Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment

Calcific tendinitis is a painful shoulder disorder characterised by either single or multiple deposits in the rotator cuff tendon. Although the disease subsides spontaneously in most cases, a subpopulation of patients continue to complain of pain and shoulder dysfunction and the deposits do not show any signs of resolution. Although several treatment options have been proposed, clinical results are controversial and often the indication for a given therapy remains a matter of clinician choice. Herein, we report on the current state of the art in the pathogenesis, diagnosis and treatment of calcific tendinitis of the rotator cuff

Complications of calcific tendinitis of the shoulder: a concise review

Abstract: Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient. Level of evidence: 5

Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: A prospective randomized comparative study

Background: Acromioclavicular (AC) dislocation involves complete loss of articular contact; it is defined as chronic when it follows conservative management or unsuccessful surgical treatment. Materials and methods: The study compared the clinical and radiographic outcomes of AC joint stabilization performed in 40 patients with chronic dislocation using a biological allograft (group A) or a synthetic ligament (group B). Demographic data included: M/F: 25/15; mean age: 35 ± 3.2 years; previous surgery in 11 patients, including Weaver-Dunn (3), coracoacromial ligament repair (4), stabilization with K-wires (4). Dislocation was type III in 14 (35 %) and type IV in 26 (65 %) patients. Clinical assessment was with the Constant-Murley score (pre- and postoperative) and with the modified UCLA score. Enrollment started in January 2004 and was completed in March 2008. Patients were evaluated at 1 and 4 years. Postoperative X-rays were examined to assess joint stability in the coronal and axial planes, coracoclavicular ossification, and signs of AC joint osteoarthritis and distal clavicular osteolysis. Results: The "biological" group achieved significantly better clinical scores than the "synthetic" group at both 1 and 4 years. Poor subjective satisfaction and lower clinical scores were found in the 3 patients (1 from group A and 2 from group B) who experienced complete postoperative dislocation. No significant correlations were found with other radiographic parameters. Conclusions: The biological graft afforded better clinical and radiographic outcomes than the synthetic ligament in patients with chronic AC joint instability. Fixation to the clavicle constitutes the main weakness of both approaches and needs improving. © 2012 The Author(s)

Ossifying tendinitis of the rotator cuff after arthroscopic excision of calcium deposits: report of two cases and literature review

Ossifying tendinitis (OT) is a type of heterotopic ossification, characterized by deposition of hydroxyapatite crystals in a histologic pattern of mature lamellar bone. It is usually associated with surgical intervention or trauma and is more commonly seen in Achilles or distal biceps tendons, and also in the gluteus maximus tendon. To our knowledge, there is no description of OT as a complication of calcifying tendinitis of the rotator cuff. In this report, we describe two cases in which the patients developed an OT of the supraspinatus after arthroscopic removal of calcium deposits. The related literature is reviewed

Arthroscopic treatment of early glenohumeral arthritis

Background: The articular cartilage of the shoulder is not endowed with intrinsic repair abilities, so the detection of chondral lesions during arthroscopy may indicate that additional articular procedures are needed. The aim of the current study was to evaluate the benefits of arthroscopy in patients with early shoulder arthritis, and to assess which clinical and radiological features are correlated with better arthroscopic outcomes. Materials and methods: Out of a total of 2,707 shoulders, 61 arthroscopies were performed on patients aged 30-55 years suffering from a painful early arthritic shoulder. We performed a retrospective study of 47 of those 61 patients with osteoarthritis at Samilson-Prieto stage I or II. SST and Constant score were used as outcome measures. Arthroscopic circumferential capsulotomy was performed to release the soft tissues and increase the joint space. Glenoid chondral lesions were caregorized according to location (anterior, posterior, centered) and size (small, large, total) and treated with microfractures; in the last 11 patients, we placed a engineered hyaluronic acid membrane, Hyalograft® C, on the surface of the glenoid. Postoperative care included mobilization the day after surgery, with the arm protected in a sling for two weeks. Follow-up examinations were performed at 3, 6, 12, and 24 months after surgery. The clinical and radiographic data collected were compared with those obtained at the last examination. Results: The mean Constant score increased from 43.8 points to 79.1, and the mean SST score increased from 4.9 points to 9.4 points. Clinical outcomes improved significantly in 44 patients (93.6 %). The three patients (6.4 %) with the lowest scores showed progression of arthritis. Age, gender, glenohumeral distance, and presence of engineered hyaluronic acid membrane were not related to clinical scores. Recovery of range of motion as well as small and centered cartilage lesions were statistically associated with improved outcome. Conclusion: The main finding was that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions. © 2012 The Author(s)

Anterior Glenoid Rim Fracture Following Use of Resorbable Devices for Glenohumeral Stabilization

