Acromioclavicular joint cyst in ASA 3-4 patients. Whether and how quickly it recurs after aspiration and steroid injection

We observed the clinical course, in the short-medium term, of patients with voluminous type II acromio-clavicular (AC) joint cyst who underwent aspiration and steroid injection regarded as the only possible treatment to avoid possible skin complications. Four patients (7.4% of cases described in literature) (3F-1M ; mean age 83 years, range : 78-87 years) with a voluminous ( > 7 cm) oval, no mobile, no fluctuant cyst overlying the AC joint, were retrospectively observed. The patients, judged by the anesthesiologist as ASA 3-4 patients, were merely submitted to cyst aspiration and steroid injection. The content of the cyst was microscopically analysed. All patients were clinically evaluated on the day of aspiration and after 14-30 days and after 1 year. Shoulder function and pain intensity were analysed with Constant score and VAS. We were able to aspirate 80-150 ml of amorphous joint fluid. At the first follow-up, all patients had a recurrence of the cyst, a lower grade of tension of the skin overlying the cyst and also a very little decreasing of pain intensity. After a month from aspiration, the cysts of the 4 patients had the same size as that present before aspiration. The range of motion, the average value of VAS and Constant were similar to those recorded before aspiration. In no case signs of infection or draining sinus occurred. Aspiration is a useless practice. However it is still a motive for discussion if the reduced suffering of the skin overlying the cyst after the aspiration has avoided, or simply postponed, an imminent complication

Association between alcohol consumption and rotator cuff tear

Background and purpose - Long-term alcohol intake is associated with various negative effects on capillary microcirculation and tissue perfusion. We hypothesized that alcohol consumption might be a risk factor for both the occurrence and the severity of rotator cuff tears (RCTs). Patients and methods - A case-control study was performed. We studied 249 consecutive patients (139 men and 110 women; mean age 64 (54-78) years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group had 356 subjects (186 men and 170 women; mean age 66 (58-82) years) with no RCT. All participants were questioned about their alcohol intake. Participants were divided into: (1) non-drinkers if they consumed less than 0.01 g of ethanol per day, and (2) moderate drinkers and (3) excessive drinkers if women (men) consumed > 24 g (36 g) per day for at least 2 years. Results - Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR = 1.7, 95% CI: 1.2-3.9; women: OR = 1.9, 95% CI: 0.94-4.1). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions. Interpretation - Long-term alcohol intake is a significant risk factor for the occurrence and severity of rotator cuff tear in both sexes

Subtle changes in central dopaminergic tone underlie bradykinesia in essential tremor

Introduction: In this research, our primary objective was to explore the correlation between basal ganglia dopaminergic neurotransmission, assessed using 123I-FP-CIT (DAT-SPECT), and finger movements abnormalities in patients with essential tremor (ET) and Parkinson's disease (PD). Methods: We enrolled 16 patients with ET, 17 with PD, and 18 healthy controls (HC). Each participant underwent comprehensive clinical evaluations, kinematic assessments of finger tapping. ET and PD patients underwent DAT-SPECT imaging. The DAT-SPECT scans were subjected to both visual and semi-quantitative analysis using DaTQUANT®. We then investigated the correlations between the clinical, kinematic, and DAT-SPECT data, in patients. Results: Our findings confirm that individuals with ET exhibited slower finger tapping than HC. Visual evaluation of radiotracer uptake in both striata demonstrated normal levels within the ET patient cohort, while PD patients displayed reduced uptake. However, there was notable heterogeneity in the quantification of uptake within the striata among ET patients. Additionally, we found a correlation between the amount of radiotracer uptake in the striatum and movement velocity during finger tapping in patients. Specifically, lower radioligand uptake corresponded to decreased movement velocity (ET: coef. = 0.53, p-adj = 0.03; PD: coef. = 0.59, p-adj = 0.01). Conclusion: The study's findings suggest a potential link between subtle changes in central dopaminergic tone and altered voluntary movement execution, in ET. These results provide further insights into the pathophysiology of ET. However, longitudinal studies are essential to determine whether the slight reduction in dopaminergic tone observed in ET patients represents a distinct subtype of the disease or could serve as a predictor for the clinical progression into PD

Shoulder pain due to cervical radiculopathy: an underestimated long-term complication of herpes zoster virus reactivation?

