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Static posterior subluxation of the humeral head (SPSH) results in glenohumeral osteoarthritis. Treatment strategies for SPSH with or without resulting osteoarthritis remain challenging. There is growing interest in evaluating the rotator cuff muscle volume, fatty infiltration, or forces in osteoarthritic shoulders with SPSH, mainly due to a possible transverse force imbalance. In nonpathological shoulders, the transverse angle of the rotator cuff muscle's resultant force may be associated with scapulohumeral alignment and glenoid vault morphology, despite an assumed transverse force balance. The purpose of this study was to assess the transverse rotator cuff muscle's resultant force angle (TRFA) and its relationship with the scapulohumeral subluxation index (SHSI) and selected glenoid vault parameters using computer modeling. Computed tomography scans of 55 trauma patients (age 31 ± 13 years, 36 males) with nonpathological shoulders were analyzed and all measurements performed in 3-dimension. We placed landmarks manually to determine the humeral head center and the rotator cuff tendon footprints. The contours of the rotator cuff muscle cross-sectional areas were automatically predicted in a plane perpendicular to the scapula. Each rotator cuff muscle was divided into virtual vector fibers with homogeneous density. The resultant force vector direction for each muscle, corresponding to the rotator cuff action line, was calculated by vectorially summing the normalized fiber vectors for each muscle, weighted by the muscle trophic ratio. The resultant force vector was projected on the axial plane, and its angle with the mediolateral scapular axis was used to determine TRFA. The SHSI according to Walch, glenoid version angle (GVA), glenoid anteroposterior offset angle (GOA), glenoid depth, glenoid width, and glenoid radius were also evaluated. The mean values for TRFA, SHSI, GVA, GOA, glenoid depth, glenoid width, and glenoid radius were 7.4 ± 4.5°, 54.3 ± 4.8%, −4.1 ± 4.4°, 5.1 ± 10.8°, 3.3 ± 0.6 mm, 20 ± 2 mm, and 33.6 ± 4.6 mm, respectively. The TRFA correlated strongly with SHSI (R = 0.731, P <.001) and GVA (R = 0.716, P <.001) and moderately with GOA (R = 0.663, P <.001). The SHSI was strongly negatively correlated with GVA (R = −0.813, P <.001) and moderately with GOA (R = −0.552, P <.001). The GVA correlated strongly with GOA (R = 0.768, P <.001). In contrast, TRFA, SHSI, GVA, and GOA did not correlate with glenoid depth, width, or radius. Despite an assumed balance in the transverse volume of the rotator cuff muscles in nonpathological shoulders, variations exist regarding the transverse resultant force depending on the SHSI, GVA, and GOA. In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset. [ABSTRACT FROM AUTHOR]

Introduction Previous trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled unblinded trial tested the hypothesis that a continuous infusion of local anesthetic for an interscalene brachial plexus block still provides superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. Methods Sixty patients undergoing shoulder arthroplasty or arthroscopic rotator cuff repair were randomized to receive a bolus of ropivacaine 0.5%, 20 mL, with or without a continuous infusion of ropivacaine 0.2% 4-8 mL/hour, for an interscalene brachial plexus block. Patients were provided with intravenous morphine patient-controlled analgesia. The primary outcome was cumulative intravenous morphine consumption at 24 hours postoperatively. Secondary outcomes included pain scores at rest and on movement, and functional outcomes, measured over 48 hours after surgery. Results Median (IQR) cumulative intravenous morphine consumption at 24 hours postoperatively was 10 mg (4-24) in the continuous infusion group and 14 mg (8-26) in the single injection group (p=0.74). No significant between-group differences were found for any of the secondary outcomes. Conclusions A continuous infusion of local anesthetic for an interscalene brachial plexus block does not provide superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. The findings of this study are limited by performance and detection biases. [ABSTRACT FROM AUTHOR]

Osteochondritis dissecans (OCD) of the humeral capitellum is an important cause of elbow disability in young athletes. Large and unstable lesions sometimes require joint reconstruction with osteochondral autograft. Several approaches have been described to expose the capitellum for the purpose of treating OCD. The posterior anconeus-splitting approach and the lateral approach with or without release of the lateral ligamentous complex are the most frequently used for this indication. The surface accessible by these approaches has not been widely studied. This study compared the extent of the articular surface of the capitellum that could be exposed with the Kocher approach (without ligament release) vs. the posterior anconeus-splitting approach. A secondary outcome was the measurement of any additional area that could be reached with lateral ulnar collateral ligament release (Wrightington approach). The 3 approaches were performed on 8 adult cadaveric elbows: first, the Kocher approach; then, the anconeus-splitting approach; and finally, the Wrightington approach. The visible articular surface was marked out after completion of each approach. The mean articular surface of the capitellum was 708 mm2 (range, 573-830 mm2). The mean visible articular surface was 49% (range, 43%-60%) of the total surface with the Kocher approach, 74% (range, 61%-90%) with the posterior anconeus-splitting approach, and 93% (range, 91%-97%) with the Wrightington approach. Although the Kocher approach provided access to the anterior part of the capitellum, the anconeus-splitting approach showed adequate exposure to the posterior three-quarters of the articular surface and overlapped the most posterior part of the Kocher approach. A combination of the 2 lateral ulnar collateral ligament–preserving approaches allowed access to 100% of the joint surface. Most OCD lesions are located in the posterior area of the capitellum and can therefore be reached with the anconeus-splitting approach. When OCD lesions are located anteriorly, the Kocher approach without ligament release is efficient. A combination of these 2 approaches enabled the entirety of the joint surface to be viewed. [ABSTRACT FROM AUTHOR]

