Effects of Surgeon-Preferred Staff and Staff Turnover on Operating Time and Complication Rates in Reverse and Anatomic Total Shoulder Arthroplasty.

BACKGROUND: This study focuses on investigating the risk factors of increased operating room time and patient complication rates after total shoulder arthroplasty cases (both reverse and anatomic). We hypothesize that the use of surgeon-preferred staff will improve operating room efficiency and reduce complication rates while increased staff turnover will decrease efficiency and increase complications. METHODS: This is a single-center, retrospective study focused on determining the effects of staffing on operating room time and efficiency in total shoulder arthroplasty. The study included patients who underwent total shoulder arthroplasty by a single fellowship-trained orthopaedic surgeon from 2018 to 2023. RESULTS: Four hundred twenty-three patients were included in the study from August 2018 to April 2023, 264 of which were reverse total shoulder arthroplasty (rTSA) and 159 were anatomic total shoulder arthroplasty (aTSA). In both rTSA and aTSA, the presence of surgeon-preferred staff markedly decreased operating room time. In rTSA, staff turnover increased risk of 90-day complications. CONCLUSION: Because the presence of surgeon-preferred staff affects operating room time and efficiency, orthopaedic surgeons should train multiple surgical teams so that efficiency is not affected by the loss of personnel during a case. To reduce 90-day complication rates in rTSA, staff breaks and turnover should be minimized as much as possible because this has a direct effect on patient outcomes. Effort from hospital administration and management should be put toward reducing turnover to improve patient outcomes.

A practical method to achieve prostate gland immobilization and target verification for daily treatment.

PURPOSE: A practical method to achieve prostate immobilization and daily target localization for external beam radiation treatment is described. METHODS AND MATERIALS: Ten patients who underwent prostate brachytherapy using permanent radioactive source placement were selected for study. To quantify prostate motion both with and without the presence of a specially designed inflatable intrarectal balloon, the computerized tomography-based coordinates of all intraprostatic radioactive sources were compared over 3 consecutive measurements at 1-min intervals. RESULTS: The placement and inflation of the intrarectal balloon were well tolerated by all patients. The mean (range) displacement of the prostate gland when the intrarectal balloon was present vs. absent was 1.3 (0-2.2) mm vs. 1.8 (0-9.1) mm (p = 0.03) at 2 min respectively. The maximum displacement in any direction (anterior-posterior, superior-inferior, or right-left) when the intrarectal balloon was inflated vs. absent was reduced to < or =1 mm from 4 mm. CONCLUSIONS: Both prostate gland immobilization and target verification are possible using a specially designed inflatable intrarectal balloon. Using this device, the posterior margin necessary on the lateral fields to ensure dosimetric coverage of the entire prostate gland could be safely reduced to 5 mm and treatment could be set up and verified using a lateral portal image.

Retinal detachment after cataract extraction in myopic eyes.

PURPOSE: To determine the incidence of retinal detachment (RD) after cataract extraction in people 40 years of age or older with axial myopia (i.e., axial length > or = 25.5 mm). SETTING: Fifteen Danish eye clinics. METHODS: Two hundred forty-five eyes had cataract extraction performed at 15 eye clinics; 237 eyes had extracapsular cataract extraction (ECCE) and 8 eyes, intracapsular cataract extraction (ICCE). Postoperative data were reported by the practicing ophthalmologists. Mean follow-up was 27 months (range 14 to 32 months). RESULTS: Five RDs occurred in the 245 eyes (2.0%). Excluding the ICCE cases and the two cases of combined cornea transplantation and ECCE, RD occurred in 4 of the 235 eyes that had ECCE (1.7%). The incidence after ECCE with posterior chamber lens implantation was 1.4%. Complete postoperative status was reported on 158 eyes. Forty-eight eyes (30.4%) had a neodymium:YAG capsulotomy and 3 (6.0%) developed an RD 1, 3.5, and 21 months after the capsulotomy. CONCLUSION: The RD incidence after ECCE with posterior chamber lens implantation was low but higher than that in unselected populations. The incidence increased after laser capsulotomy.

