Cotyledonoid dissecting leiomyoma of the uterus: a case report

Cotyledonoid dissecting leiomyoma of the uterus is a recently described rare variant of benign uterine leiomyoma. We report a case of cotyledonoid dissecting leiomyoma in a 52 year old woman who presented with menorrhagia and abdominal pain. An ultrasound scan showed a bulky uterus and a cystic heterogenous mass near the left ovary. At hysterectomy, the left broad ligament mass was removed. This was continuous with an ill-defined nodular area in the myometrial fundus. Microscopy revealed a benign smooth muscle proliferation in the myometrium that extended beyond the uterus and into the broad ligament. The lesion appeared to be dissecting the myometrial fibres and showed areas of oedema, hyalinisation and perinodular hydropic change. Cellular atypia, mitoses and coagulative necrosis were absent. The patient is alive and well 18 months after surgery. It is important to recognize this benign and unusual appearing variant of leiomyoma in order to prevent inappropriate treatment

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Survey on Knowledge, Use, and Diagnostic Applicability of Special Tests for Rotator Cuff Involvement in Clinical Practice

# Background Recently, researchers have commented that shoulder special tests cannot identify the structure causing rotator cuff symptoms and should only be considered pain provocation tests. Others have disagreed, reporting that special tests were able to accurately detect the presence of rotator cuff involvement. # Purpose The purpose of this study was to determine the knowledge, use, and perceived effectiveness of 15 selected special tests utilized to examine patients with possible rotator cuff dysfunction. # Study Design Descriptive study using survey. # Methods An electronic survey was returned by 346 members of the Academies of Orthopedic and Sports Physical Therapy through list serves. Descriptions and pictures for 15 special tests of the shoulder were included in the survey. Information regarding years of clinical experience and American Board of Physical Therapy Specialties (ABPTS) specialist certification in Sports or Orthopedics was collected. Respondents were asked if they could *identify* and *use* the special tests to evaluate dysfunction of the rotator cuff - and how confident they were in ability of the tests to *diagnose* dysfunction of the rotator cuff. # Results The four tests most readily *known* by respondents included the empty can, drop arm, full can, and Gerber's tests, and the four tests *used* regularly by the respondents included the infraspinatus, full can, supraspinatus, and champagne toast tests. The infraspinatus, champagne toast, external rotation lag (ERLS), and the belly-off tests were found to be the be most useful for establishing a *diagnosis* of the muscle-tendon complex involved. Years of experience and clinical specialization was not relevant to knowledge or use or these tests. # Conclusions This study will allow clinicians and educators to understand which special tests are easily identified, regularly used, and perceived as helpful for the diagnosis of muscles involved in a rotator cuff dysfunction. # Level of Evidence 3