Contrary to lower limb infection, POstoperative Shoulder surgery Infection (POSI) often involves Cutibacterium acnes. Our aim was to describe patient characteristics and pathogens retrieved in POSI to guide initial empiric antibiotic selection with suspected infection during revision. We also compared microorganisms in infection following trauma, arthroplasty (AP), and arthroscopy (AS). A multicenter retrospective study from 2010 to 2016 reviewed laboratory databases and medical records to identify patients with a previous shoulder surgery and a confirmed shoulder infection. The following procedures were included: AP, AS, fracture fixation (FF), and another open surgery (OS). A confirmed shoulder infection was defined as 2 positive cultures or more of the same microorganism, or clear clinical infection with 1 positive culture or more. Among the 5 hospitals and 28 surgeons involved, 94 POSI cases were identified. Mean age was 59 years at index surgery (range: 22-91) with a majority of men (n = 70, 74%). Among POSI cases, AP was the most common index surgery (n = 41), followed by FF (n = 27), AS (n = 16), and OS (n = 10). The median time between index surgery and the first positive sample was 5 months and the mean was 23 months (minimum 6 days to maximum 27 years), illustrating a positively skewed distribution. Cutibacterium spp were identified in 64 patients (68%), including 59 C acnes patients (63%), which was the most frequent germ in all 4 surgical groups. In 86% of cases, C acnes was identified at the first revision. The other 2 most common germs were Staphylococcus epidermidis and Staphylococcus aureus , with 29% and 17%, respectively. Polymicrobial infection was present in 30% of patients. Gender analysis revealed that C acnes was twice as frequent in men (male = 52 of 70, female = 7 of 24; P <.001). S epidermidis was more prevalent in women (n = 11; 46%) compared with men (n = 16; 21%) (P =.032). C acnes infection was most frequent in arthroscopic surgery (n = 14; 70%, P =.049). S epidermidis was 3 times more prevalent in chronic than in acute cases. Empiric antimicrobial therapy following POSI, while waiting for culture results, should cover C acnes , S epidermidis , and S aureus. There is a significant gender difference regarding POSI culture results. C acnes is more frequent in men, but should still be covered in women as it was found in 29% of cases. [ABSTRACT FROM AUTHOR]

Neurocysticercosis (NCC) is an unusual cause of seizures in high income settings. It typically presents as an afebrile seizure in a previously well child and can occur years after migration or travel. Children diagnosed with neurocysticercosis from 01 July 2005 to 30 June 2020 were identified from the electronic medical records of a tertiary children's hospital in Australia. Additionally, a 10-year compilation of case reports of paediatric NCC in high income settings was performed by medline search (publication years 2011–2021). Diagnosis and treatment of neurocysticercosis were reviewed with reference to diagnostic criteria of Del Brutto et al., and the 2017 Infectious Diseases Society of America treatment guidelines. Over a fifteen-year period, eight children were diagnosed with NCC at our hospital in Sydney, Australia. Seizures and history of travel to or migration from South Asia were the two most frequently occurring findings. Children diagnosed after 2016 all received antiparasitic therapy. Outcomes were generally favorable, though long-term epilepsy resulted in some cases. Compiled case reports from high income settings revealed migration and travel exposures commensurate with local demographic patterns, and treatment approaches conforming with 2017 Infectious Diseases Society of America guidelines. Clinicians should be aware of NCC as a differential diagnosis in children from endemic areas presenting with unprovoked seizures as misdiagnosis can occur. Expert review of neuroimaging facilitates diagnosis and can avert unnecessary neurosurgery. In Australia, India was a key exposure country for NCC, reflecting its endemic burden of disease and local travel and migration patterns. • Neurocysticercosis (NCC) is infrequent in high income countries. • NCC should be considered as a differential diagnosis in children with first-episode seizure who have migrated or travelled from endemic areas. • Epidemiological risk factors for NCC in non-endemic, high income settings reflect local migration and travel patterns from endemic countries. • In Australia, having lived in or travelled to India is a key risk factor for NCC. [ABSTRACT FROM AUTHOR]

