Eponymous terms in anterior shoulder stabilization surgery.

Shoulder dislocation and its treatment are probably as old as time. Surgical treatment has gained acceptance recently, especially in recurrent cases. Within roughly the last 100years, numerous treatment strategies have been developed and questions elucidated regarding the entity of shoulder instability. Shoulder instability holds many eponymous terms. By means of literature and historical research, we present the biographical background of some common eponymous terms and the original publication on which those terms are based. We describe the Perthes lesion, Bankart lesion and repair, Hill-Sachs lesion, Bristow-Latarjet procedure and Eden-Hybbinette procedure. Shoulder instability has been recognized and treated for many centuries. Before the invention of X-rays and the ability to intervene surgically, empirical reduction and time were the only feasible treatment options. Understanding of the pathophysiology of this problem and its corresponding treatment has kept increasing since the 19th century. The originators involved still have their name attached to the different signs and procedures. LEVEL OF EVIDENCE: IV.

A systematic comparison of the closed shoulder reduction techniques.

PURPOSE: To identify the optimal technique for closed reduction for shoulder instability, based on success rates, reduction time, complication risks, and pain level. METHODS: A PubMed and EMBASE query was performed, screening all relevant literature of closed reduction techniques mentioning the success rate written in English, Dutch, German, and Arabic. Studies with a fracture dislocation or lacking information on success rates for closed reduction techniques were excluded. We used the modified Coleman Methodology Score (CMS) to assess the quality of included studies and excluded studies with a poor methodological quality (CMS < 50). Finally, a meta-analysis was performed on the data from all studies combined. RESULTS: 2099 studies were screened for their title and abstract, of which 217 studies were screened full-text and finally 13 studies were included. These studies included 9 randomized controlled trials, 2 retrospective comparative studies, and 2 prospective non-randomized comparative studies. A combined analysis revealed that the scapular manipulation is the most successful (97%), fastest (1.75 min), and least painful reduction technique (VAS 1,47); the "Fast, Reliable, and Safe" (FARES) method also scores high in terms of successful reduction (92%), reduction time (2.24 min), and intra-reduction pain (VAS 1.59); the traction-countertraction technique is highly successful (95%), but slower (6.05 min) and more painful (VAS 4.75). CONCLUSION: For closed reduction of anterior shoulder dislocations, the combined data from the selected studies indicate that scapular manipulation is the most successful and fastest technique, with the shortest mean hospital stay and least pain during reduction. The FARES method seems the best alternative.

A systematic and technical guide on how to reduce a shoulder dislocation.

OBJECTIVES: Our objective is to provide a systematic and technical guide on how to reduce a shoulder dislocation, based on techniques that have been described in literature for patients with anterior and posterior shoulder instability. MATERIALS AND METHODS: A PubMed and EMBASE query was performed, screening all relevant literature on the closed reduction techniques. Studies regarding open reduction techniques and studies with fracture dislocations were excluded. RESULTS: In this study we give an overview of 23 different techniques for closed reduction and 17 modifications of these techniques. DISCUSSION: In this review article we present a complete overview of the techniques, that have been described in the literature for closed reduction for shoulder dislocations. This manuscript can be regarded as a clinical guide how to perform a closed reduction maneuver, including several technical tips and tricks to optimize the success rate and to avoid complications. CONCLUSION: There are 23 different reduction techniques with 17 modifications of these techniques. Knowledge of the different techniques is highly important for a good reduction.

The Bristow-Latarjet procedure, a historical note on a technique in comeback.

The Bristow-Latarjet procedure is a well-known surgical technique designed to treat shoulder instability. In this procedure, the coracoid process is transferred to the glenoid rim, to serve as augmentation of an associated bony defect. Because long-term results following a soft tissue procedure (Bankart repair) reveal that up to 21 and 33 % of the patients might experience recurrent instability and with the advent of the arthroscopic coracoid transfer, there is renewed interest in this procedure to treat shoulder instability. The aim of this study is to provide a historical overview, with emphasis on the original inventors Bristow and Latarjet, the complications and following modifications regarding the surgical approach, the coracoid transfer and the arthroscopic technique. Level of evidence V.

[Characterisation of Postoperative Immune Suppression by Validated Parameters in Visceral Surgery]. / Validierbare Parameter zur Beschreibung der Immunsuppression nach viszeralchirurgischen Eingriffen.

BACKGROUND: Surgical interventions induce changes in postoperative immune competence due to the surgical trauma. Consequently, the immune system cannot react sufficiently in case of septic complications. The dimension of postoperative immune suppression can be determined by HLA-DR surface expression on circulating monocytes. MATERIAL AND METHODS: In the present study relevant literature was researched and patients with visceral and thoracic surgery were included. 17 patients underwent minor surgery, i.e., cholecystectomy, thyroidectomy or hernia repair. 101 patients underwent major surgery, i.e., visceral or thoracic resections. Expression of HLA-DR on circulating monocytes (HLA-DR) was analysed by FACS, whereas gene expression of T-cells was determined by gene-array methods. RESULTS: Postoperative complications or postoperative acquired sepsis were predominantly seen in patients with significantly reduced HLA-DR. The postoperative immune suppression was influenced by the type of operation itself: following colon surgery there was a longer-lasting immune suppression compared to that after surgery on the thorax or rectum. In addition, postoperative immune suppression depends on preoperative existing risk factors: adipositas and further risk factors cause a decrease of HLA-DR. Gene expression analysis revealed a distinct down-regulation of transcriptional activity of T-cells following surgical intervention. This effect is much more pronounced in patients with septic complications. CONCLUSION: The expression of HLA-DR is a useful parameter to describe postoperative immune suppression. Furthermore, regulation of transcriptional T-cell activity can provide additional information on the postoperative immune status.

