scholarly journals Morphology of the Undersurface of the Anterolateral Acromion and Its Relationship to Surrounding Structures

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097748
Author(s):  
Yusuke Ueda ◽  
Akimoto Nimura ◽  
Keisuke Matsuki ◽  
Kumiko Yamaguchi ◽  
Hiroyuki Sugaya ◽  
...  
Keyword(s):  
Deep Layer ◽  
Micro Computed Tomography ◽  
Middle Aged ◽  
Aged Patients ◽  
Coracoacromial Ligament ◽  
3 Dimensional ◽  
Bony Surface ◽  
Inferior Aspect ◽  
Histologic Evaluation ◽  
Arthroscopic Subacromial Decompression

Background: A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens. Purpose: To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients. Study Design: Descriptive laboratory study. Methods: We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro—computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging. Results: In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers. Conclusion: The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.

Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM

Diabetes ◽  
1997 ◽  
Vol 46 (8) ◽  
pp. 1354-1359 ◽  
Author(s):  
S. Lehto ◽  
T. Ronnemaa ◽  
S. M. Haffner ◽  
K. Pyorala ◽  
V. Kallio ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Middle Aged ◽  
Aged Patients

Long Term Clinical and Echocardiographic Outcomes in Middle Aged Patients Undergoing the Ross Procedure

2019 ◽  
Vol 3 (sup1) ◽  
pp. 53-53
Author(s):  
Jamie Romeo ◽  
Grigorios Papageorgiou ◽  
Francisco da Costa ◽  
Hans Sievers ◽  
Ad Bogers ◽  
...  
Keyword(s):  
Ross Procedure ◽  
Middle Aged ◽  
Aged Patients

scholarly journals Clinical Outcomes of Hip Arthroscopy for Hip Labrum Calcification in Young and Middle‐Aged Patients

2021 ◽  
Author(s):  
Bai‐qing Zhang ◽  
Ming‐yang An ◽  
Feng Gao ◽  
Chun‐bao Li ◽  
Qi Wei ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Hip Arthroscopy ◽  
Middle Aged ◽  
Aged Patients

Outcomes and Patient Satisfaction With Arthroscopic Partial Meniscectomy for Degenerative and Traumatic Tears in Middle-Aged Patients With No or Mild Osteoarthritis

2019 ◽  
Vol 47 (10) ◽  
pp. 2412-2419
Author(s):  
Alejandro Lizaur-Utrilla ◽  
Francisco A. Miralles-Muñoz ◽  
Santiago Gonzalez-Parreño ◽  
Fernando A. Lopez-Prats
Keyword(s):  
Patient Satisfaction ◽  
Functional Outcomes ◽  
Multivariate Regression ◽  
Partial Meniscectomy ◽  
Meniscal Tears ◽  
Middle Aged ◽  
Arthroscopic Partial Meniscectomy ◽  
Aged Patients ◽  
Female Sex

Background: There is controversy about the benefit of arthroscopic partial meniscectomy (APM) for degenerative lesions in middle-aged patients. Purpose: To compare satisfaction with APM between middle-aged patients with no or mild knee osteoarthritis (OA) and a degenerative meniscal tear and those with a traumatic tear. Study Design: Cohort study; Level of evidence, 2. Methods: A comparative prospective study at 5 years of middle-aged patients (45-60 years old) with no or mild OA undergoing APM for degenerative (n = 115) or traumatic (n = 143) tears was conducted. Patient satisfaction was measured by a 5-point Likert scale and functional outcomes by the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Univariate and multivariate regression analyses were used to identify factors correlating with patient-reported satisfaction at 5 years postoperatively. Results: Baseline patient characteristics were not different between groups. At the 5-year evaluation, the satisfaction rate in the traumatic and degenerative groups was 68.5% versus 71.3%, respectively ( P = .365). Patient satisfaction was significantly associated with functional outcomes ( r = 0.69; P = .024). In the degenerative group, 43 patients (37.4%) had OA progression to Kellgren-Lawrence (K-L) grade 2 or 3, but only 24 patients (20.8%) had a symptomatic knee at final follow-up. Multivariate regression analysis for patient dissatisfaction at 5-year follow-up showed the following significant independent factors: female sex (odds ratio [OR], 1.6 [95% CI, 1.1-2.3]; P = .018), body mass index >30 kg/m2 (OR, 2.6 [95% CI, 1.7-4.9]; P = .035), lateral meniscal tears (OR, 0.6 [95% CI, 0.1-0.9]; P = .039), and OA progression to K-L grade ≥2 at final follow-up (OR, 1.4 [95% CI, 1.2-2.6]; P = .014). At the final evaluation, there were no significant differences between groups in pain scores ( P = .648), WOMAC scores ( P = .083), or KOOS-4 scores ( P = .187). Likewise, there were no significant differences in the KOOS subscores for Pain ( P = .144), Symptoms ( P = .097), or Sports/Recreation ( P = .150). Although the degenerative group had significantly higher subscores for Activities of Daily Living ( P = .001) and Quality of Life ( P = .004), the differences were considered not clinically meaningful. Conclusion: There were no meaningful differences in patient satisfaction or clinical outcomes between patients with traumatic and degenerative tears and no or mild OA. Predictors of dissatisfaction with APM were female sex, obesity, and lateral meniscal tears. Our findings suggested that APM was an effective medium-term option to relieve pain and recover function in middle-aged patients with degenerative meniscal tears, without obvious OA, and with failed prior physical therapy.

