0 ± 24.4 N ∙ m, respectively; P = .940) and endurance (429.3 ± 238.9 J and 382.4 ± 256.1 J, respectively; P = .574) on the involved side. The strength and endurance of the quadriceps muscle of the injured limb were greater after PCL tears than after ACL tears. However, there were no significant between-group differences in hamstring muscle strength and endurance on the involved side. Level III, retrospective comparative study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Tearing modes in toroidal geometry

International Nuclear Information System (INIS)

Connor, J.W.; Cowley, S.C.; Hastie, R.J.; Hender, T.C.; Hood, A.; Martin, T.J.

1988-01-01

The separation of the cylindrical tearing mode stability problem into a resistive resonant layer calculation and an external marginal ideal magnetohydrodynamic (MHD) calculation (Δ' calculation) is generalized to axisymmetric toroidal geometry. The general structure of this separation is analyzed and the marginal ideal MHD information (the toroidal generalization of Δ') required to discuss stability is isolated. This can then, in principle, be combined with relevant resonant layer calculations to determine tearing mode growth rates in realistic situations. Two examples are given: the first is an analytic treatment of toroidally coupled (m = 1, n = 1) and (m = 2, n = 1) tearing modes in a large aspect ratio torus; the second, a numerical treatment of the toroidal coupling of three tearing modes through finite pressure effects in a large aspect ratio torus. In addition, the use of a coupling integral approach for determining the stability of coupled tearing modes is discussed. Finally, the possibility of using initial value resistive MHD codes in realistic toroidal geometry to determine the necessary information from the ideal MHD marginal solution is discussed

Microarray-based IgE detection in tears of patients with vernal keratoconjunctivitis.

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Leonardi, Andrea; Borghesan, Franco; Faggian, Diego; Plebani, Mario

2015-11-01

A specific allergen sensitization can be demonstrated in approximately half of the vernal keratoconjunctivitis (VKC) patients by conventional allergic tests. The measurement of specific IgE in tears using a multiplex allergen microarray may offer advantages to identify local sensitization to a specific allergen. In spring-summer 2011, serum and tears samples were collected from 10 active VKC patients (three females, seven males) and 10 age-matched normal subjects. Skin prick test, symptoms score and full ophthalmological examination were performed. Specific serum and tear IgE were assayed using ImmunoCAP ISAC, a microarray containing 103 components derived from 47 allergens. Normal subjects resulted negative for the presence of specific IgE both in serum and in tears. Of the 10 VKC patients, six resulted positive to specific IgE in serum and/or tears. In three of these six patients, specific IgE was found positive only in tears. Cross-reactivity between specific markers was found in three patients. Grass, tree, mites, animal but also food allergen-specific IgE were found in tears. Conjunctival provocation test performed out of season confirmed the specific local conjunctival reactivity. Multiple specific IgE measurements with single protein allergens using a microarray technique in tear samples are a useful, simple and non-invasive diagnostic tool. ImmunoCAP ISAC detects allergen sensitization at component level and adds important information by defining both cross- and co-sensitization to a large variety of allergen molecules. The presence of specific IgE only in tears of VKC patients reinforces the concept of possible local sensitization. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Elephantiasis Nostras Verrucosa. Excision with full-thickness skin grafting of the penis, scrotum, and perineal area.

Science.gov (United States)

Judge, Nathan; Kilic, Ali

2016-11-13

Elephantiasis nostras verrucosa is a rare cutaneous complication of chronic lymphatic obstruction. It is most commonly caused by bacterial infection, trauma, neoplasia, obesity, and venous stasis. In this report, we describe a case of elephantiasis nostras verrucosa involving the scrotum and perineal area in a 32-year-old. The lesions were excised, and full-thickness skin grafting of the penis, scrotum, and perineal skin was performed. This case demonstrates the efficacy of excision with full-thickness skin grafting of the penis, scrotum, and perineal area in a patient with elephantiasis nostras verrucosa confined to the scrotum and perineal region.

Expression of matrix metrallproteinase-2 in human tears fluid after LASIK

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Ai-Wei Chen

2014-12-01

Full Text Available AIM: To monitor long-term changes of matrix metalloproteinase-2(MMP-2in human tears fluid after laser in situ keratomileusis(LASIK. METHODS: Thirty-two myopia cases(64 eyesunderwent uneventful LASIK were enrolled in the study. Tear fluid were collected and MMP-2 expression was analyzed by Western-bolt assay preoperatively and postoperatively on 15d, at 1, 3mo, and 1a. RESULTS: LASIK increased the concentration of MMP-2 in human tear fluid. At 15d postoperatively, the magnitude of MMP-2 was 1.4 times that of preoperative, thereafter subsided, but didn't return to preoperative level by 3mo(PP>0.05. CONCLUSION: MMP-2 is significantly expressed in human tear fluid after LASIK, then subsided with time, but didn't return to preoperative level by 3mo and almost recovered up to 1a, indicating wound healing of LASIK would continue up at least 3mo after surgery and almost recovered 1a postoperatively.

Meniscal tears: comparison of half-Fourier technique and conventional MR imaging

International Nuclear Information System (INIS)

Shabana, Wael; Maeseneer, Michel de; Machiels, Freddy; Ridder, Filip de; Osteaux, Michel

2003-01-01

Purpose: To determine whether half-Fourier MR image acquisition technique can provide similar information to that of conventional MR acquisition technique for evaluation of meniscal tears. Materials and methods: We studied 101 menisci in 52 patients who were referred for evaluation of meniscal tears. Sagittal MR images of the knee were obtained for all patients by using proton density and T2-weighted SE sequences on a 1-T clinical system. The half-Fourier technique and conventional technique were used for all patients. All other imaging parameters were identical for both sequences (TR/TE=2400/20,70; 3 mm slice thickness; 200x256 matrix; field of view, 200; one signal acquired). Both sets of images were filmed with standard window and level settings. Images were randomised and interpreted independently by two radiologists for the presence of meniscal tears. Images were also subjectively assessed for image quality using a five-point grading scale. Results: On half-Fourier images, Reader 1 interpreted 23 menisci as torn, compared to 28 for Reader 2. On conventional images, Reader 1 interpreted 24 menisci as torn, compared to 26 for Reader 2. Agreement between interpretation of the conventional and that of the half-Fourier images was 99% for Reader 1, and 98% for Reader 2. Agreement between readers for the half-Fourier images was 95%, and for the conventional images 96%. No statistically significant difference was found in the subjective evaluation of image quality between the conventional and half-Fourier images. Conclusion: The half-Fourier acquisition technique compares favourably with the conventional technique for the evaluation of meniscal tears

Full-thickness human skin explants for testing the toxicity of topically applied chemicals

International Nuclear Information System (INIS)

Nakamura, M.; Rikimaru, T.; Yano, T.; Moore, K.G.; Pula, P.J.; Schofield, B.H.; Dannenberg, A.M. Jr.

1990-01-01

This report describes a model organ-culture system for testing the toxicity of chemical substances that are topically applied to human skin. In this system, the viable keratinocytes in the full-thickness skin explants are protected by the same keratinized layer as skin remaining on the donor, and toxicity can be assessed microscopically and/or biochemically. The human skin specimens were discards from a variety of surgical procedures. They were cut into full-thickness 1.0-cm2 explants, and briefly exposed to the military vesicant sulfur mustard (SM), which was used as a model toxicant. The explants were then organ cultured in small Petri dishes for 24 h at 36 degrees C. In the 0.03-1.0% dosage range, a straight-line dose-response relationship occurred between the concentration of SM applied and the number of paranuclear vacuoles seen histologically in the epidermis. Within the same SM dosage range, there was also a proportional decrease in 14C-leucine incorporation by the explants. Thus, the number of paranuclear vacuoles reflected decreases in protein synthesis by the injured epidermal cells. The epidermis of full-thickness untreated (control) human skin explants usually remained viable for 7 d when stored at 4 degrees C in culture medium. During storage, a relatively small number of paranuclear vacuoles developed within the epidermis, but the explants were still quite satisfactory for testing SM toxicity. Incubation (for 4 or 24 h at 36 degrees C) of such control skin explants reduced (often by 50%) the small number of paranuclear vacuoles produced during 4-7 d of storage. This reduction was probably caused by autolysis of many of the vacuolated cells. Two types of paranuclear vacuoles could be identified by both light and electron microscopy: a storage type and a toxicant type. The storage type seemed to be caused by autolysis of cell components

Full-thickness human skin explants for testing the toxicity of topically applied chemicals

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Nakamura, M.; Rikimaru, T.; Yano, T.; Moore, K.G.; Pula, P.J.; Schofield, B.H.; Dannenberg, A.M. Jr. (Johns Hopkins Univ., Baltimore, MD (USA))

