Variable computed tomography appearances of COVID-19

The coronavirus disease 2019 (COVID-19) is typically diagnosed by specific assays that detect viral nucleic acid from the upper respiratory tract; however, this may miss infections involving only the lower airways. Computed tomography (CT) has been described as a diagnostic modality in the COVID-19 diagnosis and treatment plan. We present a case series with virologically confirmed COVID-19 pneumonia. Variable CT features were observed: consolidation with ground-glass opacities, ground-glass opacities with subpleural reticular bands, and an anterior-posterior gradient of lung abnormalities resembling that of acute respiratory distress syndrome. Evolution of CT findings was observed in one patient, where there was interval resolution of bilateral lung consolidation with development of bronchiolectasis and subpleural fibrotic bands. While sensitive for detecting lung parenchymal abnormalities in COVID-19 pneumonia, the use of CT for initial diagnosis is discouraged and should be reserved for specific clinical indications. Interpretation of chest CT findings should be correlated with duration of symptoms to better determine the disease stage and aid in patient management.

Arthroscopic repair of partial articular supraspinatus tendon avulsion lesions by conversion to full-thickness tears through a small incision / 中华创伤杂志(英文版)

PURPOSE@#To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion (PASTA) lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.@*METHODS@#We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of (54.7 ± 11.4) years from March 2013 to July 2017. Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study. The tears were confirmed via arthroscopy, and a polydioxanone suture was placed to indicate the position of each tear. A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear. The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor. Data were analyzed using a paired Student's t-test with statistical significance defined as p <0.05.@*RESULTS@#At the final follow-up of 2 years, the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery (p < 0.001). The postoperative American Shoulder and Elbow Surgeons shoulder score was (90.6 ± 6.2), which was significantly higher than the preoperative score of (47.9 ± 8.3) (p < 0.001). The University of California at Los Angeles shoulder rating scale score increased from (14.7 ± 4.1) prior to surgery to (32.6 ± 3.4) points after surgery (p < 0.001). No patient had joint stiffness.@*CONCLUSION@#This modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.

Arthroscopic treatment of popliteal cyst / 中华骨科杂志

Objective To evaluate the clinical effect of arthroscopic treatment of popliteal cyst.Methods Data of 42 patients,who had undergone arthroscopic treatment for popliteal cyst from November 2005 to January 2010,were retrospectively analyzed.There were 13 males and 29 females,including 6 children,aged from 11 to 68 years (average,43.2 years).All popliteal cysts were unilateral,including 14 cases of right knee and 28 cases of left knee.Eleven patients had recurrent popliteal cyst,and all of them underwent initial open surgery,and the duration from the initial surgery to recurrence ranged from 6 to 35 months (average,18 months).According to the Rauschning and Lindgren classification,there were 3 cases of grade Ⅰ,18 cases of grade Ⅱ and 21 cases of grade Ⅲ.Based on the MRI,the long diameter of the popliteal cysts ranged from 4.2 to 7.9 cm (average,5.4 cm),the transverse diameter 2.1 to 2.5 cm (average,2.3 cm) and anteroposterior diameter 1.6 to 2.2 cm (average,2.0 cm).All popliteal cysts were at posteriomedial parts of the knees,and 11 cases of popliteal cyst communicated with the knee joint cavity.Before operation,1 to 2 ml methylene blue was injected into the cyst,which was used to determine the channel intraoperatively according to the site where methylene blue flowed out.The intraarticular diseases were thoroughly treated when the inner wall of the popliteal cyst was cleaned.Results The intraarticular diseases were found in all patients intraoperatively,including medial meniscus tear in 28 cases,lateral meniscus tear in 9 cases and lateral discoid meniscus in 4 cases.There were no blood vessel complications,nerve complications and incision complications.All patients were discharged 2 or 3 days postoperatively.All patients were followed up for 10 to 30 months (average,18 months).No recurrence of popliteal cyst occurred at final follow-up.According to the Rauschning and Lindgren classification,there were 38 cases of grade 0 and 4 cases of grade Ⅰ.Conclusion The arthroscopic treatment of popliteal cyst has several advantages,such as mini-invasion,fast recovery and low recurrence rate.

Imaging evaluation of the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of blood supply of the femoral head / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of the blood supply of the femoral head through the digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement.</p><p><b>METHODS</b>Forty-five patients with the intracapsular fracture of femoral neck included 30 males and 15 females with an average age of 36.5 years ranging from 16 to 50. The course was from 6 to 25 days(means 10.2 days). There were 20 cases of sub-headfractures, 10 cases of head-neck, 15 cases of trans-neck. All patients were treated by 3 titanium alloy cannulated screws and deep circumflex iliac arterial vascularized iliac bone grafting. A follow-up for an average of 3 years and 6 months was performed. The engorging of the artery and reconstruction of the blood supply of the femoral head was viewed dynamicly,using digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement of the femoral head.</p><p><b>RESULTS</b>Three weeks after operation, 38 transferred arteries were engorging via DSA, 2 of 7 not via CTA, but engorging via DSA. One year later after operation, all arteries were engorging via DSA or CTA. ECT examination in 3, 6, 12 months after operation displayed nuclide enriching in the femoral head and distributing uniformity. The region of interest (ROI) ratios of the fractured head of femur to contralateral counterpart (D/N) in all cases > 1.0. The average D/N after 3 months was (2.12 +/- 0.21), (2.04 +/- 0.14) after 6 months, (l1.71 +/- 0.11) after 12 months. There was statistical differation between D/N after 12 months and 3 or 6 months (P < 0.05), but not between 3 and 6 months (P > 0.05), and MRI examination in all cases no founded decreasing of the density and changing of the form of the femoral head.</p><p><b>CONCLUSION</b>DSA, CTA, ECT, MRI confirmed that the deep circumflex iliac arterial vascularized iliac bone can provide effective blood supply and is profit to the reconstruction of the blood supply of the femoral head after the fracture of the femoral neck.</p>