scholarly journals Sex Differences in Perceived Stress and Early Recovery in Young and Middle-Aged Patients With Acute Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 131 (7) ◽  
pp. 614-623 ◽  
Author(s):  
Xiao Xu ◽  
Haikun Bao ◽  
Kelly Strait ◽  
John A. Spertus ◽  
Judith H. Lichtman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Sex Differences ◽  
Perceived Stress ◽  
Middle Aged ◽  
Early Recovery ◽  
Aged Patients

Age-associated features of the development of fibrosis and inflamaging in patients with arterial hypertension and ischemic stroke

2022 ◽  
pp. 879-884
Author(s):  
О.А. Осипова ◽  
Е.В. Гостева ◽  
О.Н. Белоусова ◽  
Н.И. Жернакова ◽  
Н.И. Клюшников ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Arterial Hypertension ◽  
Old Age ◽  
Control Group ◽  
Cerebral Stroke ◽  
Middle Aged ◽  
Aged Patients ◽  
Tnf Α ◽  
Immune Inflammation

В статье рассмотрены вопросы развития фиброза и иммунного воспаления у больных артериальной гипертензией (АГ) с острым ишемическим инсультом (ИИ) в пожилом возрасте. Цель исследования - изучение возраст-ассоциированных особенностей концентрации маркеров фиброза (металлопротеиназы-9, тканевого ингибитора матриксных металлопротеиназ-1, их соотношения ММП-9/ТИМП-1), иммунного воспаления (TNF-α, IL-1β, INF-γ) у больных АГ с ИИ. В исследование были включены 86 больных АГ II степени, из которых 42 человека - среднего возраста (53±5 лет) и 44 - пожилого (66±5 лет), контрольную группу составили 22 пациента пожилого возраста с АГ без ИИ в анамнезе. Критерии включения - пациенты с АГ, поступившие в стационар в остром периоде первого церебрального инсульта. Установлено, что у пожилых больных АГ с ИИ показатели инфламэйджинга и маркеры фиброза были достоверно выше, чем у лиц среднего возраста. Уровень IL-1β был выше на 31,7 % (р<0,01), TNF-α - на 55,7 % (р<0,001), INF-γ - на 36,6 % (р<0,01), уровень ММП-9 - на 46,4 % (р<0,01), ТИМП-1 - на 21,2 % (р<0,01), ММП-9/ТИМП-1 - на 19,6 % (р<0,01) в пожилом возрасте по сравнению с больными среднего возраста с АГ и острым ИИ. Таким образом, установлено, что больные АГ с ИИ имеют нарушения процессов инфламейджинга, синтеза и деградации внеклеточного матрикса, особенно выраженные в пожилом возрасте. The article deals with the development of fibrosis and immune inflammation in patients with arterial hypertension and acute ischemic stroke in old age. The aim of the study was to study age-associated features of the concentration of fibrosis markers (metalloproteinase-9, tissue inhibitor of matrix metalloproteinases-1, their ratio MMP-9/TIMP-1), immune inflammation (TNF-α, IL-1β, INF-γ) in patients with arterial hypertension and ischemic stroke (AI). The study included 86 patients with arterial hypertension (AH) of the 2nd degree, of which 42 were middle-aged (53±5 years) and 44 elderly (66±5 years). The control group consisted of 22 elderly patients with AH without a history of AI. The criteria for inclusion in the study are patients with hypertension who were admitted to the hospital in the acute period of the first cerebral stroke. It was found that in elderly patients with hypertension with AI, the indicators of inflamaging and fibrosis markers were significantly higher than in middle-aged people. The level of IL-1β was 31,7 % higher (p<0,01), TNF-α by 55,7 % (p<0,001), INF-γ by 36,6 % (p<0,01), the level of MMP-9 was 46,4 % higher (p<0,01), TIMP-1 by 21,2 % (p<0,01), MMP-9/TIMP-1 by 19,6 % (p<0,01) in the elderly compared to middle-aged patients with hypertension and acute AI. Thus, it was found that patients with arterial hypertension and ischemic stroke have violations of the processes of inflamaging, synthesis and degradation of the extracellular matrix, especially pronounced in old age.

