Ultrastructure and Pathoanatomy of the Rotator Cuff

The rotator cuff is a complex musculotendinous unit, which plays a major role in glenohumeral joint stability and mobilization. Tears of the rotator cuff tendon and its subsequent changes of the rotator cuff muscle are common, and the incidence increases with age. Several structures such as the muscle, tendon, and bone may contribute to the development of a tear as well as on the outcome following a rotator cuff repair. Knowledge of these structures may help to improve rotator cuff healing after rotator cuff tear. The goal of this chapter is to discuss the evidence which exists with regard to the pathophysiological changes in the muscle, tendon, and bone that lead to a rotator cuff rupture as well as the changes that occur in these structures after a tear has occurred.

Patient-Rated Outcomes of Lumbar Fusion in Patients with Degenerative Disease of the Lumbar Spine: Does Age Matter?

STUDY DESIGN Single centre retrospective study of prospectively collected data, nested within the Eurospine Spine Tango data acquisition system. OBJECTIVE The aim of this study was to assess the patient-rated outcome and complication rates associated with lumbar fusion procedures in three different age groups. SUMMARY OF BACKGROUND DATA There is a general reluctance to consider spinal fusion procedures in elderly patients due to the increased likelihood of complications. METHODS Before and at 3, 12, and 24 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI). At the 3-, 12-, and 24-month follow-ups they also rated the Global Treatment Outcome (GTO) and their satisfaction with care. Patients were divided into three age groups: younger (≥50y < 65y; n = 317), older (≥65y < 80y; n = 350), and geriatric (≥ 80y; n = 40). RESULTS 707 consecutive patients were included. The preoperative comorbidity status differed significantly (p < 0.0001) between the age groups, with the highest scores in the geriatric group. Medical complications during surgery were lower in the younger age group (7%) than in the older (13.4%; p = 0.006) and geriatric groups (17.5%; p = 0.007); surgical complications tended to be higher in the elderly group (younger, 6.3%; older, 6.0%; geriatric, 15.0%; p = 0.09). There were no significant group differences (p > 0.05) for the scores on any of the COMI domains, GTO, or patient-rated satisfaction at either 3-, 12-, and 24-months follow-up. CONCLUSIONS Despite greater comorbidity and complication rates in geriatric patients, the patient-rated outcome was as good in the elderly as it was in younger age groups up to two years after surgery. These data indicate that geriatric age needs careful consideration of associated risks but is not per se a contraindication for fusion for lumbar degenerative disease. LEVEL OF EVIDENCE 4.

No Routine Postoperative Head CT following Elective Craniotomy - A Paradigm Shift?

INTRODUCTION Patient management following elective cranial surgery often includes routine postoperative computed tomography (CT). We analyzed whether a regime of early extubation and close neurological monitoring without routine CT is safe, and compared the rate of postoperative emergency neurosurgical intervention with published data. METHODS Four hundred ninety-two patients were prospectively analyzed; 360 had supra- and 132 had infratentorial lesions. Extubation within one hour after skin closure was aimed for in all cases. CT was performed within 48 hours only in cases of unexpected neurological findings. RESULTS Four-hundred sixty-nine of the 492 patients (95.3%) were extubated within one hour, 20 (4.1%) within 3 hours, and three (0.6%) within 3 to 10 hours. Emergency CT within 48 hours was performed for 43/492 (8.7%) cases. Rate of recraniotomy within 48 hours for patients with postoperative hemorrhage was 0.8% (n = 4), and 0.8% (n = 4) required placement of an external ventricular drain (EVD). Of 469 patients extubated within one hour, 3 required recraniotomy and 2 required EVD placements. Of 23 patients with delayed extubation, 1 recraniotomy and 2 EVDs were required. Failure to extubate within one hour was associated with a significantly higher risk of surgical intervention within 48 hours (rate 13.0%, p = 0.004, odds ratio 13.9, 95% confidence interval [3.11-62.37]). DISCUSSION Early extubation combined with close neurological monitoring is safe and omits the need for routine postoperative CT. Patients not extubated within one hour do need early CT, since they had a significantly increased risk of requiring emergency neurosurgical intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT01987648.

Ein Wort über Religion und Philosophie nach Auffassung Saʿadjâ al-Fajjûmî's

von M. Wolff

Auswahl türkischer Erzählungen aus dem "Humajun-namé oder Kaiserbuch" : mit Urtext, Aussprache, deutscher Worterklärung und vollständiger Uebersetzung ; ein Handbuch für angehende deutsche Orientalisten

von Salih sade Ali Efendi. Bearb. durch Ed. von Adelburg

Die Memoiren der Glückel von Hameln : 1645 - 1719

hrsg. von David Kaufmann

Kunṭres Ḥevrat Rodfe Ḥesed : tokho yevoar ʿal ma ʿamude ḥevratenu ḥevrat g. ḥ. yusdu, ṿe-gam taḳanoteha ha-yesharot

Text in hebr. und jidd., in hebr. Schr.

ʿAl Shir ha-shirim, mishle ṿe-Kohelet

me-et Yehudah Yudl Rozenberg

Gubert v strane čudes : dela i dni nemeckogo pionera

Über die Reise des Paradejungpioniers Hubert L'Hoste vom Saargebiet, quer durch Europa nach Russland. Mit einem Würfel-Spielplan, der diese Reise nachstellt

Prières d'un cœur israélite : livre d'offices et recueil de prières et de méditations pour toutes les circonstances de la vie

publ. par la Société consistoriale des bons livres

Šîr ha-ḥayyîm : we-hû' ʿānāf min hā-ʿēṣ ašer šātalṭî be-ʿezrātô yitbārāk hû' sifrî be'ēr ḥayyîm ...

hak-kōl ḥûbbār mē'ētî haṣ-ṣāʿîr Dôv Ber Ze'ēv Wôlf Lîvšîṣ

Elemental- [!] oder Lesebüchlein des Paul Helicz : gedruckt in Hundsfeld 1543

hrsg. vom Verein Jüdisches Museum Breslau [Vorr.: Max Silberberg]

Grammatica Chaldaica : Methodo adeò facili conscripta, ut qvis proprio Marte sine manuductore hanc lingvam addiscere possit

Teilw. in hebr. Schr.