Subscapular and Pectoralis Major Sparing Deltopectoral Approach for Reverse Total Shoulder Arthroplasty

In reverse ball shoulder replacement, surgery is usually performed using a deltopectoral approach or an anterosuperior transdeltoid approach. The deltopectoral approach is to incise the pectoralis major to upper 1/3 to 1/2, and subscapularis tendon should be removed at the lesser tuberosity of the humerus. This approach has the problem of breaking the shoulder deltoid instead of incising the rotator cuff. Therefore, we report a detailed procedure of reverse ball shoulder replacement using approach without incision of the pectoralis major muscle and subscapularis muscle

Impacts of Comorbidities on the Association between Arterial Stiffness and Obstructive Sleep Apnea in the Elderly

BACKGROUND: Although the impact of obstructive sleep apnea (OSA) on cardiovascular risk is reasonably well established in middle-aged patients, debate persists whether OSA also increases this risk in the elderly. Arterial stiffness has been used as an early independent predictor of cardiovascular risk. STUDY OBJECTIVES: We sought to determine whether OSA had significant effects on the arterial stiffness in the elderly population and evaluate the impacts of comorbidities on the association between arterial stiffness and OSA. METHODS: We performed a cross-sectional study in a university hospital. Elderly participants (≥60 yr) were invited to participate in our study between November 2010 and January 2013. OSA was diagnosed using gold standard polysomnography and arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) as well as by central systolic and diastolic blood pressure (cSBP and cDBP). High-sensitivity C-reactive protein (hs-CRP) level was also measured. RESULTS: We found no significant association between the severity of OSA and arterial stiffness-related parameters such as cSBP, cDBP, baPWV, CAVI, and hs-CRP. However, in patients without comorbid medical conditions or use of medications (n=101), we showed a modest association between OSA and arterial stiffness-related parameters and hs-CRP. CONCLUSION: We conclude that OSA is associated with increased arterial stiffness in otherwise healthy elderly population, although the association was obviated by comorbidities and medications perhaps due to ceiling effects

Parathyroidectomy versus cinacalcet in the treatment of tertiary hyperparathyroidism after kidney transplantation: a retrospective study

Background Hyperparathyroidism is common in patients with chronic kidney disease with reduced renal function and has been observed after kidney transplantation. The optimal treatment for cases in which hyperparathyroidism persists after kidney transplantation has not been determined. Methods This retrospective study included 83 patients with tertiary hyperparathyroidism who underwent kidney transplantation between 2000 and 2018 at a single tertiary center in Korea. Sixty-four patients underwent parathyroidectomy and 19 patients were treated with cinacalcet following renal transplantation. Biochemical parameters and clinical outcomes were compared between the two groups. Results Serum calcium and parathyroid hormone (PTH) levels improved in both the parathyroidectomy and cinacalcet groups. One year after treatment, parathyroidectomy resulted in a lower mean serum calcium level than cinacalcet (9.7 ± 0.7 mg/dL vs. 10.5 ± 0.7 mg/dL, p = 0.001). Regarding serum PTH, the parathyroidectomy group showed a significantly lower PTH level than the cinacalcet group at 6 months (129.1 ± 80.3 pg/mL vs. 219.2 ± 92.5 pg/mL, p = 0.002) and 1 year (118.8 ± 75.5 pg/mL vs. 250.6 ± 94.5 pg/mL, p < 0.001). There was no statistically significant difference in the incidence of kidney transplant rejection, graft failure, cardiovascular events, fracture risk, or bone mineral density changes between the two groups. Conclusion Parathyroidectomy appears to reduce PTH and calcium levels effectively in tertiary hyperparathyroidism. However, creatinine level and allograft rejection should be monitored closely