Partial rupture of the distal biceps brachii tendon: a magnetic resonance imaging analysis.

BACKGROUND: This study is the largest cohort of partial distal biceps brachii tendon ruptures in the literature that was analyzed according to rupture morphology of the long and short tendon heads. METHODS: Patients with partial distal biceps tendon ruptures were identified using an institutional enterprise data warehouse query at a single institution. A retrospective chart review was performed to record patient demographics, past medical history, and injury mechanism for each patient. Each patient's magnetic resonance images were reviewed to determine injury patterns, specifically the extent of long head (LH) and short head (SH) tendon involvement, and associated injuries. Rupture morphologies were correlated with mechanism of injury, diabetes status, and smoking history. RESULTS: Seventy-seven patients were included in the study. The average age was 52 years (±11.9, range: 23-90 years); 67% were male, with an average body mass index of 28.3 (±4.3). A smoking history was reported in 31.2% of patients and 5.2% were diabetic. The partial ruptures were caused by a traumatic mechanism in 57.1% of cases, 23.4% were atraumatic, and 19.5% had an unknown mechanism. The most common injury morphology was a partial LH rupture with an intact SH tendon (33.8%). Isolated complete ruptures of the LH represented the least common injury morphology. Injury morphology was significantly related to mechanism (P < .01). Traumatic ruptures had a higher percentage of SH involvement compared with the atraumatic group (77.3% vs. 37.7%, respectively). In contrast, atraumatic ruptures involved the LH tendon in 89% of cases, with only 37.7% of cases involving the SH tendon. Patients with a history of smoking were more likely to have an atraumatic mechanism (P = .01). A history of diabetes was unrelated to mechanism (P = .20). CONCLUSION: Partial ruptures of the distal biceps brachii tendon represent a spectrum of patterns with varying involvement of the LH and SH tendons. Injury morphology was significantly related to mechanism (P < .01). LH tendon involvement was seen in 88.9% of atraumatic cases, whereas SH tendon involvement was seen in 77.3% of traumatic cases. A more comprehensive understanding of partial rupture patterns is critical to further understand the risk factors that may preclude to worse clinical outcomes, and aid in deciding which patients would benefit from operative vs. nonoperative management.

Radiotherapy of MRI-detected involved internal mammary lymph nodes in breast cancer.

BACKGROUND: The internal mammary (IM) lymph node chain, along with the axillary nodal basin, is a first-echelon breast lymphatic draining site. A growing body of evidence supports irradiation of this region in node-positive breast cancer. This study evaluated the effectiveness of radiotherapy in treating magnetic resonance imaging (MRI)-detected abnormal IM lymph nodes in newly-diagnosed non-metastatic breast cancer. METHODS: A structured query was performed on an electronic institutional database to identify women with radiographic evidence of abnormal IM node(s) on breast MRI from 2005 to 2013. Manual review narrowed inclusion to patients with a primary diagnosis of non-metastatic breast cancer with abnormal IM node(s) based on pathologic size criteria and/or abnormal enhancement. RESULTS: Of the 7070 women who underwent pre-treatment MRI, 19 (0.3%) were identified on imaging to have a total of 25 abnormal pre-treatment IM lymph nodes, of which 96% were located in the first two intercostal spaces and 4% in the third space. A majority of the primary tumors were high-grade (94.7%) and hormone-receptor negative (73.7%), while 47.4% overexpressed HER-2/neu receptor. Axillary nodal disease was present in 89.5% of patients, while one patient had supraclavicular involvement. At a median follow-up of 38 months, 31.6% of patients had developed metastatic disease and 21.1% had died from their disease. Of the patients who received IM coverage, none had progressive disease within the IM lymph node chain. CONCLUSIONS: Radiologic evidence of pre-treatment abnormal IM chain lymph nodes was associated with advanced stage, high grade, and negative estrogen receptor status. The majority of positive lymph nodes were located within the first two intercostal spaces, while none were below the third. Radiation of the IM chain in combination with modern systemic therapy was effective in achieving locoregional control without surgical resection in this cohort of patients.

The effect of pelvic radiotherapy on vaginal brachytherapy cylinder diameter: Implications for optimal treatment order.

PURPOSE: To determine the factors that correlate with cylinder size in vaginal brachytherapy (VB) after hysterectomy for endometrial carcinoma. METHODS AND MATERIALS: Patients treated for endometrial cancer from January 1, 2003 to December 31, 2013 were reviewed from a single institution. Patients included underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by high-dose-rate VB with or without external beam pelvic radiotherapy (EBRT). According to institutional guidelines, the vaginal cylinder size selected was the largest diameter cylinder the patient could comfortably accommodate. Patient, tumor, and treatment factors were recorded and compared with cylinder size. RESULTS: Three hundred eighty-one eligible patients were identified, including 121 patients treated with pelvic radiotherapy (RT) before VB and 260 treated with VB alone. On univariate analysis, weight (p = 0.0004), body mass index (BMI) (p = 0.001), and receipt of pelvic RT (p ≤ 0.0001) were the only statistically significant factors correlated with vaginal cylinder size. On multivariate analysis, receipt of EBRT retained significance after adjusting for weight or BMI. In patients receiving VB alone, median cylinder size was 3 cm; after pelvic RT, it was 2.5 cm. CONCLUSIONS: Higher weight and BMI correlated with accommodation of larger cylinder size. Accounting for this, the receipt of EBRT before VB was associated with smaller cylinder size. Dosimetric data show that larger cylinder size provides superior dose distribution. Although historically the VB boost follows EBRT, reversal of this order may be preferred.