Background Resorbable anchors are widely used in arthroscopic stabilization of the shoulder as a means of soft tissue fixation to bone. Their function is to ensure repair stability until they are replaced by host tissue. Complications include inflammatory soft tissue reactions, cyst formation, screw fragmentation in the joint, osteolytic reactions, and enhanced glenoid rim susceptibility to fracture. Purpose To evaluate resorption of biodegradable screws and determine whether they induce formation of areas with poor bone strength that may lead to glenoid rim fracture even with minor trauma. Study Design Case series; Level of evidence, 4. Methods This study evaluated 12 patients with anterior shoulder instability who had undergone arthroscopic stabilization with the Bankart technique and various resorbable anchors and subsequently experienced redislocation. The maximum interval between arthroscopic stabilization and the new dislocation was 52 months (mean, 22.16 months; range, 12-52 months). The mean patient age was 31.6 years (range, 17-61 years). The persistence or resorption of anchor holes; the number, area, and volume of osteolytic lesions; and glenoid erosion/fracture were assessed using computed tomography scans taken after redislocation occurred. Results Complete screw resorption was never documented. Osteolytic lesions were found at all sites (mean diameter, 5.64 mm; mean depth, 8.09 mm; mean area, 0.342 cm2; mean volume, 0.345 cm3), and all exceeded anchor size. Anterior glenoid rim fracture was seen in 9 patients, even without high-energy traumas (75% of all recurrences). Conclusion Arthroscopic stabilization with resorbable devices is a highly reliable procedure that is, however, not devoid of complications. In all 12 patients, none of the different implanted anchors had degraded completely, even in patients with longer follow-up, and all induced formation of osteolytic areas. Such reaction may lead to anterior glenoid rim fracture according to the literature and as found in 75% of the study patients with local osteolysis (9/12). Reducing anchor number and/or size may reduce the risk of osteolytic areas and anterior glenoid rim fracture

Treatment of perinfarction recurrent ventricular fibrillation by percutaneous pharmacological block of left stellate ganglion

A patient suffering from an acute myocardial infarction presented on the seventh and eighth days of hospitalization recurrent episodes of ventricular fibrillation refractory to antiarrhythmic treatment. The life-threatening ventricular fibrillation was suppressed by percutaneous pharmacological block of the left stellate ganglion

A massive nebula around the Luminous Blue Variable star RMC143 revealed by ALMA

The luminous blue variable (LBV) RMC143 is located in the outskirts of the 30~Doradus complex, a region rich with interstellar material and hot luminous stars. We report the $3\sigma$ sub-millimetre detection of its circumstellar nebula with ALMA. The observed morphology in the sub-millimetre is different than previously observed with HST and ATCA in the optical and centimetre wavelength regimes. The spectral energy distribution (SED) of RMC143 suggests that two emission mechanisms contribute to the sub-mm emission: optically thin bremsstrahlung and dust. Both the extinction map and the SED are consistent with a dusty massive nebula with a dust mass of $0.055\pm0.018~M_{\odot}$ (assuming $\kappa_{850}=1.7\rm\,cm^{2}\,g^{-1}$). To date, RMC143 has the most dusty LBV nebula observed in the Magellanic Clouds. We have also re-examined the LBV classification of RMC143 based on VLT/X-shooter spectra obtained in 2015/16 and a review of the publication record. The radiative transfer code CMFGEN is used to derive its fundamental stellar parameters. We find an effective temperature of $\sim 8500$~K, luminosity of log$(L/L_{\odot}) = 5.32$, and a relatively high mass-loss rate of $1.0 \times 10^{-5}~M_{\odot}$~yr$^{-1}$. The luminosity is much lower than previously thought, which implies that the current stellar mass of $\sim8~M_{\odot}$ is comparable to its nebular mass of $\sim 5.5~M_{\odot}$ (from an assumed gas-to-dust ratio of 100), suggesting that the star has lost a large fraction of its initial mass in past LBV eruptions or binary interactions. While the star may have been hotter in the past, it is currently not hot enough to ionize its circumstellar nebula. We propose that the nebula is ionized externally by the hot stars in the 30~Doradus star-forming region.Comment: Paper accepted by A&A on 09/05/2019 and in proof stage. Second comments by referee are included in this versio

Enhancing Children’s Experience with Recommendation Systems

Recommender Systems (RSs) offer a personalized support in exploring large amounts of information, assisting users in decision making about products matching their taste and preferences. Most of the research todate on recommender systems have focused on traditional users, i.e., adult individuals who are able to offer explicit feedback, write reviews, or purchase items themselves. However, children's patterns of attention and interaction are quite different from those of adults. This paper presents the first results of a research-in-progress that can be suited to bridge the barrier between children and a recom-mender system by providing a child-friendly interaction paradigm. Specifically, a web application is developed that employs real-time object recognition on movie thumbnails or DVD cover-photos in a real-time manner. The tangible object can be manipulated by the user and provide input to the system for the purpose of generating movie recommendations. We plan to extend this work to the scenario where the child could ask for a video content showing a related toy (e.g., a car, a plane, the doll of a character that she likes in a cartoon) and the system could generate the videos that matches these implicit preferences expressed by the chil