Muscle regeneration following repair of the rotator cuff.

AIMS: The aim of this study was to analyse human muscle tissue before and after rotator cuff repair to look for evidence of regeneration, and to characterise the changes seen in the type of muscle fibre. PATIENTS AND METHODS: Patients were assessed pre-operatively and one year post-operatively using the Oxford Shoulder Score (OSS) and MRI. The cross-sectional area and distribution of the type of muscle fibre were assessed on biopsies, which were taken at surgery and one year post-operatively. Paired samples from eight patients were analysed. There were three men and five women with a mean age of 63 years (50 to 73). RESULTS: All but one patient showed improvement in OSS (p = 0.004). The mean increase in the cross-sectional area of the muscle was 1220 µm2 (-801 to 3712; p = 0.03). There was a reduction of type 2a fibres (p = 0.02). A clear relationship could not be seen between the MRI findings and the histological appearances. CONCLUSION: This is the first study to provide evidence that atrophy of the supraspinatus muscle is reversible. Changes in the types of fibre are discussed. MRI assessment of muscle atrophy may not be fully representative of myofibre atrophy. Cite this article: Bone Joint J 2016;98-B:1389-94.

A rare cause of small bowel infarction.

We report a rare case of small bowel infarction due to superior mesenteric artery occlusion secondary to cardiac tumour embolism. To our knowledge, this has not been previously reported in the literature. This case highlights a rare case and reviews current knowledge on the subject.

Urinary tract obstruction and nephrostomy drainage in pelvic malignant disease.

OBJECTIVE: To determine the survival of patients after percutaneous nephrostomy drainage (PND) for obstructive uropathy secondary to pelvic malignant disease. PATIENTS AND METHODS: The records of 77 patients undergoing PND for obstructive uropathy were reviewed. Patients were classified according to the nature of the obstructing lesion: Group I (primary untreated malignancy, 31 patients); Group II (recurrent malignancy with further treatment, 15 patients); Group III (recurrent malignancy with no further treatment, 12 patients); and Group IV (benign disease as a consequence of previous treatment, 19 patients). Outcome was assessed by survival over a mean follow-up of 20 months (range 2 days-8.3 years). RESULTS: Overall median survival was 26 weeks, with a 5-year survival of 22%. The survival in Groups I and II was not significantly different (median survival 27 and 20 weeks, respectively; 5-year survival, 10% and 20%, respectively). Group III patients had a poor prognosis (median survival 6.5 weeks) with no patient surviving beyond one year, whilst Group IV patients fared best with a 5-year survival of 64%. The commonest primary tumour type was carcinoma of the cervix (42 patients), and these patients were analysed as a subset. Benign post-radiation fibrosis was found in 16 of 27 patients (59%). Survival was related to the diagnostic group. CONCLUSION: The nature and extent of the obstructing lesion and its potential for further treatment are the major determinants of post-nephrostomy survival. Every effort should therefore be made to identify the nature of the obstruction before deciding on PND.

Diabetics treated with continuous subcutaneous insulin infusion pumps.

Sixteen insulin-dependent diabetics commenced continuous subcutaneous insulin infusion (CSII) pumps either because of poor control (15 patients), or because of preference (1 patient). The study examined the diabetic control achieved, patients attitudes and CSII pump complications. Statistically significant improvements in HbAlC which fell from a pre-treatment mean of 12.57% to 10.0% at three months (p less than 0.01) and 10.6% at six months (p less than 0.02) were achieved. At nine months the improvement was not statistically significant. Fourteen of the 16 patients wished at the end of one year to continue this treatment. This study reports a low rate of symptomatic hypoglycaemia and infusion site infection. However, there was a large number of cases of ketoacidosis which highlights the need for extreme vigilance in monitoring patients treated by this method.