Rotator Cuff Calcific Tendinopathy : Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles

Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years \ub1 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, \u3c7(2), and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 \ub1 7; 1 month, 69 \ub1 7; 3 month, 90 \ub1 5; 1 year, 92 \ub1 4; double-needle group: 57 \ub1 6; 71 \ub1 9; 89 \ub1 7; 92 \ub1 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year

Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial

Purpose: To compare short- and long-term outcomes of patients with rotator cuff calcific tendonitis who did and did not undergo ultrasonographically (US)-guided percutaneous treatment. Materials and Methods: Institutional review board approval and informed patient consent were obtained. Of patients referred for US-guided treatment of rotator cuff calcific tendonitis, 219 (86 men, 133 women; mean age, 40.3 years \ub1 10.9 [standard deviation]) were treated; 68 (31 men, 37 women; mean age, 40.2 years \ub1 11.3) patients refused treatment and served as control subjects. After local anesthesia was induced, two 16-gauge needles were inserted into the calcific deposit. Saline solution was injected through one needle, and the dissolved calcium was extracted through the other needle. Shoulder joint function was assessed by using Constant scores, and pain was assessed by using visual analogue scale (VAS) scores. Mann-Whitney U and \u3c72 tests were performed. Results: At baseline, no significant difference in age or sex distribution, Constant score, or VAS score was detected between treated and nontreated (control) patients. Compared with control subjects, treated patients reported a significant decrease in symptoms at 1 month (mean Constant score, 73.2 \ub1 6.2 vs 57.5 \ub1 3.9; mean VAS score, 4.8 \ub1 0.6 vs 9.1 \ub1 0.5), 3 months (mean Constant score, 90.2 \ub1 2.6 vs 62.6 \ub1 7.2; mean VAS score, 3.3 \ub1 0.4 vs 7.3 \ub1 1.8), and 1 year (mean Constant score, 91.7 \ub1 3.1 vs 78.4 \ub1 9.5; mean VAS score, 2.7 \ub1 0.5 vs 4.5 \ub1 0.9) (P < .001). Symptom scores were not significantly different between the groups at 5 years (mean Constant score, 90.9 \ub1 3.6 vs 90.5 \ub1 4.8; mean VAS score, 2.6 \ub1 0.5 vs 2.8 \ub1 0.7) (P 65 .795) and 10 years (mean Constant score, 91.8 \ub1 5.0 vs 91.3 \ub1 9.6; mean VAS score, 2.5 \ub1 0.6 vs 2.7 \ub1 0.6) (P 65 .413). Conclusion: US-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief. Treated patients had better outcomes than did nontreated patients at 1 year. However, 5 and 10 years after the procedure, the nontreated group reported outcomes similar to those of the treated group

Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity

Purpose: Intramuscular injection of botulinum toxin A (BTX-A) is a common treatment for iliopsoas muscle spasticity, but it is not easy to position the needle in this muscle without guidance. In this paper we describe an ultrasound-guided technique for the intramuscular injection of BTX-A to treat spasticity of the iliopsoas muscle. Its effectiveness was assessed in 10 patients. Method and materials: The ultrasound-guided technique for BTX-A injection was used on 10 patients. The needle was inserted into the muscle belly at an angle of 45\ub0 along the longitudinal axis of the muscle when allowed by patient's condition. Results: In all cases, the iliopsoas muscle was easily identified and both the iliac and psoas components were assessed. Introduction of the needle and drug injection were entirely carried out under ultrasonographic guidance. The procedure was successful in all patients, even in those with a high-grade spasticity, and general anesthesia was not required. Conclusions: This ultrasound-guided technique allows accurate guidance for the injection of BTX-A, and it can be considered as an alternate supportive therapy in patients with spasticity and dystonia

La ley Nacional de Salud Mental: Avances y dificultades en su implementación en Hospitales Generales del Gran Rosario.

A partir de la sanción de la Ley Nacional de Salud Mental (año 2010) y posterior reglamentación, nos ha interesado relevar y analizar las prácticas en Salud Mental que se llevan a cabo con quienes padecen sufrimiento psíquico en hospitales públicos polivalentes del Gran Rosario. El objetivo se centra en indagar si se han generado cambios en las modalidades de atención en estos últimos años y, desde la visión de los propios trabajadores de salud mental, cuáles son las potencialidades y dificultades que perciben en el proceso de implementación de legislación vigente en la actualidad. El presente trabajo es un avance de una investigación descriptivo-exploratoria que se viene realizando desde una estrategia cualitativa, a través de entrevistas semi-estructuradas y desde una perspectiva interdisciplinaria a diferentes profesionales que integranServicios de Salud Mental. Uno de los cambios significativos que identifican a partir de la ley es la mejora generada al legitimar las internaciones en los hospitales generales y el trabajo interdisciplinario en la toma de decisiones en los tratamientos ambulatorios y en los criterios de internación o de externaciónpara sujetos con sufrimiento psíquico. Si bien admiten que les resulta dificultoso por la formación recibida en sus respectivas carreras el trabajar con profesionales de otras disciplinas y, específicamente en Salud Mental, observan resultados positivos en esa modalidad de atención. Se tienden a fortalecer las acciones en red e intercambios intersectoriales e interinstitucionales. Las internaciones son breves y cuando es necesario prolongarlas se deriva al hospital monovalente por la disposición edilicia. Observan que aún persisten resistencias del personal en la atención a personas con padecimiento psíquico. En algunos casos señalan la dificultad que se presenta en la Guardia donde no suele haber presencia de psicólogos o psiquiatras y la necesidad de incrementar la planta profesional y mejorar las condiciones laborales

Penile inflammation

RésuméLa collectivisation de l’agriculture et les éleveurs de bétail kazakhs, 1928-1934.L’article expose les grandes lignes de la politique adoptée par l’État soviétique envers les éleveurs de bétail kazakhs entre la crise de 1928 et le milieu des années 1930 dans le but d’expliquer la mort de plus d’un million de Kazakhs pendant la famine de 1931-1933. À la cause le plus souvent invoquée par les historiens -- la perte des moyens de subsistance qui résulta de la réquisition et de l’abattage du bétail avant l’introduction forcée des Kazakhs dans les kolkhozes -- on peut ajouter les initiatives de l’appareil administratif local qui obéissait aux ordres de Moscou, telle la réquisition des céréales, imposée dans le cadre d’une « redistribution des préjudices » infligés aux paysans vers les éleveurs. De plus, les réquisitions et la famine causèrent l’effondrement du commerce entre les paysans et les éleveurs de bétail. Ce sont les éleveurs qui en souffrirent le plus.AbstractThe article outlines the policies of the Soviet state towards the Kazakh herdsmen between the 1928 crisis and the mid-1930s, in order to explain the death of more than a million Kazakhs during the 1931-1933 famine. Together with the cause more frequently indicated in the literature, the loss of means of subsistence which resulted from the requisitioning and butchering of the herdsmen’s livestock before they were pushed into the kolkhozes, it is possible to add the initiatives of the local administrative apparatus, determined primarily by the logic of the requests arriving from Moscow. These initiatives materialized principally in grain requisitions being imposed on the herdsmen, in a process of “redistribution of damages” from the peasants to the herdsmen. Moreover, requisitions and famine caused the collapse of trade between herdsmen and peasants, and this worked more against the former than the latter