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OBJECTIVE@#To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives.@*METHODS@#A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated.@*RESULTS@#The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). Compared with the first follow-up, except for a significant increase in ASES score ( P<0.05), there was no significant difference in the other indicators ( P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up ( P<0.05), GFDI-5 increased significantly ( P<0.05), and there was significant difference in the tangent sign ( P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle ( P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up ( P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder ( P>0.05).@*CONCLUSION@#Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Rotator Cuff Injuries/surgery , Retrospective Studies , Shoulder Joint/surgery , Treatment Outcome , Arthroscopy/methods , Range of Motion, ArticularABSTRACT
OBJECTIVE@#To observe the therapeutic effect of electroacupuncture on lumbar disc herniation (LDH) with different multifidus fatty infiltration rates.@*METHODS@#A total of 108 eligible LDH patients received MRI test before treatment and the multifidus fatty infiltration rate (FI) was measured. According to theresults, they were divided to group A (FI20%), 36 cases in each one. EA was provided in all of the groups. The selected acupoints were Jiaji (EX-B 2) from L@*RESULTS@#Compared with before treatment, ODI score was reduced (@*CONCLUSION@#Electroacupuncture relieves pain and improves physical and psychological health of LDH patients. Multifidus fatty infiltration rate is probably one of the factors to influence the therapeutic effect of electroacupuncture.
Subject(s)
Humans , Acupuncture Points , Electroacupuncture , Intervertebral Disc Degeneration , Intervertebral Disc Displacement/therapy , Lumbar Vertebrae , Paraspinal MusclesABSTRACT
We present a case report that a longitudinal calf MR evaluation was performed for a patient with Charcot-Marie-Tooth disease who underwent bilateral reconstructive foot surgeries. A 39 years-old female was referred to our department because of severe bilateral cavus foot deformities and difficulty to walk. On radiological findings, severe bilateral cavus foot deformities were confirmed. On MR findings, fatty infiltrations were detected in the wide range of bilateral lower leg compartments. Difficulty to walk aggravated despite of the conservative treatment, so bilateral reconstructive foot surgeries were performed. She acquired plantigrade and better walking function postoperatively. Two years after surgery, no recurrence of cavus foot deformity was observed, but claw toe deformities and fatty infiltrations were mildly progressing. Since CMT is slowly progressive, we need to conduct a careful follow-up.
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We present a case report that a longitudinal calf MR evaluation was performed for a patient with Charcot-Marie-Tooth disease who underwent bilateral reconstructive foot surgeries. A 39 years-old female was referred to our department because of severe bilateral cavus foot deformities and difficulty to walk. On radiological findings, severe bilateral cavus foot deformities were confirmed. On MR findings, fatty infiltrations were detected in the wide range of bilateral lower leg compartments. Difficulty to walk aggravated despite of the conservative treatment, so bilateral reconstructive foot surgeries were performed. She acquired plantigrade and better walking function postoperatively. Two years after surgery, no recurrence of cavus foot deformity was observed, but claw toe deformities and fatty infiltrations were mildly progressing. Since CMT is slowly progressive, we need to conduct a careful follow-up.
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BACKGROUND: Fat infiltration is a key factor in the failure of rotator cuff repair. However, the pathological mechanism of fatty infiltration after rotator cuff injury is unclear. OBJECTIVE: To explore the differences in the expression of key genes after rotator cuff injury, to determine their functions and mechanism pathways, and to provide a theoretical basis for the pathological mechanism of fatty infiltration after rotator cuff injury. METHODS: GSE93661 was obtained through GEO database to screen differentially expressed genes. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were used to analyze the underlying mechanism of fatty infiltration. The protein-protein interaction network was constructed to obtain the pivot genes and analyze the potential pathogenic targets. RESULTS AND CONCLUSION: A total of 471 differentially expressed genes were identified. GO and KEGG analysis showed that neuroactive ligand-receptor interactions and cell adhesion molecular pathways were potential mechanisms of fat infiltration in rotator cuff tears. Leukotriene B4 receptor, as a pivot gene in the protein-protein interaction network, may be a key target for fat infiltration in rotator cuff tears. We have discovered potential key genes and pathways in the pathological development of fatty infiltration, providing a reference direction for future treatment.
