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Background There are a number of different techniques available for the repair of distal biceps tendon ruptures. Recent evidence has revealed satisfactory clinical outcomes for suture button techniques. Aims The aim of this study was to determine if the ToggleLocTM soft tissue fixation device (Zimmer Biomet, Warsaw, Indiana) confers satisfactory clinical outcomes in the surgical management of distal biceps ruptures. Methods Twelve consecutive patients underwent distal biceps repair using the ToggleLocTM soft tissue fixation device over a two-year period. Patient-Reported Outcome Measures (PROMs) were collected by means of validated questionnaires on two occasions. Symptoms and function were quantified using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Oxford Elbow Score (OES). Patient-reported health scores were determined using the EQ-5D-3L (European Quality of Life 5 Dimensions 3 Level Version) questionnaire. Results The mean initial follow-up time was 10.4 months and the mean final follow-up time was 34.6 months. The mean DASH score at the initial follow-up was 5.9 (se = 3.6), compared to 2.9 (se = 1.0) at the final follow-up (p = 0.30). The mean OES at the initial follow-up was 91.5 (se = 4.1); and 91.5 (se = 5.2) at the final follow-up (p = 0.23). The mean EQ-5D-3L level sum score at the initial follow-up was 5.3 (se = 0.3); and 5.8 (se = 0.5) at the final follow-up (p = 0.34). Discussion The ToggleLocTM soft tissue fixation device confers satisfactory clinical outcomes, as determined by PROMS, in the surgical management of distal biceps ruptures.

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PURPOSE: The aim of this retrospective study was to introduce a novel technique of a double-scan protocol with markerfree registration and compare it to the already-used techniques regarding the accuracy of registration. MATERIALS AND METHODS: Fifty-nine fully edentulous patients underwent double-scan procedures by three different methods: the barium sulfate method for 11 patients; the gutta-percha method for 26 patients; and the marker-free method for 22 patients. Point-to-point registration of the two scans was followed by a voxel-based surface "best fit" registration. The mean registration error of each case was digitally recorded. Differences in registration error between groups were evaluated using one-way analysis of variance (ANOVA). RESULTS: The accuracy of the registration showed no significant differences according to the method (P = .719). CONCLUSION: The marker-free procedure was presented as a novel technique for registration of the scans in the double-scan protocol. There was no significant difference in the accuracy of the registration between the three techniques: marker-free, gutta-percha markers, and fully radiopaque barium sulfate scan appliance. Therefore, the marker-free technique might be a viable option for the double-scan protocol.

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A series of hybrid of triazoloquinoxaline-chalcone derivatives 7a-k were designed, synthesized, fully characterized, and evaluated for their cytotoxic activity against three target cell lines: human breast adenocarcinoma (MCF-7), human colon carcinoma (HCT-116), and human hepatocellular carcinoma (HEPG-2). The preliminary results showed that some of these chalcones like 7b-c, and 7e-g exhibited significant antiproliferative effects against most of the cell lines, with selective or non-selective behavior, indicated by IC50 values in the 1.65 to 34.28 µM range. In order to investigate the mechanistic aspects of these active compounds, EGFR TK and tubulin inhibitory activities were measured as further biological assays. The EGFR TK assay results revealed that the derivatives 7a-c, 7e, and 7g could inhibit the EGFR TK in the submicromolar range (0.093 to 0.661 µM). Moreover, an antitubulin polymerization effect was noted for the active derivatives compared to the reference drug colchicine, with compounds 7e and 7g displaying 14.7 and 8.4 micromolar activity, respectively. Furthermore, a molecular docking study was carried out to explain the observed effects and the binding modes of these chalcones with the EGFR TK and tubulin targets.

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Limb compartment syndrome may be sequelae of trauma, but in the context of critical care blood sampling, arterial damage may have profound consequences. We describe a series of three cases and their progress and discuss guidelines for prevention of this potentially devastating occurrence in critically ill patients.

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Peri-implant fractures of the wrist are uncommon, and usually present as stress fractures distal to the site of the implant. We report an unusual case where the radius has fractured beneath a plate, causing bending and deformity of the implant. This prevented reduction of the fracture under sedation, so urgent intervention became necessary due to neurovascular compromise.

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BACKGROUND: Rotator cuff tears (RCTs) represent a significant proportion of shoulder diseases, hence they are a frequent cause of patient visits in shoulder clinics. However, the diagnosis of rotator cuff tears is controversial. Investigation of cuff tears is based on ultrasonography (US) and magnetic resonance imaging (MRI). Both modalities have been in use for decades, and their advantages and limitations are known. A recent Cochrane review of the subject suggested that US and MRI both performed well with respect to full thickness rotator cuff tears (FTT). However, they were less accurate with respect to partial thickness tears (PTT). The aim of this study is to assess the accuracy of US and MRI in diagnosing rotator cuff tears. MATERIAL/METHODS: This is a retrospective analysis of a cohort of 255 patients who underwent shoulder arthroscopy. Of them, 125 patients had preoperative US, and 130 had preoperative MRI. The imaging results were compared with arthroscopic findings for patient. RESULTS: After calculating sensitivity, specificity, positive prediction value (PPV), and negative prediction value, we found no statistically significant difference between US and MRI in detection of rotator cuff tears of any type (RCT) or FTT. However, US is more specific in detecting PTT compared to MRI (P=0.00008) but with no significant difference in other parameters. CONCLUSIONS: We concluded that US and MRI both have similar accuracy in diagnosing RCT of any sort and FTT. However, US is more specific than MRI in detecting PTT. In our institute, we now recommend US as the investigation of choice for diagnosing rotator cuff tears.