Purpose To evaluate if herpes zoster virus (HZV) reactivation may be considered in the aetiology of cervical radiculopathy. Methods The study group was composed of 110 patients (52 M-58F;mean age ± SD:46.5 ± 6.12; range:40-73) with a clinical diagnosis of cervical radiculopathy. Patients with signs of chronic damage on neurophysiological studies were submitted to an X-ray and to an MRI of the cervical spine in order to clarify the cause of the cervical radiculopathy and were investigated for a possible reactivation of HZV; HZV reactivation was considered as “recent” or “antique” if it occurs within or after 24 months from the onset of symptoms, respectively. Data were submitted to statistics. Results Thirty-eight patients (34,5%,16 M-22F) had a history of HZV reactivation: four (2 M-2F) were “recent” and 34 (14 M-20F) were “antique”. In 68 of 110 participants (61,8%,30 M-38F), pathological signs on X-ray and/or MRI of the cervical spine appeared; in the remaining 42 (38,2%,22 M-20F) X-ray and MRI resulted as negative. Among patients with HZV reactivation, seven (18,4%) had a “positive” X-ray-MRI while in 31 (81,6%) the instrumental exams were considered as negative. The prevalence of “antique” HZV reactivations was statistically greater in the group of patients with no pathological signs on X-ray/MRI of the cervical spine with respect to the group with a pathological instrumental exam (p < 0.01). Conclusions It may be useful to investigate the presence of a positive history of HZV reactivation and to consider it as a long-term complication of a cervical root inflammation especially in patients in which X-ray and MRI of the cervical spine did not show pathological findings

Acromioclavicular joint cyst in ASA 3-4 patients. Whether and how quickly it recurs after aspiration and steroid injection

Introduction:We retrospectively observed the clinical course of patients with voluminous(&gt;7cm)  type II acromioclavicular(AC) joint cyst who underwent cyst aspiration and steroid injection.Methods: Cyst aspiration and steroid injection on 4 ASA 3-4 patients (3F-1M;mean age 83 years,range:78-87 years) with a cyst overlying the AC joint was performed. Patients were evaluated on the day of aspiration and after 14-30 days and after 1 year; VAS and Constant score were registered.Results:After 14 days patients had a cyst recurrence, a lower grade of skin tension overlying the cyst and a little decreasing of pain intensity. After one month, the cysts of the 4 patients had the same size as that present before aspiration. VAS and Constant were similar to those recorded before aspiration.Conclusion:Aspiration is a useless practice;it is still a motive for discussion if the reduced suffering of the skin overlying the cyst has avoided, or simply postponed, an imminent complication

Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area

Background: Literature lacks data concerning several epidemiologic aspects of proximal humeral fractures (PHFs). Methods: This retrospective study included 711 consecutive patients (209 men, 502 women) who sustained a PHF in the last 3 years. Participants were divided into 2 groups, adults and children. Data regarding age, sex, date, and fracture side were collected. According to the mechanism of injury, we arbitrarily distinguished 7 subgroups. PHFs were classified according to the head-greater-lesser-shaft (HGLS)-Hertel classification and to the Salter-Harris classification using x-ray and computed tomography imaging. Results: PHFs represent 5.03% of the overall fractures. The right side was involved in 389 patients (54.7%; P = .6). The mean age of male and female patients was 55.4 (standard deviation,  21.9) years and 67.0 (standard deviation, 16.1) years, respectively (P = .0001). Significant differences in the trauma mechanism between female patients (street/home low-energy trauma) and male patients (high-energy trauma) were found. A significant correlation between trauma mechanisms from 1 to 5 and fracture patterns H-G-L-S, HL-G-S, HGL-S, and HLS-G was observed. The occurrence of the same patterns significantly varied according to different age subgroups. Considering the pediatric population, a significant incidence of Salter-Harris 2 in both genders was found. No correlation was observed between the fracture patterns and the trauma mechanism. Conclusions: PHFs have a higher prevalence and incidence in females and in older age, respectively; they are more frequent in the winter months. In addition, male fractures are due to different traumatic events than those in females. A correlation between trauma and PHF pattern was evident only for adults. Some fracture patterns are correlated with different ranges of age in all patient

Erratum: association between alcohol consumption and rotator cuff tear (Acta Orthop, (2016), 87, 2, (165-168), 10.3109/17453674.2015.1119599)

Results - Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR =3.0, CI: 1.5-6.0, p < 0.001; women: OR =3.6, CI: 1.7-7.8, p < 0.001). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions

Hardware Optimizations of the X-ray Pre-Processing for Interventional Computed Tomography Using the FPGA

In computed tomography imaging, the computationally intensive tasks are the pre-processing of 2D detector data to generate total attenuation or line integral projections and the reconstruction of the 3D volume from the projections. This paper proposes the optimization of the X-ray pre-processing to compute total attenuation projections by avoiding the intermediate step to convert detector data to intensity images. In addition, to fulfill the real-time requirements, we design a configurable hardware architecture for data acquisition systems on FPGAs, with the goal to have a “on-the-fly” pre-processing of 2D projections. Finally, this architecture was configured for exploring and analyzing different arithmetic representations, such as floating-point and fixed-point data formats. This design space exploration has allowed us to find the best representation and data format that minimize execution time and hardware costs, while not affecting image quality. Furthermore, the proposed architecture was integrated in an open-interface computed tomography device, used for evaluating the image quality of the pre-processed 2D projections and the reconstructed 3D volume. By comparing the proposed solution with the state-of-the-art pre-processing algorithm that make use of intensity images, the latency was decreased 4.125×, and the resources utilization of ∼6.5×, with a mean square error in the order of 10−15 for all the selected phantom experiments. Finally, by using the fixed-point representation in the different data precisions, the latency and the resource utilization were further decreased, and a mean square error in the order of 10−1 was reached