1990-09-01

This report describes a model organ-culture system for testing the toxicity of chemical substances that are topically applied to human skin. In this system, the viable keratinocytes in the full-thickness skin explants are protected by the same keratinized layer as skin remaining on the donor, and toxicity can be assessed microscopically and/or biochemically. The human skin specimens were discards from a variety of surgical procedures. They were cut into full-thickness 1.0-cm2 explants, and briefly exposed to the military vesicant sulfur mustard (SM), which was used as a model toxicant. The explants were then organ cultured in small Petri dishes for 24 h at 36 degrees C. In the 0.03-1.0% dosage range, a straight-line dose-response relationship occurred between the concentration of SM applied and the number of paranuclear vacuoles seen histologically in the epidermis. Within the same SM dosage range, there was also a proportional decrease in 14C-leucine incorporation by the explants. Thus, the number of paranuclear vacuoles reflected decreases in protein synthesis by the injured epidermal cells. The epidermis of full-thickness untreated (control) human skin explants usually remained viable for 7 d when stored at 4 degrees C in culture medium. During storage, a relatively small number of paranuclear vacuoles developed within the epidermis, but the explants were still quite satisfactory for testing SM toxicity. Incubation (for 4 or 24 h at 36{degrees}C) of such control skin explants reduced (often by 50%) the small number of paranuclear vacuoles produced during 4-7 d of storage. This reduction was probably caused by autolysis of many of the vacuolated cells. Two types of paranuclear vacuoles could be identified by both light and electron microscopy: a storage type and a toxicant type. The storage type seemed to be caused by autolysis of cell components.

Repair of full-thickness articular cartilage defect using stem cell-encapsulated thermogel.

Science.gov (United States)

Zhang, Yanbo; Zhang, Jin; Chang, Fei; Xu, Weiguo; Ding, Jianxun

2018-07-01

Cartilage defect repair by hydrogel-based tissue engineering is becoming one of the most potential treatment strategies. In this work, a thermogel of triblock copolymer poly(lactide-co-glycolide)-block-poly(ethylene glycol)-block-poly(lactide-co-glycolide) (PLGA-PEG-PLGA) was prepared as scaffold of bone marrow mesenchymal stem cells (BMMSCs) for repair of full-thickness articular cartilage defect. At first, the copolymer solution showed a reversible sol-gel transition at physiological temperature range, and the mechanical properties of such thermogel were high enough to support the repair of cartilage. Additionally, excellent biodegradability and biocompatibility of the thermogel were demonstrated. By implanting the BMMSC-encapsulated thermogel into the full-thickness articular cartilage defect (5.0 mm in diameter and 4.0 mm in depth) in the rabbit, it was found that the regenerated cartilage integrated well with the surrounding normal cartilage and subchondral bone at 12 weeks post-surgery. The upregulated expression of glycosaminoglycan and type II collagen in the repaired cartilage, and the comparable biomechanical properties with normal cartilage suggested that the cell-encapsulated PLGA-PEG-PLGA thermogel had great potential in serving as the promising scaffold for cartilage regeneration. Copyright © 2018 Elsevier B.V. All rights reserved.

[Clinical study of full-thickness skin graft for reconstruction of completely defect nail unit].

Science.gov (United States)

Li, Wen-jun; Li, Chun; Zhu, Jin; Tian, Guang-lei; Chen, Shan-lin; Tian, Wen

2012-12-18

To explore a reconstruction method for complete nail bed defect caused by various kinds of reasons and to retrospectively analyze the effect of application of free full-thickness skin graft for the whole nail unit repair. Between Apr. 2010 and Mar. 2012, the method of free full-thickness skin graft was done for reconstruction of the completely nail unit defect in seven cases. There were 2 male and 5 female patients; the mean age of these patients at the time of surgery was 51.9 years (range: 7 to 70 years). The preoperative diagnoses included two cases of malignant melanoma, one of chronic infection, one of squamous cell carcinoma, two of subungual pigmentation and one of junctional nevus. There were 2 thumb lesions, 3 middle and 2 index finger lesions. Nail unit defect was in the range of 1.5 cm×2 cm to 2.5 cm × 3.5 cm and full thickness skin graft was harvested from the same medial side of upper arm (3 cases), forearm cubital fossa (1 case) and contralateral side of groin region (3 cases). All the patients were followed with an average follow-up time being 10 months. All the free skin graft taken was achieved with 100% in all the 7 cases, even in those patients whose partial cortical bone had been curetted. The skin graft was often bluish initially, and superficial blisters were always noticed within 1.5 months postoperatively and the survival skin graft was smooth eventually, and skin graft was adhered to the underlying bone tightly. There was no epidermal inclusion cyst and no residual nail formation. The skin donor sites were without complications. Aesthetic appearance was assessed by the surgeons and found no unacceptable for their patients. And all the patients were satisfied with the cosmetic appearance and active range of motion of their involved fingers, who did not express a desire to undergo any further of nail reconstruction. Free full-thickness skin grafting for reconstruction of the complete nail unit defect is a simple, safe and effective

Fast MR arthrography using VIBE sequences to evaluate the rotator cuff

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Vandevenne, Jan E. [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium); Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Vanhoenacker, Filip; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Mahachie John, Jestinah M. [University of Hasselt, Centre for Statistics, Diepenbeek (Belgium); Gelin, Geert [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium)

2009-07-15

The purpose of this paper was to evaluate if short volumetric interpolated breath-hold examination (VIBE) sequences can be used as a substitute for T1-weighted with fat saturation (T1-FS) sequences when performing magnetic resonance (MR) arthrography to diagnose rotator cuff tears. Eighty-two patients underwent direct MR arthrography of the shoulder joint using VIBE (acquisition time of 13 s) and T1-FS (acquisition time of 5 min) sequences in the axial and paracoronal plane on a 1.0-T MR unit. Two radiologists scored rotator cuff tendons on VIBE and T1-FS images separately as normal, small/large partial thickness and full thickness tears with or without geyser sign. T1-FS sequences were considered the gold standard. Surgical correlation was available in a small sample. Sensitivity, specificity, and positive and negative predictive values of VIBE were greater than 92% for large articular-sided partial thickness and full thickness tears. For detecting fraying and articular-sided small partial thickness tears, these parameters were 55%, 94%, 94%, and 57%, respectively. The simple kappa value was 0.76, and the weighted kappa value was 0.86 for agreement between T1-FS and VIBE scores. All large partial and full thickness tears at surgery were correctly diagnosed using VIBE or T1-FS MR images. Fast MR arthrography of the shoulder joint using VIBE sequences showed good concordance with the classically used T1-FS sequences for the appearance of the rotator cuff, in particular for large articular-sided partial thickness tears and for full thickness tears. Due to its very short acquisition time, VIBE may be especially useful when performing MR arthrography in claustrophobic patients or patients with a painful shoulder. (orig.)

Reverse tissue expansion by liposuction deflation adopted for harvest of large sheet of full-thickness skin graft.

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Ibrahim, A E; Debbas, C C; Dibo, S A; Atiyeh, B S; Abu-Sittah, G S; Isik, S

2012-06-30

Full-thickness skingraft is a valid option to release burn scar contractures with the main purpose of correcting the induced limitation in function and improve the disfiguring appearance of the scar. The main pitfall remains the limited availability of these grafts, especially when large sheets are needed. We present an application of a previously described technique known as reverse tissue expansion, which permits the harvesting of a large sheet of full thickness skin graft when needed. This method was adopted to release a burn scar contracture in a 32-yr-old man who sustained a 65% TBSA burn secondary to a gasoline tank explosion at the age of 7 yr followed by multiple reconstructive procedures. The patient presented with a disfiguring anterior neck contracture coupled to limited range of motion. Improvement of neck extension was contemplated using full-thickness skin graft harvested following reverse tissue expansion achieved by deflation liposuction of the donor site.

Thermal effects on tearing mode saturation

International Nuclear Information System (INIS)

Kim, J.S.; Chu, M.S.; Greene, J.M.