Abstract TP115: Carotid Endarterectomy in Young and Middle Aged Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Isibor J Arhuidese ◽  
Tammam Obeid ◽  
Besma Nejim ◽  
Kanhua Yin ◽  
Sophie Wang ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Physical Dependence ◽  
Female Gender ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Middle Aged ◽  
Improvement Program ◽  
Chi Square ◽  
Aged Patients ◽  
Cardiac Intervention

Introduction: The increasing prevalence and earlier onset of risk factors has resulted in an expanding population of younger patients undergoing carotid endarterectomy (CEA) in recent times. Outcomes after CEA are largely unreported in these patients. In this study, we evaluate 30-day postoperative outcomes after CEA in an exclusive cohort of young and middle aged patients. Methods: We studied all patients aged 64 years and younger, who underwent CEA in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 2005 to December, 2013. Univariate methods (Chi Square, ttest) were employed to compare patients’ characteristics. Multivariate regression adjusting for patient characteristics was used to identify predictors of adverse outcomes. Results: There were 15830 CEA’s performed in this cohort with a mean age of 58 (S.D:5.1) years. The majority of patients were male (59%), Caucasian (85%) and hypertensive (81%). Nearly half (46%) were symptomatic. Overall, 266 (1.7%) patients suffered stroke in the 30 day post-operative period, while mortality and myocardial infarction rates were 0.6% and 0.4% respectively. The significant predictors of stroke or death were female gender (OR: 1.49; 95%CI: 1.15-1.92; p=0.002), symptomatic status (OR: 1.69; 95%CI: 1.30-2.21; p<0.001), previous cardiac intervention (OR: 1.42; 95%CI: 1.04-1.93; p=0.026) and physical dependence (OR: 1.81; 95%CI: 1.16-2.82; p=0.01). The mean length of in-hospital stay was 3 (SD:5.6) days and complications within 30 days of surgery are shown in Table 1. Conclusions: Absolute stroke and mortality rates after CEA in young and middle aged patients are not different from those reported in the general population. Stroke and mortality are significantly higher in symptomatic, physically dependent patients and those with prior cardiac intervention. We recommend extra vigilance in the management of these patients in order to improve CEA outcomes.

Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus

2021 ◽  
pp. 105566562110363
Author(s):  
Jiuli Zhao ◽  
Hengyuan Ma ◽  
Yongqian Wang ◽  
Tao Song ◽  
Chanyuan Jiang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Treatment Options ◽  
Muscle Fibers ◽  
Three Dimensional ◽  
Anatomical Structure ◽  
Micro Computed Tomography ◽  
3 Dimensional ◽  
Middle Ear Ventilation ◽  
Optimal Approach ◽  
Velopharyngeal Function

Objective Palatoplasty would involve the structures around the pterygoid hamulus. However, clinicians hold different opinions on the optimal approach for the muscles and palatine aponeurosis around the pterygoid hamulus. The absence of a consensus regarding this point can be attributed to the lack of investigations on the exact anatomy of this region. Therefore, we used micro-computed tomography to examine the anatomical structure of the region surrounding the pterygoid hamulus. Design Cadaveric specimens were stained with iodine–potassium iodide and scanned by micro-computed tomography to study the structures of the tissues, particularly the muscle fibers. We imported Digital Imaging and Communications in Medicine images to Mimics to reconstruct a 3-dimensional model and simplified the model. Results Three muscles were present around the pterygoid hamulus, namely the palatopharyngeus (PP), superior constrictor (SC), and tensor veli palatini (TVP). The hamulus connects these muscles as a key pivot. The TVP extended to the palatine aponeurosis, which bypassed the pterygoid hamulus, and linked the PP and SC. Some muscle fibers of the SC originated from the hamulus, the aponeurosis of which was wrapped around the hamulus. There was a distinct gap between the pterygoid hamulus and the palatine aponeurosis. This formed a pulley-like structure around the pterygoid hamulus. Conclusions Transection or fracture of the palatine aponeurosis or pterygoid hamulus, respectively, may have detrimental effects on the muscles around the pterygoid hamulus, which play essential roles in the velopharyngeal function and middle ear ventilation. Currently, cleft palate repair has limited treatment options with proven successful outcomes.

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