Arthroscopic subacromial decompression: outcome comparison between outpatient and hospitalized patients with 2- to 5-year follow-up.

BACKGROUND AND AIMS: The purpose of this study was to evaluate the mid-term result of the arthroscopic subacromial decompression after failed conservative treatment of shoulder pain caused by subacromial impingement, when the patients were treated as an outpatient way or by staying overnight in hospital after surgery (hospitalized patients). Our hypothesis was that the results would be equal in both groups. MATERIAL AND METHODS: Arthroscopic subacromial decompression was performed in 80 consecutive patients, of which 40 patients were treated as an outpatient way (Outpatient Group), and 40 patients as a hospitalized way (Hospitalized Group). A prospective, comparative 2- to 5-year follow-up study including clinical examination, radiographic evaluation, isometric elevation strength measurements, as well as the University of California, Los Angeles (UCLA) and Constant shoulder scores was performed in 74 patients (93%). RESULTS: Preoperatively, the mean UCLA score was 19 (SD 3) in the Outpatient Group, and 19 (SD 3) in the Hospitalized Group. Respectively, the mean Constant scores were 62 (SD 10) and 60 (SD 11). At the follow-up, the mean UCLA score was 32 (SD 4) in the Outpatient Group, and 32 (SD 3) in the Hospitalized Group, which both indicated good clinical outcome. Respectively, the mean Constant scores were 95 (SD 7) and 92 (SD 11), which both indicated excellent clinical outcome. At the follow-up, the UCLA and the Constant shoulder scores were significantly bet-ter than preoperatively in both groups (p < 0.01, p < 0.01), although no differences were found between the groups.The duration of the sick leaves and ability to return to work were similar in both groups. Also, the isometric elevation strengths of the operated shoulders were equally good in both groups. CONCLUSIONS: According to this study, the results of arthroscopic subacromial decompression were equally good whether the patient was treated as an outpatient way or by staying over-night in hospital after surgery. The results were significantly better at follow-up than preoperatively in both groups. Key words: Shoulder pain; subacromial impingement; arthroscopic subacromial decompression; outpatient unit; hospitalized patient; clinical result.

Expression of leucine-rich repeats and immunoglobulin-like domains (LRIG) proteins in human ependymoma relates to tumor location, WHO grade, and patient age.

Three human leucine-rich repeats and immunoglobulin-like domains (LRIG1-3) genes and proteins have recently been characterized. LRIG1 has been shown to be a suppressor of tumor growth by counteracting the signaling of epidermal growth factor receptor (EGFR) family members, including EGFR (ERBB1). Expression of LRIG proteins seems to be of importance in the pathogenesis of astrocytic tumors. In this study, the expression of LRIG1-3 was evaluated in 51 human ependymomas by immunohistochemistry. LRIG proteins were detected in all ependymomas analyzed, however, with a pronounced heterogeneity in expression and subcellular localization. Higher cytoplasmic immunoreactivity of LRIG1 correlated with older patient age and higher LRIG1 nuclear immunoreactivity with lower WHO Grade. LRIG1 displayed a stronger immunoreactivity in the cytoplasm and nuclei in spinal ependymomas than in the posterior fossa or supratentorial ependymomas, while perinuclear LRIG3 was more highly expressed in supratentorial than in infratentorial ependymomas. The indications that expression and subcellular localization of LRIG proteins could be pathogenetically associated with specific clinicopathological features of ependymoma tumors might be of importance in the carcinogeneses and tumor progression of human ependymomas.

[Copper-silver T: The classic T resuscitated]. / T Cuivre-argent--le T classique ressuscite.

PIP: Tests of the contraceptive efficacy of different amounts of copper have indicated that effectiveness is proportional to surface area, but the improvement achieved with more than 200 sq mm of copper is minimal. Rates of release of copper vary considerably in different women. IUDs removed because of bleeding had a significantly higher release of copper. 1 consequence of variations in release of copper is unequal dissolution of copper leading to fragmentation of the copper thread. The Nova-T IUD has 200 sq mm of copper and a flexible body which is able to maintain correct placement in the uterus. A new device with a wire of silver coated with copper was designed to avoid the fragmentation of the copper and thus increase the duration of use. The new copper silver T was compared to the Nova-T in a randomized study in Scandinavia. The pregnancy rate after 1 year was under 1% in users aged 30 and over. Cumulative rates after 5 years of use of the Nova-T and copper silver T respectively for women under 25 were 3.0 and 7.1 for pregnancy, 8.2 and 12.5 for expulsion, 27.1 and 30.2 for removal for pain and bleeding, 42.7 and women 25-29 the cumulative rates were 2.6 and 9.0 for pregnancy, 12.3 and 5.8 for expulsion, 26.1 and 21.8 for removal for pain and bleeding, 25.3 and 29.1 for removal for other reasons, and 33.6 and 34.2 for continuation. For women 30-34 cumulative rates were 1.1 and 2.2 for pregnancy, 5.9 and 3.4 f expulsion, 27.4 and 20.6 for removal for pain and bleeding, 17.5 and 22.0 for removal for other reasons, and 48.0 and 51.7 for continuation. Among women 35 and over cumulative rates were .8 and 2.1 for pregnancy, 10.9 and 3.7 for expulsions, 25.0 and 17.6 for removal for pain and bleeding, 18.8 and 12.0 for removal for other reasons, and 44.5 and 64.7 for continuation. Cumulative pregnancy rates were better for the Nova-T after 1, 3, and 5 years of use, but differences diminished with age and parity. After age 30 the pregnancy rate with the copper silver T is particularly appropriate for women whose cervical canals permit insertion of a larger device.^ieng