Comparison of Fucithalmic viscous eye drops and Chloramphenicol eye ointment as a single treatment in corneal abrasion.

PURPOSE: To compare the healing of the cornea and the incidence of infection after traumatic corneal epithelial defect after single treatment with double bandage combined with either Fucithalmic single unit dose eye drops or chloramphenicol eye ointment. METHODS: This is a single-centre, randomised, single-blind, parallel-group study of 144 patients with accidental corneal abrasion or corpus alieni cornea who were referred to the Eye Department at Gentofte Hospital. The injured eye was examined with a photo slit-lamp before and 24 hours after treatment. The size of the abrasion was recorded and calculated on a PCX computerized video system and by slit-lamp photography. RESULTS & CONCLUSION: The Fucithalmic and chloramphenicol ointment treated groups showed no significant difference in corneal healing, local side effects, or signs of local infection.

Chlamydia pneumoniae infection associated with multi-organ failure and fatal outcome in a previously healthy patient.

Chlamydia pneumoniae has been associated with respiratory infections and with cardiovascular disease. We describe here a patient with multi-organ failure and fatal outcome in whom C. pneumoniae was implicated as a causative agent. Serological analysis for C. pneumoniae was done by immunofluorescence. Immunohistochemistry was carried out with avidin-biotin peroxidase staining. The patient had pneumonia I month prior to death. C. pneumoniae was detected in the heart and lungs by immunohistochemistry at autopsy. The patient had an antibody pattern suggestive of current or chronic C. pneumoniae infection. Serological analysis for Legionella sp., Mycoplasma pneumoniae, CMV, EBV, enteroviral agents and markers for autoimmune disease were negative. The findings suggest C. pneumoniae as the aetiological agent in this case of multi-organ failure.

[Risk of cataract surgery in patients with myopia. A prospective Danish multicenter study with special reference to a complication]. / Risiko ved operation for grå staer hos naersynede. En prospektiv dansk multicenterundersøgelse med soerligt henblik på komplikationen nethindeløsning.

A prospective Danish multicentre study was conducted to evaluate the incidence of retinal detachment after cataract extraction in myopic eyes (axial length, > or = 25.5 mm). Two hundred and forty-seven cataract extractions in myopic eyes were reported during a period of 13 months. Two hundred and forty-one eyes underwent extracapsular and six eyes intracapsular cataract extraction. The mean follow-up time for 158 eyes was seven months (ranging from 1-30 months). In five cases a retinal detachment was observed, one case was probably present preoperatively, this person had undergone intracapsular cataract extraction. The incidence of retinal detachment was thus 1.62-2.02% in the total material and 1.66% in eyes operated with extracapsular cataract extraction.

Childhood progressive spinal muscular atrophy with facioscapulo-humeral predominance, sensory and autonomic involvement and optic atrophy.

A female child of healthy parents developed rotary nystagmus at the age of 15 months. Ophthalmoscopy disclosed incomplete optic atrophy. Blood tests, EEG and CT scans were normal. At 20 months progressive muscular weakness and wasting with limb-girdle distribution commenced, followed later by disturbance of gait. From muscle and nerve biopsy the diagnosis of a peripheral neuropathy with neurogenic muscular atrophy was made. No mental change occurred. At 23 months she sustained cardiac arrest and was resuscitated; thereafter, she remained in a vegetative state and expired 9 months later. Her brain was markedly atrophic and firm. Diffuse old ischemic necroses and neuronal loss with gliosis were found in the cortex, the neostriatum, the thalamus, parts of the lower brainstem, and the cerebellum. Her optic nerves and tracts showed complete atrophy. The spinal cord exhibited degeneration and loss of motor neurons with cervical accentuation. The intermediolateral nuclei, the dorsal nuclei and the spinal ganglia were also involved. There was demyelination of the posterior funiculi, the pyramidal tracts, and the sciatic, peroneal, sural, and superior frontal nerve. The voluntary muscles exhibited large group atrophy with liposclerotic change and limb-girdle predominance. The neck, tongue and ocular muscles were also involved, as were, to a less extent, the lower limbs. Although the loss of motor neurons in the spinal cord and at the bulbar level with the typical pattern of neurogenic muscular atrophy, as well as its distribution, resemble the facioscapulo-humoral type of heredity motor neuropathy (HMN), early onset, rapid course, sensory and autonomic involvement, and atrophy of the optic nerve do not fit this or any one type of HMN.