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BACKGROUND: The redislocation rate after arthroscopic stabilization for anterior glenohumeral instability is up to 30%. The Instability Severity Index Score (ISIS) was developed to preoperatively rationalize the risk of failure, but it has not yet been validated by an independent group. PURPOSE: To assess the utility of the ISIS in predicting failure of arthroscopic anterior shoulder stabilization and to identify other preoperative factors for failure. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A case-control study was performed on 141 consecutive patients, comparing those who suffered failure of arthroscopic stabilization with those who had successful arthroscopic stabilization. The mean follow-up time was 47 months (range, 24-132 months). The ISIS was applied retrospectively, and an analysis was performed to establish independent risk factors for failure. A receiver operator coefficient curve was constructed to set a threshold ISIS for considering alternative surgery. RESULTS: Of 141 patients, 19 (13.5%) suffered recurrent instability. The mean ISIS of the failed stabilization group was higher than that of the successful stabilization group (5.1 vs 1.7; P < .001). Independent risk factors for failure were Hill-Sachs lesion (P < .001), glenoid bone loss (P < .001), age <21 years at the time of surgery (P < .001), age at first dislocation (P = .01), competitive-level participation in sports (P < .001), and participation in contact or overhead sports (P = .03). The presence of glenoid bone loss carried the highest risk of failure (70%). There was a 70% risk of failure if the ISIS was ≥4, as opposed to a 4% risk of failure if the ISIS was <4. CONCLUSION: This is the first completely independent study to confirm that the ISIS is a useful preoperative tool. It is recommended that surgeons consider alternative forms of stabilization if the ISIS is ≥4.

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PURPOSE: To predict malignancy of mediastinal lymphadenopathy with diffusion-weighted imaging. MATERIAL AND METHODS: A prospective study was conducted on 35 patients with mediastinal lymphadenopathy (28 malignant and seven benign nodes). They underwent echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum with b-factors of 0, 300 and 600 s/mm(2). The apparent diffusion coefficient (ADC) values of the mediastinal lymph nodes were calculated. The ADC values were correlated with the biopsy results and statistical analysis was done. A value of P<.05 was considered significant. RESULTS: The mean ADC value of malignant mediastinal lymphadenopathy (1.06±0.3×10(-3) mm(2)/s) was significantly lower (P=.001) than that of benign lymphadenopathy (2.39±0.7×10(-3) mm(2)/s). There was an insignificant difference in the ADC values between metastatic and lymphomatous mediastinal lymph nodes (P=.32) as well as within benign nodes (P=.07). When an ADC value of 1.85×10(-3) mm(2)/s was used as a threshold value for differentiating malignant mediastinal nodes from benign nodes, the best results were obtained with an accuracy of 83.9%, a sensitivity of 96.4%, a specificity of 71.4%, a negative predictive value of 95.2% and a positive predictive value of 77.1%. The area under the curve was 0.98. CONCLUSION: Diffusion weighted magnetic resonance imaging is a promising noninvasive imaging modality that can be used for characterization of mediastinal lymphadenopathy and differentiation of malignant from benign mediastinal lymph nodes.

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PURPOSE: To assess the role of diffusion-weighted single-shot echo-planar magnetic resonance imaging (MRI) in patients with mediastinal tumors. METHODS: Prospective study was conducted on 45 consecutive patients (29 male, 16 female, age 22-66 years, mean 41 years) with mediastinal tumor. They underwent diffusion-weighted single-shot echo-planar MRI of the mediastinum with a b-factor of 0, 300, and 600 sec/mm(2). The apparent diffusion coefficient (ADC) value of the mediastinal tumor was correlated with the histopathological findings. RESULTS: The mean ADC value of malignant mediastinal tumors was 1.09 +/- 0.25 x 10(-3) mm(2)/sec, and of benign tumors was 2.38 +/- 0.56 x 10(-3) mm(2)/sec. There was a significant difference in the mean ADC value between malignant and benign tumors (P = 0.001) and within different grades of malignancy (0.001). When an ADC value of 1.56 x 10(-3) mm(2)/sec was used as a threshold value for differentiating malignant from benign tumor, the best results were obtained with an accuracy of 95%, sensitivity of 96%, specificity of 94%, positive predictive value of 94%, negative predictive value of 96%, and area under the curve of 0.938. CONCLUSION: The ADC value is a noninvasive parameter that can be used for differentiation of malignant from benign mediastinal tumors and grading of mediastinal malignancy.

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