The purpose of this study is to correlate spinal ultrasound (US) and magnetic resonance imaging (MRI) findings in patients with anorectal malformations (ARMs). A retrospective analysis of records was performed for children with ARM presenting to two major pediatric hospitals between 2009 and 2017. The primary outcome analyzed was detection of spinal cord anomalies. Spinal US was performed up to 4 months and MRI within the first year of life. The conus medullaris was considered normal if it had a tapering contour and terminated at or above the Lumbar 2-3 disk space. One hundred ninety-three patients with ARM presented during the study period with a slight male preponderance (108, 56%). Spinal imaging was performed in 157(82%) - 137(87%) had US, 64(41%) had MRI and 44 (28%) had both. Of the 44 who had both; US was abnormal in 25 children-confirmed by MRI in 20 (80%). US was normal in 17 children- MRI showed a filum cyst in 1 and a lipoma in 2 children and was inconclusive in 2 children (p < 0.001). All who required surgery except one child, were reported on spinal US to have a low lying cord, borderline low cord or tethered cord (p <.05). No child who was reported to have a normal spinal US required de-tethering at a later stage. Spinal US had an overall sensitivity of 91% and specificity of 75% compared to MRI for detecting spinal cord anomalies in children with ARM Spinal US performed in a tertiary pediatric imaging department was a good screening test for spinal cord anomalies in children with ARM. The finding of a low, borderline low or tethered cord on US mandates an MRI to confirm the findings and correlates with the need for operative correction of spinal cord tethering. Clinical research paper. 2. [ABSTRACT FROM AUTHOR]

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Rationale and Objectives: To prospectively analyze the correlation between parameters of liver perfusion from technetium99m-macroaggregates of albumin (99mTc-MAA) single photon emission computed tomography (SPECT) with those obtained from dynamic CT perfusion in patients with primary or metastatic liver malignancy. Materials and Methods: Twenty-five consecutive patients (11 women, 14 men; mean age 60.9 ± 10.8; range: 32–78 years) with primary (n = 5) or metastatic (n = 20) liver malignancy planned to undergo selective internal radiotherapy underwent dynamic contrast-enhanced CT liver perfusion imaging (four-dimensional spiral mode, scan range 14.8 cm, 15 scans, cycle time 3 seconds) and 99mTc-MAA SPECT after intraarterial injection of 180 MBq 99mTc–MAA on the same day. Data were evaluated by two blinded and independent readers for the parameters arterial liver perfusion (ALP), portal venous perfusion (PVP), and total liver perfusion (TLP) from CT, and the 99mTc-MAA uptake-ratio of tumors in relation to normal liver parenchyma from SPECT. Results: Interreader agreements for quantitative perfusion parameters were high for dynamic CT (r = 0.90–0.98, each P < .01) and 99mTc -MAA SPECT (r = 0.91, P < .01). Significant correlation was found between 99mTc-MAA uptake ratio and ALP (r = 0.7, P < .01) in liver tumors. No significant correlation was found between 99mTc-MAA uptake ratio, PVP (r = −0.381, P = .081), and TLP (r = 0.039, P = .862). Conclusion: This study indicates that in patients with primary and metastatic liver malignancy, ALP obtained by dynamic CT liver perfusion significantly correlates with the 99mTc-MAA uptake ratio obtained by SPECT. [Copyright &y& Elsevier]

The article discusses the paper "Adenosine Stress High-Pitch 128-Slice Dual-Source Myocardial Computed Tomography Perfusion for Imaging of Reversible Myocardial Ischemia," by Gudrun Feuchtner, Robert Goetti, André Plass, and others. It states that the study sought to determine the efficacy of 128-slice myocardial computed tomography perfusion (CTP) imaging using a high-pitch tone, and compare that with cardiac magnetic resonance imaging (CMR). Methodology and conclusions are presented.

Background: Identification and differentiation of coronary atherosclerotic plaques may improve risk stratification for incident coronary events. Objective: We investigated the ability of dual-source computed tomography (CT) to depict and characterize atherosclerotic coronary plaques. Methods: Contrast-enhanced CT was performed in 25 human heart specimens with a total of 322 histologically determined plaques. Coronary plaques were classified on CT as (1) noncalcified, mixed, or calcified and (2) by CT attenuation values. Atherosclerotic plaques were histopathologically characterized according to the Stary classification. Results: CT detected 79% (245/322) of all plaques. Lesions missed by CT were generally early lesions, type I (n = 31), type II (n = 38), or type III (n = 8), according to Stary. CT detected 29% of early (Stary I–III) and 100% of advanced (Stary IV–VIII) plaques. Plaque classification as noncalcified was sensitive (100%) and specific (72%) for early, whereas classification as mixed/calcified was sensitive (92%, 89%) and specific (100%) for advanced plaques. Calcified plaques on CT were detected with high sensitivity (80%) and specificity (95%). Other subtypes were not distinguishable with CT according to the presence or absence of calcification. CT density was significantly higher for advanced (306 ± 470 HU) than for early (42 ± 14 HU; P < 0.01) plaques. The mean CT density value of type VII plaques (512 ± 349 HU) was significantly higher than those of other plaques (34–101 HU; P < 0.001). Conclusions: CT reliably depicts advanced coronary plaques and allows for the differentiation between early and advanced plaques. [ABSTRACT FROM AUTHOR]