1988-01-01

The effect of geometry on tearing modes, saturated states of tearing modes, and the thermal effect on tearing modes are presented. The configuration of current and magnetic fields are quite different in slabs and in Tokamaks. However, for any magnetic island regardless of geometry and heating conditions, at island saturation the product of resistivity and current is the same at magnetic O and X lines. The temperature perturbation effect on the nonlinear development of tearing modes is investigated. Thermal conduction along the field lines is much faster than that in the perpendicular direction, and thus the temperature profile follows the island structure. Utilizing Spitzer's conductivity relation, the temperature perturbation is modelled as helical components of resistivity. For a usual tearing mode unstable Tokamak, where shear is positive, the islands continue to grow to a larger size when the islands are cooled. When they are heated, the island sizes are reduced. The temperature perturbation can induce islands even for equilibria stable with respect to tearing modes. Again, the islands appear when cooling takes place. The equilibria with the cooled islands show enhanced field line stochasticity, thus enhanced heat transport. Therefore, thermal instability can be directly related to pressure disruptions. (author)

Cytokine biomarkers in tear film for primary open-angle glaucoma

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Gupta D

2017-02-01

Full Text Available Divakar Gupta,1,* Joanne C Wen,2,* Janet L Huebner,3 Sandra Stinnett,1 Virginia B Kraus,3,4 Henry C Tseng,1 Molly Walsh1 1Department of Ophthalmology, Duke University Medical Center, Durham, NC, 2Department of Ophthalmology, University of Washington, Seattle, WA, 3Duke Molecular Physiology Institute, 4Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA *These authors contributed equally to this work Purpose: To determine the utility of tear film cytokines as biomarkers for early primary open-angle glaucoma (POAG. Methods: Patients without POAG and eye drop-naïve patients with newly diagnosed POAG were recruited from an academic hospital-based glaucoma practice. Tear films of recruited patients were obtained and analyzed using a multiplex, high-sensitivity electrochemiluminescent enzyme-linked immunosorbent assay for proinflammatory cytokines (IFNγ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8, and TNFα. Results: Mean concentrations of tear film cytokines were lower in the glaucoma group for 8 of 10 cytokines tested. IL-12p70 (3.94±2.19 pg/mL in control vs 2.31±1.156 pg/mL in POAG; P=0.035 was significantly lower in the tear film of patients with newly diagnosed POAG. Conclusion: Proinflammatory cytokines were lower in eye drop-naïve newly diagnosed glaucoma patients. Tear film cytokine profiles may be used as biomarkers of early POAG. Keywords: glaucoma, biomarkers, tear film, cytokines, glaucoma diagnosis, lower limit of detection

MR accuracy and arthroscopic incidence of meniscal radial tears

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Magee, Thomas; Shapiro, Marc; Williams, David [Department of Radiology, Neuroimaging Institute, 27 East Hibiscus Blvd., Melbourne, FL 32901 (United States)

2002-12-01

A meniscal radial tear is a vertical tear that involves the inner meniscal margin. The tear is most frequent in the middle third of the lateral meniscus and may extend outward in any direction. We report (1) the arthroscopic incidence of radial tears, (2) MR signs that aid in the detection of radial tears and (3) our prospective accuracy in detection of radial tears. Design and patients. Three musculoskeletal radiologists prospectively read 200 consecutive MR examinations of the knee that went on to arthroscopy by one orthopedic surgeon. MR images were assessed for location and MR characteristics of radial tears. MR criteria used for diagnosis of a radial tear were those outlined by Tuckman et al.: truncation, abnormal morphology and/or lack of continuity or absence of the meniscus on one or more MR images. An additional criterion used was abnormal increased signal in that area on fat-saturated proton density or T2-weighted coronal and sagittal images. Prospective MR readings were correlated with the arthroscopic findings.Results. Of the 200 consecutive knee arthroscopies, 28 patients had radial tears reported arthroscopically (14% incidence). MR readings prospectively demonstrated 19 of the 28 radial tears (68% sensitivity) when the criteria for diagnosis of a radial tear were truncation or abnormal morphology of the meniscus. With the use of the additional criterion of increased signal in the area of abnormal morphology on fat-saturated T2-weighted or proton density weighted sequences, the prospective sensitivity was 25 of 28 radial tears (89% sensitivity). There were no radial tears described in MR reports that were not demonstrated on arthroscopy (i.e., there were no false positive MR readings of radial tears in these 200 patients). Radial tears are commonly seen at arthroscopy. There was a 14% incidence in this series of 200 patients who underwent arthroscopy. Prospective detection of radial tears was 68% as compared with arthroscopy when the criteria as

MR accuracy and arthroscopic incidence of meniscal radial tears

International Nuclear Information System (INIS)

Magee, Thomas; Shapiro, Marc; Williams, David

2002-01-01

A meniscal radial tear is a vertical tear that involves the inner meniscal margin. The tear is most frequent in the middle third of the lateral meniscus and may extend outward in any direction. We report (1) the arthroscopic incidence of radial tears, (2) MR signs that aid in the detection of radial tears and (3) our prospective accuracy in detection of radial tears. Design and patients. Three musculoskeletal radiologists prospectively read 200 consecutive MR examinations of the knee that went on to arthroscopy by one orthopedic surgeon. MR images were assessed for location and MR characteristics of radial tears. MR criteria used for diagnosis of a radial tear were those outlined by Tuckman et al.: truncation, abnormal morphology and/or lack of continuity or absence of the meniscus on one or more MR images. An additional criterion used was abnormal increased signal in that area on fat-saturated proton density or T2-weighted coronal and sagittal images. Prospective MR readings were correlated with the arthroscopic findings.Results. Of the 200 consecutive knee arthroscopies, 28 patients had radial tears reported arthroscopically (14% incidence). MR readings prospectively demonstrated 19 of the 28 radial tears (68% sensitivity) when the criteria for diagnosis of a radial tear were truncation or abnormal morphology of the meniscus. With the use of the additional criterion of increased signal in the area of abnormal morphology on fat-saturated T2-weighted or proton density weighted sequences, the prospective sensitivity was 25 of 28 radial tears (89% sensitivity). There were no radial tears described in MR reports that were not demonstrated on arthroscopy (i.e., there were no false positive MR readings of radial tears in these 200 patients). Radial tears are commonly seen at arthroscopy. There was a 14% incidence in this series of 200 patients who underwent arthroscopy. Prospective detection of radial tears was 68% as compared with arthroscopy when the criteria as

Tear and decohesion of bovine pericardial tissue.

Science.gov (United States)

Tobaruela, Almudena; Elices, Manuel; Bourges, Jean Yves; Rojo, Francisco Javier; Atienza, José Miguel; Guinea, Gustavo

2016-10-01

The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluating tear clearance rate with optical coherence tomography.

Science.gov (United States)

Garaszczuk, Izabela K; Mousavi, Maryam; Cervino Exposito, Alejandro; Bartuzel, Maciej M; Montes-Micó, Robert; Iskander, D Robert

2018-02-01

To assess the early-phase of tear clearance rate (TCR) with anterior segment optical coherence tomography (OCT) and to determine the association between TCR and other clinical measures of the tear film in a group of young subjects with different levels of tear film quality. TCR was classified as the percentage decrease of subject's inferior tear meniscus height 30s after instillation of 5μl 0.9% saline solution. Fifty subjects (32F and 18M) aged (mean±standard deviation) 25.5±4.3 years volunteered for the study. It consisted of a review of medical history, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity measurements, slit lamp examination and TCR estimation based on dynamic measurements of the lower tear meniscus with OCT. Estimates of TCR were contrasted against subject age and tear film measures commonly used for dry eye diagnosis, which includes OSDI score, fluorescein tear film break-up time (FBUT), tear meniscus height (TMH), blinking frequency, tear film osmolarity and corneal staining. The group mean TCR was 29±13% and 36±19% respectively after 30 and 60s margin after saline solution instillation. Statistically significant correlations were found between TCR and FBUT (r 2 =0.319, placrimal functional unit. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Rotator cuff disease – basics of diagnosis and treatment

Directory of Open Access Journals (Sweden)

Robert E. Boykin

2010-03-01

Full Text Available Rotator cuff (RTC disease is a particularly prevalent cause of shoulder pain and weakness presenting to primary care physicians, internists, rheumatologists, and orthopedists. An understanding of the anatomy of the RTC tendons and the underlying pathogenesis aids in the diagnosis, which is based largely on history and specific physical examination tests. Imaging may further define the pathology and aid in the evaluation of other sources of shoulder pain. Injuries to the RTC range from tendonitis to partial thickness tears to full thickness tears. The majority of patients with impingement and some cases of partial thickness tears may be managed effectively with non-operative measures including non-steroidal anti-inflammatory drugs, local injections, and physical therapy. Predictors of a good outcome with non-operative treatment include pre-injury strength, ability to raise the arm to the level of the shoulder, and a more acute presentation. Persistent symptoms may require operative intervention including debridement, subacromial decompression, and/or RTC repair. Acute full thickness tears in younger patients in addition to failed non-operative management of full thickness tears in older patients are the most likely to require surgery, which may be done open or arthroscopically. The majority of tears are amenable to the less invasive arthroscopic method, which yields good success rates and high patient satisfaction.