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BACKGROUND: This study aimed to verify the diagnostic performance of Ultrasonography (US) in the evaluation of fatty infiltration (FI) in rotator cuff muscles and to analyze the diagnostic values of each measurement component.METHODS: The degree of FI in 108 shoulders was assessed by magnetic resonance imaging (MRI) and US. MRI findings were graded by the Goutallier classification. US findings were graded by the Strobel method. Agreement between MRI and US findings was evaluated. The sensitivity and specificity for detecting FI and intraobserver reliabilities were also assessed.RESULTS: US grading of the infraspinatus based on short-axis architecture showed good agreement (κ = 0.62). US grading-based on architecture showed good agreement for both supraspinatus and infraspinatus in long- and short-axis scans (supraspinatus, κ = 0.63; infraspinatus, κ = 0.68), while that based on echogenicity showed moderate agreement (supraspinatus, κ = 0.51; infraspinatus, κ = 0.50). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detecting advanced FI were significant in both axes.CONCLUSIONS: US is effective for detecting advanced FI in the rotator cuff muscles. US can assess the infraspinatus more accurately than the supraspinatus, and architecture is a more decisive component of FI status than echogenicity.
Subject(s)
Classification , Magnetic Resonance Imaging , Methods , Muscles , Rotator Cuff , Sensitivity and Specificity , Shoulder , UltrasonographyABSTRACT
BACKGROUND: This study evaluated postoperative changes in the supraspinatus from time-zero to 6 months, using magnetic resonance imaging (MRI). We hypothesized that restoration of the musculotendinous unit of the rotator cuff by tendon repair immediately improves the rotator cuff muscle status, and maintains it months after surgery. METHODS: Totally, 76 patients (29 men, 47 women) with rotator cuff tears involving the supraspinatus tendon who underwent arthroscopic rotator cuff repairs were examined. MRI evaluation showed complete repair with intact integrity of the torn tendon at both time-zero and at 6 months follow-up. All patients underwent standardized MRI at our institution preoperatively, at 1 or 2 days postoperative, and at 6 months after surgery. Supraspinatus muscular (SSP) atrophy (Thomazeau grade) and fatty infiltrations (Goutallier stage) were evaluated by MRI. The cross-sectional area of SSP in the fossa was also measured. RESULTS: As determined by MRI, the cross-sectional area of SSP significantly decreased 11.41% from time-zero (immediate repair) to 6 months post-surgery, whereas the Goutallier stage and Thomazeau grade showed no significant changes (p<0.01). Furthermore, compared to the preoperative MRI, the postoperative MRI at 6 months showed a no statistically significant increase of 8.03% in the cross-sectional area. In addition, morphological improvements were observed in patients with high grade Goutallier and Thomazeau at time-zero, whereas morphology of patients with low grade factors were almost similar to before surgery. CONCLUSIONS: Our results indicate that cross-sectional area of the initial repair appears to decrease after a few months postoperatively, possibly due to medial retraction or strained muscle.
Subject(s)
Humans , Male , Atrophy , Follow-Up Studies , Magnetic Resonance Imaging , Muscular Atrophy , Rotator Cuff , Tears , TendonsABSTRACT
Thymus is an encapsulated organ having its bilateral origin from the third pharyngeal pouch. It appears to be a single organ but actually it is bilobed. It attains its maximum development at puberty and then it begins to involute. The parenchyma is replaced by adipocytes and lymphocyte production declines. Here we present a large thymus with a small area of persistent active tissue in it which was obtained during routine undergraduate dissection class. Tissues taken from different quadrants of the large thymic mass were processed, embedded in paraffin and sections were taken for hematoxylin and eosin staining which showed presence of thymic tissue in only one quadrant. Further sections from that quadrant was treated with cytokeratin to confirm its epithelial origin. Therefore knowledge of a large persistent thymus will be helpful to the radiologists and surgeons for making differential diagnosis and in avoiding unnecessary surgical intervention.
Subject(s)
Adolescent , Aged , Humans , Adipocytes , Cadaver , Diagnosis, Differential , Eosine Yellowish-(YS) , Hematoxylin , Immunohistochemistry , Keratins , Lymphocytes , Paraffin , Puberty , Surgeons , Thymus GlandABSTRACT
Pancreatic fatty infiltration is defined as the deposition of excess adipose tissue (mainly consisting of triacylglyceride ) in the pancreas.Epidemiological studies have revealed that the prevalence of pancreatic fatty infiltration is high , but the research is still at a preliminary stage and there is no consensus on the relevant pathophysiological mechanisms so far .The diagnosis of pancreatic fatty infiltration relies on histopathologic examination and imaging techniques .This article reviews the recent research advances on the pancreatic fat infiltration in order to improve our understanding of the disease .
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BACKGROUND: This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. METHODS: This study retrospectively reviewed the MRIs of 106 patients (age 50–79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. RESULTS: ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values (p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. CONCLUSIONS: A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements.
