Pulmonary embolism following rotator cuff repair

Background: Previous studies have provided data on the incidence of pulmonary embolism following shoulder arthroplasty and repair of fractures of the proximal humerus. However; there is no information on the risk of pulmonary embolism following the surgical management of rotator cuff tears. Methods: We performed a review of 1176 patients who underwent operative procedures for rotator cuff tears between January 1 st ; 2001 and December 31 st ; 2005 to identify all patients who developed a symptomatic pulmonary embolism postoperatively. Results: Three patients developed pulmonary embolisms that were diagnosed with computed tomography angiography. The overall incidence was calculated to be 0.26. None of the patients died as a result of the pulmonary embolism. Conclusions: The data from this review indicates that the risk of pulmonary embolism following surgery for rotator cuff repair is low; but not nonexistent. The most common presenting symptoms of pulmonary embolism were chest pain; shortness of breath; and hypoxia. This study should raise surgeons' awareness about this possible complication following rotator cuff repair surgery

Computerised analysis of auscultatory sounds associated with vascular patency of haemodialysis access.

Vascular access for renal dialysis is a lifeline for about 120 000 individuals in the United States. Stethoscope auscultation of vascular sounds has some utility in the assessment of access patency, yet can be highly skill-dependent. The objective of the study was to identify acoustic parameters that are related to changes in vascular access patency. The underlying hypothesis is that stenoses of haemodialysis access vessels or grafts cause vascular sound changes that are detectable using computerised data acquisition and analysis. Eleven patients participated in the study. Their vascular sounds were recorded before and after angiography, which was accompanied by angioplasty in most patients. The sounds were acquired using two electronic stethoscopes and then digitised and analysed on a personal computer. Vessel stenosis changes were found to be associated with changes in acoustic amplitude and/or spectral energy distribution. Certain acoustic parameters correlated well (correlation coefficient = 0.98, p < 0.0001) with the change in the degree of stenosis, suggesting that stenosis severity may be predictable from these parameters. Parameters also appeared to be sensitive to modest diameter changes (> 20%), (p < 0.005, Wilcoxon rank sum test). These results suggest that computerised analysis of vascular sounds may be useful in vessel patency surveillance. Further testing using longitudinal studies may be warranted.

Effects of Sl nerve-root lengthening on tibial nerve F-wave latency in healthy subjects.

OBJECTIVE: To determine if lengthening the tibial portion of the sciatic nerve in healthy patients significantly alters F-wave latency. SUBJECTS: Ten volunteer students (6 men and 4 women). SETTING: Chiropractic college clinic. METHODS: F-wave latency was measured bilaterally in the supine position and supine in 40-50 degrees of passive hip flexion. Block randomization determined the test sequence. Supramaximal surface stimulation was delivered over the tibial nerve using transcutaneous electrical stimulation. The nerve was stimulated no more than 30 times at a rate of 1 Hz for 0.5 ms to get 16 F-wave latencies. The paired t test was used to determine mean difference between neutral and flexion. RESULTS: The F-wave latency was found to be longer in hip flexion (average 46.12 +/- 3.80 ms) than neutral (average 45.12 +/- 3.33 ms). CONCLUSION: Positioning a patient to optimize nerve lengthening and elicit symptoms may reveal occult dysfunction in electrodiagnostic examination.

Wounding effects of the AK-47 rifle used by Patrick Purdy in the Stockton, California, schoolyard shooting of January 17, 1989.

The limited disruption produced in tissue simulant by the rifle and bullets used in the Stockton, California, schoolyard shooting is entirely consistent with the autopsy reports on the five children who died of their wounds. It is also entirely consistent with well-documented battlefield studies and with previous tissue-simulant studies from many laboratories. It is inconsistent with many exaggerated accounts of assault-rifle wounding effects described by the media in the aftermath of this incident. This information should be documented for the historical record. However, the critical reason for correcting the misconceptions produced by media reaction to this incident is to prevent inappropriate gunshot-wound treatment.