Wound Healing Effects of Rose Placenta in a Mouse Model of Full-Thickness Wounds

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Yang Woo Kim

2015-11-01

Full Text Available BackgroundRosa damascena, a type of herb, has been used for wound healing in Eastern folk medicine. The goal of this study was to evaluate the effectiveness of rose placenta from R. damascena in a full-thickness wound model in mice.MethodsSixty six-week-old C57BL/6N mice were used. Full-thickness wounds were made with an 8-mm diameter punch. Two wounds were made on each side of the back, and wounds were assigned randomly to the control and experimental groups. Rose placenta (250 µg was injected in the experimental group, and normal saline was injected in the control group. Wound sizes were measured with digital photography, and specimens were harvested. Immunohistochemical staining was performed to assess the expression of epidermal growth factor (EGF, vascular endothelial growth factor (VEGF, transforming growth factor-β1 (TGF-β1, and CD31. Vessel density was measured. Quantitative analysis using an enzyme-linked immunosorbent assay (ELISA for EGF was performed. All evaluations were performed on postoperative days 0, 2, 4, 7, and 10. Statistical analyses were performed using the paired t-test.Results On days 4, 7, and 10, the wounds treated with rose placenta were significantly smaller. On day 2, VEGF and EGF expression increased in the experimental group. On days 7 and 10, TGF-β1 expression decreased in the experimental group. On day 10, vessel density increased in the experimental group. The increase in EGF on day 2 was confirmed with ELISA.ConclusionsRose placenta was found to be associated with improved wound healing in a mouse full-thickness wound model via increased EGF release. Rose placenta may potentially be a novel drug candidate for enhancing wound healing.

Effect of Time after Anterior Cruciate Ligament Tears on Proprioception and Postural Stability.

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Dae-Hee Lee

Full Text Available This study was designed to compare proprioception and postural stability in patients with acute (time from injury ≤ 3 months and chronic (time from injury > 3 months ACL tears, and to evaluate the correlation between time interval after ACL injury and proprioception. Thigh muscle strength, postural stability, and joint position sense were compared in 48 patients with acute ACL tears and in 28 with chronic ACL tears. Maximal torque (60°/sec of the quadriceps and hamstring was evaluated using an isokinetic testing device. Postural stability was determined from the anterior-posterior (APSI, medial-lateral (MLSI, and overall (OSI stability indices using stabilometry. Joint position sense was also tested by reproduction of passive positioning (RPP. Muscle strengths and stability indices on both the involved and uninvolved sides were similar in the acute and chronic ACL tear groups. RPP on the involved side was significantly greater in the chronic than in the acute ACL tear group (7.8° vs. 5.6°, P = 0.041. Two of three stability indices (APSI, OSI and RPP were significantly greater on the involved than the uninvolved side in the chronic ACL tear group.

Tearing mode instability due to anomalous resistivity

International Nuclear Information System (INIS)

Furuya, Atsushi; Itoh, Sanae I.; Yagi, Masatoshi

2000-01-01

Tearing mode instability in the presence of microscopic truculence is investigates. The effects of microscopic turbulence on tearing mode are taken as drags which are calculated by one-point renormalization method and mean-field approximation. These effects are reduced to effective diffusivities in reduced MHD equations. Using these equations, the stability analyses of the tearing mode are performed. It is shown that a finite amplitude of fluctuation enhances the growth rate of tearing mode. For very high values of turbulent diffusivities, marginally stable state exists. The effects of each turbulent diffusivity on mode stability are examined near marginal stability boundary. Parameter dependence of the resistive ballooning mode turbulence on tearing mode is analyzed as an example. (author)

Two-Tunnel Transtibial Repair of Radial Meniscus Tears Produces Comparable Results to Inside-Out Repair of Vertical Meniscus Tears.

Science.gov (United States)

Cinque, Mark E; Geeslin, Andrew G; Chahla, Jorge; Dornan, Grant J; LaPrade, Robert F

2017-08-01

Radial meniscus tears disrupt the circumferential fibers and thereby compromise meniscus integrity. Historically, radial tears were often treated with meniscectomy because of an incomplete understanding of the biomechanical consequences of these tears, limited information regarding the biomechanical performance of repair, and the technical difficulty associated with repair. There is a paucity of studies on the outcomes of the repair of radial meniscus tears. Purpose/Hypothesis: The purpose was to determine the outcomes of 2-tunnel transtibial repair of radial meniscus tears and compare these results to the outcomes of patients who underwent the repair of vertical meniscus tears with a minimum of 2-year follow-up. The hypothesis was that radial and vertical meniscus tear repair outcomes were comparable. Cohort study; Level of evidence, 3. Patients who underwent 2-tunnel transtibial pullout repair for a radial meniscus tear were included in this study and compared with patients who underwent inside-out repair for a vertical meniscus tear. Subjective questionnaires were administered preoperatively and at a minimum of 2-year follow-up, including the Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form-12 (SF-12) physical component summary (PCS), the Tegner activity scale, and patient satisfaction. Analysis of covariance was used to compare postoperative outcome scores between the meniscus repair groups while accounting for baseline scores. Adjusted mean effects relative to the radial repair group were reported with 95% CIs. Twenty-seven patients who underwent 2-tunnel transtibial pullout repair for radial meniscus tears and 33 patients who underwent inside-out repair for vertical meniscus tears were available for follow-up at a mean of 3.5 years (range, 2.0-5.4 years). No preoperative outcome score significantly differed between the groups. There were no significant group differences for any of the 2-year

Laser corrective surgery with fractional carbon dioxide laser following full-thickness skin grafts

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Emily Forbat

2017-01-01

Full Text Available Full-thickness skin grafts (FTSGs are frequently used to treat patients with burn injuries and to repair defects rendered by excisional (including Mohs surgery. The evidence for corrective laser surgery after scar formation is well established. With regard to laser treatment of FTSG, the evidence is sparse. Laser treatment after FTSG is a novel concept, with minimal literature. We present a case series, one of the first to our knowledge, of the treatment of FTSG with fractional CO2 laser in five patients after Mohs surgery.

Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?

Science.gov (United States)

Buncamper, Marlon E; van der Sluis, Wouter B; de Vries, Max; Witte, Birgit I; Bouman, Mark-Bram; Mullender, Margriet G

2017-03-01

Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. A total of 100 patients were included (32 with and 68 without additional full-thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p skin graft use, in penile inversion vaginoplasty. The additional use of full-thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient- and physician-reported aesthetic or functional outcome. Therapeutic, IV.

Chemosignalling effects of human tears revisited: Does exposure to female tears decrease males' perception of female sexual attractiveness?

Science.gov (United States)

Gračanin, Asmir; van Assen, Marcel A L M; Omrčen, Višnja; Koraj, Ivana; Vingerhoets, Ad J J M

2017-01-01

Gelstein et al. reported the results of three experiments suggesting a dampening influence of inhalation of female emotional tears on males' arousal and perception of female sexual attractiveness, specifically in non-sexual situations. This prompted the hypothesis that crying exerts its influence on others not only via the auditory and visual mode but also via chemosignals. In three studies, we attempted to replicate and extend Gelstein et al.'s findings by including an additional condition with irritant tears, by using pictures of sexually attractive women, and by testing related hypotheses on the pro-social effects of exposure to tears. All three studies, separately or combined in a meta-analysis, failed to replicate the original inhibitory effects of tears. In addition, sniffing tears did not affect measures of connectedness, aggression and pro-social behaviour. It is concluded that the effects of female tears on male arousal and perception of female sexual attractiveness, if any, are very weak at best. Rather, it seems that crying exerts its strong inter-personal effects through the visual and auditory sensory channels.

Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time.

Science.gov (United States)

Kim, Yung Hui; Kang, Yeon Soo; Lee, Hyo Seok; Choi, Won; You, In Cheon; Yoon, Kyung Chul

2017-10-01

The aim of this study was to evaluate the effectiveness of combined tear film therapy targeted to aqueous, mucin, and lipid layers in patients with refractory evaporative dry eye (EDE) with short tear film breakup time (TBUT). The patients who had EDE with short TBUT and severe symptoms refractory to artificial tears were treated with hyaluronic acid (HA) 0.15% and diquafosol tetrasodium (DQS) 3% (Group 1), HA and carbomer-based lipid-containing eyedrops (Liposic EDO Gel, LPO) (Group 2), or HA, DQS, and LPO (Group 3). Ocular Surface Disease Index (OSDI) score, visual analog scale (VAS) symptom score, TBUT, Schirmer score, and corneal and conjunctival staining scores were evaluated, and noninvasive tear film breakup time (NIBUT) and tear meniscus height were measured using Keratograph ® 5 M before and 1 and 3 months after treatment. OSDI scores, VAS scores, TBUT, and NIBUT were improved at 1 and 3 months after treatment in all groups (all P film layers was most effective in improving ocular symptoms and tear film quality.

Tear ferning test in healthy dogs.

Science.gov (United States)

Oriá, Arianne P; Raposo, Ana Claudia S; Araújo, Nayone L L C; Lima, Felipe B; Masmali, Ali M

2017-11-07

To evaluate and compare three tear sampling methods using two grading scales for administering the tear ferning test (TFT) to healthy dogs. In total, 90 dogs (180 eyes) were subjected to tear sampling using millimetered strips, reused after the Schirmer tear test (STT) (Schirmer group, SG). Then, the dogs were subdivided into three groups according to sampling approach: micropipette (MPG), microcapillary (MCG), and Schirmer sample 2 (S2G). The collected tears were dried on a clean microscope glass slide at room temperature and humidity. The ferning patterns were observed under a polarized light microscope and classified according to the Rolando and Masmali grading scales. Although all three methods were feasible, the STT was easier to perform in clinical settings. Type I and Grade 1 were the most commonly observed (64.17% and 61.7%, respectively) regardless of collection method. There was no significant difference between the STT median values and the TFT classifications. The TFT is appropriate for dogs and can be performed using the three suggested sampling methods, with a higher frequency of Type I and Grade 1. Thus, it is possible to use both grading scales in the classification of tear ferning in dogs. © 2017 American College of Veterinary Ophthalmologists.