Subject(s)
Humans , Male , Magnetic Resonance Imaging , Retrospective Studies , Rotator Cuff , Spine , TearsABSTRACT
Macrodystrophia lipomatosa is a rare presentation and only few cases are reported in scientific literature. We report a case of Macrodystrophia lipomatosa in a 7 year young girl from a tertiary care hospital Mumbai. Case presentation: A 7 year old female was presented to outpatient department with progressive enlargement of right lower limb with increase in size of right great toe since birth. On clinical examination there was non tender fluctuant soft tissue swelling with good functional limb. Scannogram showed reduction of the medial compartment of right knee joint and the right lower limb length was slightly longer compared to the left side with presence of soft tissue swelling on medial distal thigh and knee region. MRI showed un-encapsulated subcutaneous fatty tissue involving the entire right lower limb along its medial aspect up to the great toe with fatty infiltration of the vastus medialis muscle suggestive of macrodystrophia lipomatosa. Arterial and venous colour Doppler study of right lower limb was normal. Conclusion: Macrodystrophia lipomatosa is a rare congenital, non hereditary condition with localized macrodactyly and proliferation of mesenchymal element and marked increase in fibroadipose tissue. X-ray and MRI are investigation of choice. Doppler study shows normal vascularity.
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Objective:To describe a method based on analysis of the histogram of intensity values pro-duced from the magnetic resonance imaging (MRI)for quantifying the degree of fatty infiltration. Methods:The study included 25 patients with dystrophinopathy.All the subjects underwent muscle MRI test at thigh level.The histogram Mvalues of 250 muscles adjusted for subcutaneous fat,representing the degree of fatty infiltration,were compared with the expert visual reading using the modified Mercuri scale.Results:There was a significant positive correlation between the histogram Mvalues and the scores of visual reading (r =0.854,P <0.001).The distinct pattern of muscle involvement detected in the pa-tients with dystrophinopathy in our study of histogram M values was similar to that of visual reading and results in literature.The histogram M values had stronger correlations with the clinical data than the scores of visual reading as follows:the correlations with age (r =0.730,P <0.001 )and (r =0.753, P <0.001);with strength of knee extensor (r =-0.468,P =0.024)and (r =-0.460,P =0.027) respectively.Meanwhile,the histogram Mvalues analysis had better repeatability than visual reading with the interclass correlation coefficient was 0.998 (95% CI:0.997 -0.998,P <0.001)and 0.958 (95%CI:0.946 -0.967,P <0.001)respectively.Conclusion:Histogram Mvalues analysis of MRI with the advantages of repeatability and objectivity can be used to evaluate the degree of muscle fatty infiltration.
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Objective To analyze the characteristics of fat infiltration into the muscles of patients with Becker and Duchenne muscular dystrophy (DMD) so as to provide a guide for rehabilitation therapy.Methods Twenty-three children with Becker muscular dystrophy (BMD) and 47 with DMD who had never been treated with glucocorticoids were enrolled.MRI was performed on both of their thigh muscles.T1 weighted images were used to assess the fat infiltration of their thigh muscles using a 0-5 modified version of Mercuri's scale.The progression of fatty infiltration of the thigh muscles in BMD was analyzed using descriptive statistics.The differences in fat infiltration between BMD and DMD were analyzed using rank sum tests.Results In patients with BMD the adductor magnus most often showed severe fat infiltration,followed by the biceps femoris,quadriceps,semimembranosus and semitendinosus,while the sartorius,gracilis and adductor longus had the lowest percentages of severe fat infiltration.Among the BMD patients the adductor magnus,biceps femoris and quadriceps showed moderate to severe involvement at the age of 8 to 9.The semimembranosus and semitendinosus showed moderate to severe involvement at the age of 10 to 11,and the sartorius,gracilis and adductor longus showed mild to moderate involvement after 15 years of age.Among the age groups of 8,9,10 and 11 years old,the median total fat infiltration scores were 10,22,28 and 25 respectively among the BMD patients,and 29,34,34 and 30 respectively among the DMD patients.At age 8 significant differences between the BMD and DMD patients were observed in the infiltration scores of the adductor magnus,biceps femoris,vastus lateralis,rectus femoris,vastus medialis,vastus intermedius and in the total scores.At age 9 significant differences persisted in the scores of the adductor magnus,rectus femoris,vastus medialis,vastus intermedius and the total scores.Conclusions The muscle MRIs showed significant differences in the degree of fatty infiltration between BMD and DMD patients.These findings may be useful when designing therapeutic regimens and rehabilitation programs for patients with BMD and DMD.