[Glaucoma blindness in Denmark]. / Glaukomblindhed i Danmark.

The prevalence and the incidence of glaucoma blindness in Denmark was evaluated by examining all registration forms of persons > or = 50 years of age admitted to the Danish Association of the Blind (DAB) between 1955 and 1987 with glaucoma as main cause of blindness. In 1987, 6.7% of DAB-members > or = 50 years suffered from blindness caused at least partially by glaucoma, equivalent to an estimated prevalence of 45 per 100,000 of the Danish population > or = 50 years. The estimated annual incidence of blindness due to glaucoma was seven per 100,000 > or = 65 years, and in an equal number of patients glaucoma was a contributory cause of blindness. The incidence of glaucoma blindness was decreasing in the younger age groups (< 65 years) throughout the study period. Glaucoma blindness seems to occur at a later age now than earlier, leaving the patients blind for a shorter time. The proportion of glaucoma blindness in the glaucoma population was estimated to be 4-5%.

Giant cell arteritis and visual loss. A 3-year retrospective hospital investigation in a Danish county.

An ophthalmic status is given for 95 consecutive patients referred from other departments of the Central County Hospital 1986-88 due to suspected giant cell arteritis. Eventually, the diagnosis was confirmed in 51/95 (18 had positive biopsy of the temporal artery; in 33 it was on clinical grounds). Nine of the 51 had significant visual loss, in one even as bilateral blindness. Generalized malignancies were found in 2 of the 44 with diagnosis other than giant cell arteritis. Retrospectively, in the same 3-year period a total of 263 cases of giant cell arteritis were registered in the somatic hospitals of the county (population 340,000). One further case with visual loss became known from requests to the primary health sector ophthalmologists. Between 3-4% were thus known to have significant visual loss, a result mainly in keeping with other Nordic clinical studies. Probably, the low figures of visual impairment are related to high diagnostic rates of giant cell arteritis, and to early treatment. Our hospital-based data of giant cell arteritis gave a calculated annual incidence of 1 per 1000 of those older than 50 years in the county, or 27/100,000 including all ages. The true county incidence would be even higher had it been possible to find and include the additional cases of giant cell arteritis who were diagnosed and treated in the primary health sector only.

[Giant cell arteritis and vision complications. Illustrated by a 3-year study from hospitals in the county of Frederiksborg]. / Kaempecellearteritis og synskomplikationer. Belyst gennem en tre års opgørelse fra sygehusene i Frederiksborg Amt.

During the three-year period 1986-1988, 95 patients were referred to the county eye department on account of suspected giant cell arteritis (GCA = temporal arteritis/polymyalgia rheumatica). Among the 51 with GCA, nine had visual loss. Bilateral blindness occurred in one patient. Temporal artery biopsy was positive in 18 patients. Malignancies were found in two of the 44 patients in whom the GCA diagnosis was subsequently rejected. In the somatic hospitals of the county, a total of 263 GCA patients could be collected during the sampling period. Requests to the primary health service ophthalmologists revealed one further case with marked visual loss. A total of ten out of 264 patients visual loss associated with GCA denotes a lower ocular risk than traditionally presumed. The result is in agreement with previous Danish and Nordic investigations. Probably the low visual risk is related to a high diagnostic rate of GCA, given here by an annual hospital based incidence in the county of 1 per 1,000 of age 50+. Considering the number of cases diagnosed and treated outside hospital, the real incidence is even higher. Regarding visual loss, however, we feel that all known cases with serious reduction of sight due to recognized GCA have been included.

Glaucoma blindness in Denmark.