Tear clearance implications for ocular surface health.

Science.gov (United States)

de Paiva, Cintia Sade; Pflugfelder, Stephen C

2004-03-01

Tear clearance/turnover provides a global assessment of the function of the lacrimal functional unit and of tear exchange on the ocular surface. It is an indirect measure of dry eye induced inflammation on the ocular surface. It shows better correlation with the severity of ocular irritation symptoms and corneal epithelial disease in dry eye than the Schirmer 1 test. Delayed tear clearance may prove to be the best measure for identifying patients with tear film disorders who may respond to anti-inflammatory therapy.

Role of MRI in predicting meniscal tear reparability

Energy Technology Data Exchange (ETDEWEB)

Felisaz, Paolo Florent [Universita degli Studi di Pavia, Pavia (Italy); Fondazione IRCCS Policlinico San Matteo, Istituto di Radiologia, Pavia (Italy); Alessandrino, Francesco; Perelli, Simone [Universita degli Studi di Pavia, Pavia (Italy); Zanon, Giacomo; Benazzo, Francesco [Fondazione IRCCS Policlinico San Matteo, Clinica Ortopedica e Traumatologica, Pavia (Italy); Calliada, Fabrizio; Sammarchi, Luigi [Fondazione IRCCS Policlinico San Matteo Radiologia, Diagnostica per Immagini-Istituto di Radiologia, Pavia (Italy)

2017-10-15

To elucidate the role of MRI in predicting meniscal tear reparability according to tear type and location in relation to vascular zones. In this retrospective study, two readers evaluated 79 pre-surgical MRIs of meniscal tears arthroscopically treated with meniscectomy or meniscal repair. Tears were classified according to type into vertical, horizontal, radial, complex, flaps and bucket handle and were considered reparable if the distance measured from the tear to the menisco-capsular junction was less than or equal to 5 mm. Predictions were compared with the surgical procedure performed in arthroscopy. We assessed the diagnostic performance of MRI, agreement between MRI and arthroscopy, and interrater agreement. Then, we conducted an ROC analysis on the distances measured by the first reader and built a multivariate logistic regression model. MRI had a sensitivity, specificity, PPV, NPV and accuracy, respectively, of 85%, 79%, 86%, 76% and 83% in predicting meniscal tear reparability. Correct predictions for the specific tear pattern were 76% for vertical, 84% for horizontal, 88% for radial, 86% for complex, 84% for flaps and 86% for bucket handle. Agreement between the two readers' predictions and arthroscopy was good (k = 0.65 and 0.61, respectively). Inter-rater agreement was almost excellent (k = 0.79). The ROC analysis revealed sensitivity and specificity of 73% and 83% with a cutoff value of <4 mm (p < 0.001). Anterior cruciate ligament injury and medial meniscal tear increased the likelihood of meniscal tear reparability. MRI can be a reliable and accurate tool to predict the reparability of meniscal tears, with higher prediction rates for bucket-handle tears. (orig.)

Standard test method for drop-weight tear tests of ferritic steels

CERN Document Server

American Society for Testing and Materials. Philadelphia

2003-01-01

1.1 This test method covers drop-weight tear tests (DWTT) on ferritic steels with thicknesses between 3.18 and 19.1 mm. 1.2 The values stated in SI units are to be regarded as standard. No other units of measurement are included in this standard. 1.3 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

Evaluation of the efficacy of cell and micrograft transplantation for full-thickness wound healing

DEFF Research Database (Denmark)

Kruse, Carla R.; Sakthivel, Dharaniya; Sinha, Indranil

2018-01-01

Background: Skin grafting is the current standard of care in the treatment of full-thickness burns and other wounds. It is sometimes associated with substantial problems, such as poor quality of the healed skin, scarring, and lack of donor-site skin in large burns. To overcome these problems...

Antioxidant content and ultraviolet absorption characteristics of human tears.

Science.gov (United States)

Choy, Camus Kar Man; Cho, Pauline; Benzie, Iris F F

2011-04-01

Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p tears. The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the tear film of the aging eye may help prevent or improve dry eye symptoms and promote ocular health.

A study of re-tear cases after ARCR

International Nuclear Information System (INIS)

Ishida, Yasuyuki; Chosa, Etsuo; Yano, Hiroaki

2011-01-01

Recently, good clinical outcomes of arthroscopic rotator cuff repair (ARCR) are reported, but the re-tear rate of massive and large rotator cuff tears is still high. The purpose of this study is to review the clinical outcome and postoperative cuff integrity of ARCR in our hospital. We evaluated 80 shoulders (61 males, 19 females), whose age rauged from 30 to 78 (average: 61.8 years old). The size of tears were 8 small, 22 medium, 36 large, and 14 massive. We evaluated the pre-and postoperative Japanese Orthopedic Association (JOA) scored, and MRI findings 12 months postoperatively. We evaluated the cuff integrity and fatty degeneration of the ruptured cuff by Goutallier's classification. Postoperative MRI findings showed complete repair in 56 shoulders (70%) and re-tear in 24 shoulders (30%). Postoperative JOA score was poor in cases with large re-tears. Retear rates were high in large and massive tears, tears with advanced fatty degeneration, and subscapularis tears. As this operation is not a replacement procedure, the quality of the ruptured rotator cuff is important. Further discussion on the operative indication and method is necessary. (author)

Impact of environmental adaptation on tear film assessments.

Science.gov (United States)

Fagehi, R

2018-03-01

The purpose of this study was to investigate the effect of ocular environmental adaptation on clinical tear film assessment. Thirty subjects (male, mean age 23±2.5) participated in this study. A number of clinical tear film tests were applied, including: fluorescein tear break-up time (FTBUT), Schirmer test and tear prism height test (TPH). The tear physiology of each subject was evaluated twice, once immediately when they arrived from the external environment, and then after 30minutes adaptation in the exam room environment. The mean values were: Schirmer test A (22.1±2.99), Schirmer test B (24.2±2.63), FTBUT A (8.00±1.94), FTBUT B (9.13±2.04), TPH A (0.179±0.026) and TPH B* (0.187±0.023). Statistical testing using Wilcoxon-signed rank test showed a significant difference between the Schirmer test results measured at the different times (P=0.008). Also, the FTBUT and tear prism height test results showed significant differences between the two evaluation times, (P=0.001, 0.011, respectively) (A: tear assessed when the subject comes from the outside environment, B: tear film assessed after 30min adaptation in the clinical environment). This study showed a significant difference between the tear film test results evaluated when the subjects were assessed immediately from the outside environment and after an adaptation time in the clinic environment. Practitioners must consider the effect of differences between external and clinical environment adaptation on clinical tear film physiology. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

MR imaging-based diagnosis and classification of meniscal tears.

Science.gov (United States)

Nguyen, Jie C; De Smet, Arthur A; Graf, Ben K; Rosas, Humberto G

2014-01-01

Magnetic resonance (MR) imaging is currently the modality of choice for detecting meniscal injuries and planning subsequent treatment. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures, and anatomic variants and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery. High-spatial-resolution imaging of the meniscus can be performed using fast spin-echo and three-dimensional MR imaging sequences. Normal anatomic structures that can mimic a tear include the meniscal ligament, meniscofemoral ligaments, popliteomeniscal fascicles, and meniscomeniscal ligament. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. When a meniscal tear is identified, accurate description and classification of the tear pattern can guide the referring clinician in patient education and surgical planning. For example, longitudinal tears are often amenable to repair, whereas horizontal and radial tears may require partial meniscectomy. Tear patterns include horizontal, longitudinal, radial, root, complex, displaced, and bucket-handle tears. Occasionally, meniscal tears can be difficult to detect at imaging; however, secondary indirect signs, such as a parameniscal cyst, meniscal extrusion, or linear subchondral bone marrow edema, should increase the radiologist's suspicion for an underlying tear. Awareness of common diagnostic errors can ensure accurate diagnosis of meniscal tears. Online supplemental material is available for this article. ©RSNA, 2014.