Surgical trauma and postoperative immune dysfunction.

BACKGROUND: In postoperative sepsis, mortality is increased due to the surgically induced immune dysfunction. Further causes of this traumatic effect on the immune system include burn injuries and polytrauma, as well as endogenous traumata like stroke. Several animal models have been defined to analyse the characteristics of trauma-induced immune suppression. This article will correlate our results from animal studies and clinical observations with the recent literature on postoperative immune suppression. METHODS: The previously described model of surgically induced immune dysfunction (SID) was performed in mice by laparotomy and manipulation of the small intestine in the antegrade direction. Blood samples were collected 6 and 72 h following SID to analyse the white blood cell count and corticosterone levels. To assess the postoperative immune status in humans, we analysed expression of HLA-DR on monocytes of 118 patients by flow cytometry prior to and 24, 48 and 72 h after surgery. RESULTS: The postoperative immune suppression in our SID model is characterised by lymphocytopenia and significantly increased corticosterone levels in mice dependent on the degree of surgical trauma. This is comparable to the postoperative situation in humans: major and especially long-lasting surgery results in a significantly reduced expression of HLA-DR on circulating monocytes. Previous studies describe a similar situation following burn injury and endogenous trauma, i.e. stroke. CONCLUSIONS: We suggest the completion of our previously published sepsis classification due to the immune status at the onset of sepsis: type A as the spontaneously acquired sepsis and type B as sepsis in trauma-induced pre-existing immune suppression.

[The Depression Recognition Scale: and aid in the diagnosis of depression in family practice]. / De 'Depressieherkenningsschaal': een hulpmiddel bij het diagnosticeren van depressie in de huisartspraktijk.

OBJECTIVE: To assess the reliability, positive predictive value and concurrent validity of a brief and simple interview to diagnose major depression in general practice, the Depression recognition scale (DRS). DESIGN: Descriptive. SETTING: University of Leiden, the Netherlands. METHODS: The DRS was compared with a semi-structured psychiatric interview to assess major depression and with the depression items of the Symptom checklist-90 (SCL-90), a self-rating scale for perceived symptoms. RESULTS: The study consisted of 233 subsequent patients of II general practices who were screened for an interview; 95 patients were actually interviewed, 15 of these patients had a major depression (15/233; 6%). The DRS was also compared with the SCL-90 among 428 other patients. The validity was 0.73 and 0.66 and the internal consistency (Cronbach's alpha) was 0.63 and 0.75, respectively. If the DRS were used only for patients the general practitioner considers mildly depressed (43/233 = 18%), few cases of major depression would be missed (2/15). CONCLUSION: The DRS appears a practical, reliable and valid diagnostic tool.

Induction of DNA damage in Ehrlich ascites tumour cells by exposure to eupatoriopicrin.

The sesquiterpene lactone eupatoriopicrin (EUP) from Eupatorium cannabinum L. has been shown to be cytotoxic in a glutathione (GSH)-dependent way. In order to assess possible DNA damage as a cause for cell death, the study reported was initiated. After 2 hr incubation of Ehrlich ascites tumour cells with EUP, the DNA damage, determined by the use of an alkaline DNA unwinding method, followed by hydroxylapatite column chromatography of degraded DNA, was observed at concentrations only slightly higher than those causing cell death in a clonogenic assay. The amount of EUP, requested to demonstrate DNA damage after a 24-hr post-incubation period lay within the concentration range that was effective in the clonogenic assay (1-10 micrograms/ml). Glutathione (GSH) depletion of the cells to about 99%, by use of buthionine sulphoximine (BSO), enhanced the extent of DNA damage. It is concluded that EUP-induced DNA damage may play a role in the observed cytotoxicity.

Paraganglioma of the larynx. A case report and clinical review.

An 8-year-old Black boy recently underwent surgery for the excision of a non-chromaffin laryngeal paraganglioma. The peri-operative management of this patient is presented. The specific problems involved and their importance to the anaesthesiologist and surgeon alike are discussed.

Polypoid lesions of the acalculous gallbladder.

The controversy about gallbladder polyps has centered chiefly around their potential for malignancy. Among 3,525 cholecystectomies done over a 25-year period, there were 26 cases of carcinoma with only 9% not associated with stones. Thirty-nine cases of polypoid lesions of the acalculous gallbladder were investigated. The classic symptoms of pain, flatulence, food intolerance, and nausea were present in the great majority of cases. Most patients, especially those with symptoms of short duration, reported improvement following cholecystectomy.