In order to evaluate the prevalence and the incidence of glaucoma blindness in Denmark, all registration forms of persons greater than or equal to 50 years of age at admission, admitted to the Danish Association of the Blind (DAB) between 1955 and 1987 with glaucoma as main cause of blindness, were examined. In 1987 6.7% of DAB-members greater than or equal to 50 years of age suffered from blindness caused at least partially by glaucoma, equivalent to an estimated prevalence of 45 per 100,000 of the Danish population greater than or equal to 50 years. The estimated annual incidence of blindness due to glaucoma was 7 per 100,000 greater than or equal to 65 years, and in an equal number of patients glaucoma was a contributory cause of blindness. The incidence of blindness due to glaucoma was decreasing in the young age groups (less than 65 years) throughout the study period. Glaucoma blindness seems to occur at a later age now than earlier, leaving the patients blind for a shorter time. This pattern may be explained by improved health services but could also be due to a change in the spontaneous course of glaucoma. The proportion of glaucoma blindness in the glaucoma population was estimated to be 4-5%.

Ovarian cysts in women with inflammatory bowel disease.

The frequency of ovarian cysts in patients with Crohn's disease (CD) or ulcerative colitis (UC) is believed to be higher than in the normal population, but this aspect has not been studied hitherto. The prevalence of ovarian cysts in the normal population is unknown. By ultrasonic scanning, we studied the frequency of ovarian cysts in 61 patients with CD, 64 with UC, and in 100 controls. The findings were positive in 3 out of 61 with CD, 5 of 64 with UC, and in 2 of 100 controls. There is a tendency to a higher frequency of ovarian cysts in patients with inflammatory bowel diseases than in the normal population, but no statistically significant difference.

UV-induced formation of pyrimidine dimers in nucleosome core DNA is strongly modulated with a period of 10.3 bases.

We have determined the distribution of the major UV-induced photoproducts in nucleosome core DNA using the 3'----5' exonuclease activity of T4 DNA polymerase, which has been shown to stop digestion immediately 3' to UV-induced pyrimidine dimers. This assay is extremely sensitive since all DNA fragments without photoproducts (background) are reduced to small oligonucleotides, which can be separated from those fragments containing photoproducts. The results show that the distribution of UV-induced photoproducts (primarily cyclobutane dipyrimidines) is not uniform throughout core DNA but displays a striking 10.3 (+/- 0.1) base periodicity. Furthermore, this characteristic distribution of photoproducts was obtained regardless of whether nucleosome core DNA was isolated from UV-irradiated intact chromatin fibers, histone H1-depleted chromatin fibers, isolated mononucleosomes, or cells in culture. The yield of pyrimidine dimers along the DNA seems to be modulated in a manner that reflects structural features of the nucleosome unit, possibly core histone-DNA interactions, since this pattern was not obtained for UV-irradiated core DNA either free in solution or bound tightly to calcium phosphate crystals. Based on their location relative to DNase I cutting sites, the sites of maximum pyrimidine dimer formation in core DNA mapped to positions where the phosphate backbone is farthest from the core histone surface. These results indicate that within the core region of nucleosomes, histone-DNA interactions significantly alter the quantum yield of cyclobutane dipyrimidines, possibly by restraining conformational changes in the DNA helix required for formation of these photoproducts.

Stability of nucleosome placement in newly repaired regions of DNA.

Rearrangements of chromatin structure during excision repair of UV-damaged DNA appear to involve unfolding of nucleosomal DNA while repair is taking place, followed by refolding of this DNA into a native nucleosome structure. Recently, we found that repair patches are not distributed uniformly along the DNA in nucleosome core particles immediately following their refolding into nucleosomes (Lan, S. Y., and Smerdon, M. J. (1985) Biochemistry, 24,7771). Therefore, the distribution of repair patches in nucleosome core DNA was used to monitor the stability of nucleosome placement in these regions. Our results indicate that in nondividing human cells undergoing excision repair there is a slow change in the positioning of nucleosomes in newly repaired regions of chromatin, resulting in the eventual randomization of repair patches in nucleosome core DNA. Furthermore, the nonrandom placement of nucleosomes observed just after the refolding event is not re-established during DNA replication. Possible mechanisms for this change in nucleosome placement along the DNA are discussed.