The Use Level of Chrome Tannage For Rabbit Fur Leather Observed on Tearing Strength, Stitch Tearing Strength, Water Absorption and Organoleptic

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Mustakim Mustakim

2012-02-01

Full Text Available The purpose of this study was to find out the appropiate of chrome tannage level for rabbit fur leather quality. The result were expected to contribute information for many people who relate with tanning technology, especialy about the use level of chrome tannage for fur leather quality and could as patern to hold further research.The material that used were 12 pieces of three months of rabbit skin. The method is Completely Randomized Design, consist of three treatments of chrome tannage (Chromosal B, they were : B1 (Chromosal B 6%, B2 (Chromosal B 8%, and B3 (Chromosal B 10%. Each of treatment hold on four replications. The variables which measured are tearing strength, stitch teraing strength, water absorption and organoleptic consist of “kekuatan bulu”’ “kerataan bulu” and “kelemasan kulit” in fur leather. Data was analysed by analysis variance followed by Duncan’s Multiple Range Test. The result of this research show that the use level of chromosal B give very significant influence among tearing strength, stitch tearing strength and water absorption. It gave significant influence among the organoleptic test. Based on the result, can be concluded that 10 percent of chrome tannage (chromosal B, produce the best result on tearing strength, stitch tearing strength, water absorption and organoleptic for “kekuatan bulu” and “kerataan bulu”. The incrase of chrome tannage offer will decrease the “kelemasan kulit” in fur leather and the best “kelemasan kulit” produced by the lowest chrome tannage offer, that was 6 percent of Chromosal B. The best quality of rabbit fur leather produced by 10 percent of chrome tannage offer.   Keywords: chrome, tannage, fur leather

Diagnostic value of self-reported mechanical symptoms for diagnosing large meniscal tears in patients aged 40 years or older with meniscal tears

DEFF Research Database (Denmark)

Pihl, Kenneth; Englund, Martin; Lohmander, Stefan

2017-01-01

Purpose: Meniscal tears, which are longitudinal-vertical tears (e.g. bucket-handle tears) and/or involve all three meniscal sub regions (anterior horn, body and posterior horn), are typically large and assumed to cause patient perceived mechanical knee symptoms (knee grinding or clicking and knee...... catching or locking). However, whether the presence of such mechanical symptoms is useful for diagnosing these forms of meniscus tears is unknown. Therefore, we investigated the diagnostic values of having mechanical symptoms in diagnosing a bucket-handle tear and/or a tear involving all three meniscal sub...... regions in middle-aged and older patients undergoing arthroscopic meniscal surgery. Methods: This study is a secondary analysis of Pihl et al. OARSI 2017. The study included patients aged 40 years or older undergoing surgery for a meniscal tear from Knee Arthroscopy Cohort Southern Denmark (KACS...

Influence of Ophthalmic Solutions on Tear Components.

Science.gov (United States)

Shigeyasu, Chika; Yamada, Masakazu; Akune, Yoko

2016-11-01

Tear fluids are a mixture of secretions derived from lacrimal glands, accessory lacrimal glands, conjunctiva, and meibomian glands. Compositional changes to tears occur in the normal state and during ocular surface disease, such as dry eye conditions. We have investigated compositional changes to tears after topical application of ophthalmic solutions, with regard to tear-specific proteins (secretory immunoglobulin A, lactoferrin, lipocalin-1, and lysozyme) and ocular surface mucin in normal and dry eye conditions using high-performance liquid chromatography. After application of saline solution (0.9% sodium chloride) in normal subjects, transient but significant decreases in all tear components were observed. The recovery of protein concentrations took up to 30 minutes and lasted longer when the saline solution was applied more frequently. When applying ophthalmic solutions, a balance between washout and dilutional effects should be considered in addition to the therapeutic effect. Investigation of the effect of diquafosol solution (3%) in normal subjects revealed a significant increase in sialic acid concentration, a marker of ocular mucin, at 5 minutes after application, whereas a significant decrease was observed with saline. This result indicates the accelerated secretion of mucin from ocular tissues induced by diquafosol. A clinical study to determine the efficacy of diquafosol in patients with dry eye revealed improvements in tear breakup time, keratoconjunctival staining scores, and Schirmer test score, accompanied by an increase in sialic acid concentration in tears. Investigating normal and dry eye conditions through tear analysis may clarify the pathophysiology of dry eye conditions and support the efficacy of treatments.

Return to Sport After Rotator Cuff Tear Repair: A Systematic Review and Meta-analysis.

Science.gov (United States)

Klouche, Shahnaz; Lefevre, Nicolas; Herman, Serge; Gerometta, Antoine; Bohu, Yoann

2016-07-01

One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play. The main goal of this study was to determine the rate of return to sport after treatment of rotator cuff tears. Meta-analysis and systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature, as well as for the presentation of results. A search of the literature was performed on the electronic databases MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Inclusion criteria were studies in English evaluating return to sport after treatment of traumatic, degenerative, partial or full-thickness rotator cuff tears in patients practicing a sport regularly, whatever the level, all ages and sports included. The main judgment criterion was the number of patients who returned to a sports activity after treatment of a rotator cuff tear. The criterion was analyzed in 2 ways: return to sport (yes/no) and the level of play (identical or higher/lower level). Twenty-five studies were reviewed, including 859 patients (683 athletes), all treated surgically after a mean follow-up of 3.4 years (range, 0.3-13.4 years). The level of sports was recorded in 23 studies or 635 (93%) athletes and included 286 competitive or professional athletes and 349 recreational athletes. The most commonly practiced sports were baseball (224 participants), tennis (104 participants), and golf (54 participants). The overall rate of return to sport was 84.7% (95% CI, 77.6%-89.8%), including 65.9% (95% CI, 54.9%-75.4%) at an equivalent level of play, after 4 to 17 months. Of the professional and competitive athletes, 49.9% (95% CI, 35.3-64.6%) returned to the same level of play. Most

Morphological classification of acromial spur: correlation between Rockwood tilt view and arthroscopic finding

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Kongmalai Pinkawas

2017-01-01

Full Text Available Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. Methods: We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rockwood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. Results: The keel spur (33.9% was the most common finding followed by the heel spur (27.8%. The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively. These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. Conclusion: The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur.

Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears.

Science.gov (United States)

Aydin, Nuri; Kocaoglu, Baris; Guven, Osman

2010-07-01

Double-row rotator cuff repair leads to superior cuff integrity and clinical results compared with single-row repair. The study enrolled 68 patients with a full-thickness rotator cuff tear who were divided into 2 groups of 34 patients according to repair technique. The patients were followed-up for at least 2 years. The results were evaluated by Constant score. Despite the biomechanical studies and cadaver studies that proved the superiority of double-row fixation over single-row fixation, our clinical results show no difference in functional outcome between the two methods. It is evident that double-row repair is more technically demanding, expensive, and time-consuming than single-row repair, without providing a significant improvement in clinical results. Comparison between groups did not show significant differences. At the final follow-up, the Constant score was 82.2 in the single-row group and 78.8 in the double-row group. Functional outcome was improved in both groups after surgery, but the difference between the 2 groups was not significant. At long-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair in small to medium tears. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Effect of sildenafil citrate on secondary healing in full thickness skin defects in experiment.

Science.gov (United States)

Cakmak, E; Karasoy Yesilada, A; Sevim, K Z; Sumer, O; Tatlidede, H S; Sakiz, D

2014-01-01

An acceleration of the wound healing process expedites chronic wound patient's return to normal social environments significantly. Sildenafil, a cyclic guanosine monophosphate (cGMP)-dependent phosphodiesterase- 5 inhibitor has been shown to be a potent stimulator of angiogenesis through upregulation of cGMP. In our study, sildenafil was administered orally as a cost-effective supplement in the treatment of full thickness defects and chronic wounds in that manner with low incidence of side effects and morbidity. Randomly selected 72 Wistar-Albino rats were divided into the two groups, 36 rats in each group. Control group (n =36) was divided further into a secondary healing group consisting of 9 rats and a pathology group consisting of 27 rats (pathology group 1: 9 rats, 4th and 7th day of wound healing, pathology group 2: 9 rats, 10th and 14th day of wound healing, pathology group 3: 9 rats, 21st and 28th day of wound healing. Experimental group consisted of 36 rats which received sildenafil citrate (Viagra® Pfizer, Germany) for secondary wound healing to proceed. The average wound healing period in the control group was 17.89 days and in the sildenafil citrate administered group 14.56 days. The difference of the epithelialisation on full thickness defects were more prominent on days 5 and 11 postoperatively. In the sildenafil citrate applied group, on the 7th day, the defect was 25% smaller and on the 13th day, the defect contracted by 38%. In conclusion, we believe that sildenafil citrate administered orally is a cost- effective supplement in the treatment of full thickness defects and chronic wounds in that manner with low incidence of side effects and morbidity (Tab. 4, Fig. 7, Ref. 34).