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Background: Cyclophosphamide is widely used in the treatment of various neoplastic diseases and diseases associated with altered immunity. Higher doses used for longer duration effects many organs like urinary bladder, lungs, liver, heart and male reproductive organs. Methods: To study the effect of cyclophosphamide on the micro anatomy of liver, sixty eight Albino rats were taken and divided into three groups, group A (control group) of 20 animals, were fed with routine diet, group B (low dose group) of 24 animals, were given cyclophosphamide at the dose of 0.5 mg/100 gms in addition to the routine diet and group C (high dose group) of 24 animals, were given high dose of cyclophosphamide at the dose of 0.7 mg/100 gms of weight of animal in addition to the routine diet. The animals were sacrificed at intervals of 3, 6, 9 and 12 weeks, 5 microns sections of the tissue were prepared and stained with Haematoxylin and Eosin stain. Results: Microscopic changes in liver were apparent in the drug treated animals. In group B the changes appeared after 6 weeks while in group C they started appearing after 3 weeks of drug treatment. The changes were in the form of fatty changes, hemorrhages and central vein congestion. Conclusion: Cyclophosphamide induces histological changes like fatty infiltration and central vein congestion in the liver. These changes are with low doses given for longer durations and manifest earlier when larger doses are used. Thus it is advised that patients receiving cyclophosphamide should be periodically evaluated for liver dysfunction.
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Objective To explore the clinical value of real time contrast-enhanced ultrasound in diagnosis of liver localized fatty deletion and fatty infiltration which couldn't be confirmed by conventional ultrasonography. Methods Contrast-enhanced ultrasound was performed on 94 patients with liver localized diseases confirmed by baseline sonography, among them 34 patients with liver localized fatty deletion and fatty infiltration were enrolled. Results Contrast-enhanced ultrasonography didn't show apparent occupancy nidus in 34 patients. Enhancement mode of lesions was the same as liver parenchyma, which was distinctly different from liver occupancy diseases. Conclusion Real time contrast-enhanced ultrasound can display typical signs of liver localized fatty deletion and fatty infiltration and has significant value in diagnosis and differentiating diagnosis of them.
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Forty-three cases of fatty infiltration of the heart were studied from a review of 1787 consecutive autopsies done at White Cross Hospital from 1932 to 1950 inclusive. This constituted 2.4 per cent of the total autopsies and 7.61 per cent of 565 autopsied cases of heart disease during this period of studyFatty infiltration of the myocardium was frequently found in the right ventricle. This entity was more commonly seen in the older age group, past 50 years and both men and women equally affected in this series. There was no relationship to obesity or alcoholismThe clinical histories of 31 cases revealed that the patients were seriously ill and the conditions were severe enough to cause the death of the patients even without fatty infiltration of the myocardium. Two patients supposedly died from fatty infiltration. of the heartLiver biopsy as a diagnostic procedure in this condition offers no real possibilities. The critical condition of these patients may actually be a limiting factor as far as diagnostic procedures are concerned. The electrocardiogram may offer nothing specific. Perhaps myocardial biopsy will provide a specific diagnosis. (Summary)
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The authors have studied 67 biopsy specimens of the levator muscle, obtained from the external levator resection for ptosis of 50 patients. Atrophy marking as 3+ and complete absence of the levator muscle fiber were predominating in the specimens of severe congenital ptosis or ptosis with poor levator funtion. The degree of levator muscle atrophy seemed to be related with levator function. Fibrosis and fatty infiltration of the levator muscle and Muller's muscle were examined frequently in the specimens with severe atrophy of muscle fibers. On histochemical detection of muscle fibers using ATPase stain, lightly stained Type I fibers of the levator muscle were larger in amount than darkly stained Type II fibers and atrophy of the two fibers was similar in degree. Muller's muscle fibers were evenly stained with positive ATPase reaction but slightly lighter than Type II fibers.
Subject(s)
Humans , Adenosine Triphosphatases , Atrophy , Biopsy , Fibrosis , Muscular AtrophyABSTRACT
Objectives To approach the effect of the disturbance of lipid metabolism, fatty infiltration in oropharyngeal tissues on the patient with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods 19 obese patients of OSAHS, 15 nonobese patients of OSAHS and 9 healthy people (as control) were selected. Among the three groups, The related clinical index and size and the weight of uvula were measured. The fatty weight of uvula was analyzed by biochemical methods. The uvular tissue sections were evaluated by light microscope (LM) and transmission electron microscope (TEM). Results 1 Both the obese and nonobese groups, the TC, TC/HDL, size and weight and the adipose tissue in uvula were obviously different compared with control group( P