Clinical Outcomes and Safety of Partial Full-Thickness Myotomy versus Circular Muscle Myotomy in Peroral Endoscopic Myotomy for Achalasia Patients

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Chenyu Li

2017-01-01

Full Text Available Background. Here we aimed to evaluate and compare the efficacy and safety between partial full-thickness myotomy and circular muscle myotomy during POEM procedure in achalasia patients. Methods. Clinical data of achalasia of cardia (AC patients who underwent POEM in our center during January 2014 to January 2015 was collected (34 cases. 19 patients who received partial full-thickness myotomy were assigned to group A and 14 patients who received circular muscle myotomy were assigned to group B. The procedure-related parameters between the two groups were compared. Symptom relief rate and postprocedure manometry outcomes were compared to evaluate the efficacy. Procedure-related adverse events and complications were compared to evaluate the safety. Results. (1 Mean operation times were significantly shorter in group A than group B (62.42±23.17 vs 87.86±26.44 min, p0.05. (3 Comparison of procedure-related adverse events and complications had no statistical differences (all p>0.05. Conclusion. Partial full-thickness myotomy had no significant differences in efficacy or safety with circular myotomy, but partial full-thickness myotomy significantly reduced the procedure time.

Kinetic theory of tearing instabilities

International Nuclear Information System (INIS)

Drake, J.F.; Lee, Y.C.

1977-01-01

The transition of the tearing instability from the collisional to the collisionless regime is investigated kinetically using a Fokker--Planck collision operator to represent electron-ion collisions. As a function of the collisionality of the plasma, the tearing instability falls into three regions, which are referred to as collisionless, semi-collisional, and collisional. The width Δ of the singular layer around kxB 0 =0 is limited by electron thermal motion along B 0 in the collisional and semi-collisional regimes and is typically smaller than rho/sub i/, the ion Larmor radius. Previously accepted theories, which are based on the assumption Δvery-much-greater-thanrho/sub i/, are found to be valid only in the collisional regime. The effects of density and temperature gradients on the instabilities are also studied. The tearing instability is only driven by the temperature gradient in the collisional and semi-collisional regimes. Numerical calculations indicate that the semi-collisional tearing instability is particularly relevant to present day high temperature tokamak discharges

Posterior horn medial meniscal root tear: the prequel

Energy Technology Data Exchange (ETDEWEB)

Umans, H. [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Morrison, W. [Thomas Jefferson University Hospital, Philadelphia, PA (United States); DiFelice, G.S. [Hospital for Special Surgery, New York, NY (United States); Vaidya, N. [Crystal Run Healthcare, Middletown, NY (United States); Winalski, C.S. [Cleveland Clinic, Imaging Institute, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)

2014-06-15

To determine whether subarticular marrow changes deep to the posterior horn medial meniscal root anchor might predict subsequent medial meniscal root tear. Fifteen patients with MR-diagnosed posterior horn medial meniscal root (PHMMR) tear and a knee MRI antecedent to the tear were identified at three imaging centers over a 7-year period. The pre- and post-tear MR images were evaluated for marrow signal changes deep to the root anchor, meniscal root signal intensity, medial compartment articular cartilage thinning, and meniscal body extrusion. Images of 29 age- and gender-matched individuals with two MRIs of the same knee were reviewed as a control group. MRI in 11 of 15 (73 %) cases with subsequent PHMMR tear demonstrated linear subcortical marrow edema deep to the meniscal root anchor on the antecedent MRI compared to only 1 of 29 (3 %) non-tear controls (p < 0.0001). The abnormal signal resolved on post-tear MRI in all but two patients. Cyst-like changes deep to the PHMMR were present on initial MRI in three of 15 (23 %) cases and three of 29 (10 %) controls, persisting in all but one case on follow-up imaging. The PHMMR was gray on the initial MRI in seven of 15 (47 %) of cases that developed tears compared to four of 29 (14 %) controls (p < 0.0001). There was medial meniscal extrusion (MME) prior to tear in two of 15 (13 %) patients and in ten of 15 (67 %) patients after PHMMR failure. In the control group, MME was present in one (3 %) and three (10 %) of 29 subjects on the initial and follow-up MRIs, respectively. Articular cartilage loss was noted in two of 15 (15 %) cases before tear and nine of 15 (69 %) on follow-up imaging, as compared to one (3 %) and four (14 %) of 29 subjects in the control group. Subcortical marrow edema deep to the PHMMR may result from abnormal stresses and thus be a harbinger of meniscal root failure. This hypothesis is supported by resolution of these marrow signal changes after root tear. Following tear, extrusion of the

Human tears reveal insights into corneal neovascularization.

Science.gov (United States)

Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

2012-01-01

Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

Negative pressure wound therapy using polyvinyl alcohol foam to bolster full-thickness mesh skin grafts in dogs.

Science.gov (United States)

Or, Matan; Van Goethem, Bart; Kitshoff, Adriaan; Koenraadt, Annika; Schwarzkopf, Ilona; Bosmans, Tim; de Rooster, Hilde

2017-04-01

To report the use of negative pressure wound therapy (NPWT) with polyvinyl alcohol (PVA) foam to bolster full-thickness mesh skin grafts in dogs. Retrospective case series. Client-owned dogs (n = 8). Full-thickness mesh skin graft was directly covered with PVA foam. NPWT was maintained for 5 days (in 1 or 2 cycles). Grafts were evaluated on days 2, 5, 10, 15, and 30 for graft appearance and graft take, granulation tissue formation, and complications. Firm attachment of the graft to the recipient bed was accomplished in 7 dogs with granulation tissue quickly filling the mesh holes, and graft take considered excellent. One dog had bandage complications after cessation of the NPWT, causing partial graft loss. The PVA foam did not adhere to the graft or damage the surrounding skin. The application of NPWT with a PVA foam after full-thickness mesh skin grafting in dogs provides an effective method for securing skin grafts, with good graft acceptance. PVA foam can be used as a primary dressing for skin grafts, obviating the need for other interposing materials to protect the graft and the surrounding skin. © 2017 The American College of Veterinary Surgeons.

Age-related changes in the signal value of tears.

Science.gov (United States)

Zeifman, Debra M; Brown, Sarah A

2011-08-12

Emotional tears may be uniquely human and are an effective signal of distress in adults. The present study explored whether tears signal distress in younger criers and whether the effect of tears on observers is similar in magnitude across the life span. Participants rated photographs of crying infants, young children, and adults, with tears digitally removed or added. The effectiveness of tears in conveying sadness and eliciting sympathy was greatest for images of adults, intermediate for images of children, and least potent for images of infants. These findings suggest that the signal value of tears varies with the age of the crier. The results may shed light on the functional significance of crying at different stages of human development.

Realistic Facial Expression of Virtual Human Based on Color, Sweat, and Tears Effects

Directory of Open Access Journals (Sweden)

Mohammed Hazim Alkawaz

2014-01-01

Full Text Available Generating extreme appearances such as scared awaiting sweating while happy fit for tears (cry and blushing (anger and happiness is the key issue in achieving the high quality facial animation. The effects of sweat, tears, and colors are integrated into a single animation model to create realistic facial expressions of 3D avatar. The physical properties of muscles, emotions, or the fluid properties with sweating and tears initiators are incorporated. The action units (AUs of facial action coding system are merged with autonomous AUs to create expressions including sadness, anger with blushing, happiness with blushing, and fear. Fluid effects such as sweat and tears are simulated using the particle system and smoothed-particle hydrodynamics (SPH methods which are combined with facial animation technique to produce complex facial expressions. The effects of oxygenation of the facial skin color appearance are measured using the pulse oximeter system and the 3D skin analyzer. The result shows that virtual human facial expression is enhanced by mimicking actual sweating and tears simulations for all extreme expressions. The proposed method has contribution towards the development of facial animation industry and game as well as computer graphics.

Time course of changes in tear meniscus radius and blink rate after instillation of artificial tears.

Science.gov (United States)

Bandlitz, Stefan; Purslow, Christine; Murphy, Paul J; Pult, Heiko

2014-08-26

Using a novel digital meniscometer (PDM), alterations in tear meniscus radius (TMR) were measured simultaneously with blink rate (BR) following the instillation of artificial tears. Central TMR and BR of 22 subjects (11 male and 11 female; mean age, 24.3 ± 2.6 SD years) were measured at baseline, and 0, 1, 5, 10, and 30 minutes after instillation of an artificial tear containing hydroxypropyl-guar and glycol (SYS) or saline (SAL). A dose of 35 μL was applied in one eye in a randomized order with a washout period between each drop. For SAL, compared to baseline TMR (0.33 ± 0.08 mm), TMR significantly increased with drop instillation (1.55 ± 0.69 mm) and at 1 minute (0.66 ± 0.36 mm; P tears. Difference in residence time reflects the different viscosity of each drop. An overload with a large drop may result in an initially increased BR. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Effects of epidermal growth factor in artificial tear on vitamin C levels of corneal wounded eye tissues.

Science.gov (United States)

Gönül, B; Kaplan, B; Bilgihan, K; Budak, M T

2001-04-01

To investigate the effect of artificial tear (AT) solution and epidermal growth factor (EGF) treatment on the cornea and aqueous humour ascorbic acid (AA) levels of full-thickness corneal wounded eyes. The effect of EGF on the AA levels of aqueous humour and corneal wound tissue was determined in full-thickness corneal wounded rabbit eyes on the seventh post-operative day. There were three groups: untreated controls, AT-treated controls and an EGF+AT-treated experimental group (n = 6 in each group). Corneal wounded eyes were topically treated with 5 microl AT or 5 microl EGF in AT (1 mg/l EGF in AT prepaaration which contained 3.0% carbopol 940) twice daily for 6 days after operation. The wound strengths were also measured on the seventh post-operative day as a measure of wound healing. Statistical analysis was carried out using the Mann-Whitney U-test by Statview program. The wound strengths of corneas, and AA levels of wound tissues and aqueous humour, increased significantly following AT and EGF treatment (p < 0.05). In the corneal wounded eye, aqueous humour serves as a source of vitamin C and there may be a relation between EGF treatment in AT and AA levels of corneal wounded eye tissues.

Long Term Effects of Tear Gases on Respiratory System: Analysis of 93 Cases

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Peri Arbak

2014-01-01

Full Text Available Aim. This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. Materials and Methods. A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. Results. The mean numbers of total exposure and last 2 years exposure were 8.4±6.4 times, 5.6±5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P>0.05. Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P=0.046 and 89.9% versus 109.6%, P=0.0004, resp.. % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P=0.05. Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. Conclusion. The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis.

Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience.

Science.gov (United States)

Schmidt, Arthur; Bauerfeind, Peter; Gubler, Christoph; Damm, Michael; Bauder, Markus; Caca, Karel

2015-08-01

Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract may be a valuable therapeutic and diagnostic approach for a variety of indications. Although feasibility of EFTR has been demonstrated, there is a lack of safe and effective endoscopic devices for routine use. The aim of this study was to investigate the efficacy and safety of a novel over-the-scope device for colorectal EFTR. Between July 2012 and July 2014, 25 patients underwent EFTR at two tertiary referral centers. All resections were performed using the full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Data were collected retrospectively. Indications for EFTR were: recurrent or incompletely resected adenoma with nonlifting sign (n = 11), untreated adenoma and nonlifting sign (n = 2), adenoma involving the appendix (n = 5), flat adenoma in a patient with coagulopathy (n = 1), diagnostic re-resection after incomplete resection of a T1 carcinoma (n = 2), adenoma involving a diverticulum (n = 1), submucosal tumor (n = 2), and diagnostic resection in a patient with suspected Hirschsprung's disease (n = 1). In one patient, the lesion could not be reached because of a sigmoid stenosis. In the other patients, resection of the lesion was macroscopically complete and en bloc in 20/24 patients (83.3 %). The mean diameter of the resection specimen was 24 mm (range 12 - 40 mm). The R0 resection rate was 75.0 % (18/24), and full-thickness resection was histologically confirmed in 87.5 %. No perforations or major bleeding were observed during or after resection. Two patients developed postpolypectomy syndrome, which was managed with antibiotic therapy. Full-thickness resection in the lower gastrointestinal tract with the novel FTRD was feasible and effective. Prospective studies are needed to further evaluate the device and technique. © Georg Thieme Verlag KG Stuttgart · New York.

Meniscotibial (coronary) ligament tears

International Nuclear Information System (INIS)

El-Khoury, G.Y.; Usta, H.Y.; Berger, R.A.

1984-01-01

Preservation of the meniscus whenever possible is essential in maintaining knee stability and preventing premature osteoarthritis. Peripheral meniscal tears are the most amenable to surgical repair. This study evaluates the peripheral attachments of the medial meniscus and focuses on a specific tear limited to the meniscotibial ligament (coronary ligament). The diagnosis is made arthrographically when the medial meniscus floats above the tibial plateau without separating completely from the capsule. The lateral meniscus is rarely involved in this type of injury. (orig.)

SLAP tears of the glenoid labrum in contact athletes.

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Funk, Lennard; Snow, Martyn

2007-01-01

To describe the distribution and clinical presentation of labral injuries in rugby players and the time taken for them to return to sports. Retrospective cohort study. Busy shoulder practice in the North West of England, treating a large number of professional athletes. A review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Eighteen patients had a documented SLAP tear; this group represented our study population. Arthroscopic debridement and/or stabilization was carried out for all labral injuries using Panaloc anchors and No. 2 PDS via a 2 portal technique. Classification of injury, Satisfaction, Time to return to play. The incidence of SLAP tears in our study population was 35%. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior labral lesion (11%), and 2 SLAP tears associated with an anterior and posterior labral injuries (11%). Of the 18 SLAP tears, 14 (78%) were type 2, 3 (17%) were type 3, and 1 (5%) was type 4. None of the patients with a SLAP tear presented with symptoms of instability. MR Arthrogram had a 76% sensitivity for detecting SLAP tears. By 6 months postsurgery, 89% of patients were satisfied. Patients with isolated SLAP tears were the quickest to return to sports, at an average of 2.6 months postsurgery. SLAP tears are a common injury in rugby players. These can often be diagnosed with MR arthrography. Arthroscopic repair is associated with excellent results and early return to sports.

Tear Film Break-Up Time: Comparison between Patients using Psychiatric Drugs and Healthy Individuals

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Parvin Dibajnia

2014-09-01

Full Text Available Background: Ocular dryness is a well-recognized adverse side effect of many medications. The purpose of this study was to compare tear film stability between psychiatric patients that use lithium carbonate or carbamazepine and normal cases. Materials and Methods: Tear film break up time test was performed in three groups, 30 patients using lithium carbonate, 30 patients using carbamazepine and 30 normal cases. Values of the TBUTs were compared among groups by the independent t-test. Results: Differences between both of patients and control groups were significant (p<0.0001. Conclusion: The results show that these drugs contribute to decrease of tear film break up time.

Comparison of TEAR and TFRC throughput for Drop tail and RED Queue Management Techniques

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Parminderjeet Singh

2014-12-01

Full Text Available The comparison of throughput for TEAR (TCP emulation at receivers and TFRC TCP friendly rate control in MANETs is done with varying Active queue Management Techniques. The analysis reveals that for bandwidth constraint links, TEAR and TFRC perform far better than normal traffic propagation through TCP. In case of TEAR, the processing and route congestion algorithm load is shared by the receiver resulting in lesser load at the transmitters. In TFRC the TCP traffic is propagated via an algorithm to curb acknowledgement congestions. The effect of these two techniques is monitored on Droptail and RED, two of the most common Active Queue Management Techniques.

Chitosan Dermal Substitute and Chitosan Skin Substitute Contribute to Accelerated Full-Thickness Wound Healing in Irradiated Rats

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Abu Bakar Mohd Hilmi

2013-01-01

Full Text Available Wounds with full-thickness skin loss are commonly managed by skin grafting. In the absence of a graft, reepithelialization is imperfect and leads to increased scar formation. Biomaterials can alter wound healing so that it produces more regenerative tissue and fewer scars. This current study use the new chitosan based biomaterial in full-thickness wound with impaired healing on rat model. Wounds were evaluated after being treated with a chitosan dermal substitute, a chitosan skin substitute, or duoderm CGF. Wounds treated with the chitosan skin substitute showed the most re-epithelialization (33.2 ± 2.8%, longest epithelial tongue (1.62 ± 0.13 mm, and shortest migratory tongue distance (7.11 ± 0.25 mm. The scar size of wounds treated with the chitosan dermal substitute (0.13 ± 0.02 cm and chitosan skin substitute (0.16 ± 0.05 cm were significantly decreased (P<0.05 compared with duoderm (0.45 ± 0.11 cm. Human leukocyte antigen (HLA expression on days 7, 14, and 21 revealed the presence of human hair follicle stem cells and fibroblasts that were incorporated into and surviving in the irradiated wound. We have proven that a chitosan dermal substitute and chitosan skin substitute are suitable for wound healing in full-thickness wounds that are impaired due to radiation.

Advanced Rotator Cuff Tear Score (ARoCuS): a multi-scaled tool for the classification and description of rotator cuff tears.

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Walter, S G; Stadler, T; Thomas, T S; Thomas, W

2018-03-02

To introduce a (semi-)quantitative surgical score for the classification of rotator cuff tears. A total of 146 consecutive patients underwent rotator cuff repair and were assessed using the previously defined Advanced Rotator Cuff Tear Score (ARoCuS) criteria: muscle tendon, size, tissue quality, pattern as well as mobilization of the tear. The data set was split into a training (125 patients) and a testing set (21 patients). The training data set fitted a nonlinear predictive model of the tear score based on the ARoCuS criteria, while the testing data served as control. Based on the scoring results, rotator cuff tears were assigned to one of four categories (ΔV I-IV) and received a stage-adapted treatment. For statistical analysis, mean values ± standard deviation, interclass correlation coefficients (ICC) and kappa values were calculated. Overall, 32 patients were classified as ΔV I, 68 as ΔV II and 37 as ΔV III. Nine patients showed ΔV IV tears. Patients of all ΔV groups improved significantly their Constant scores (p tears in a standardized and reproducible manner.