scholarly journals 20 YEARS OF RSP – THE 5 MOST IMPORTANT LESSONS I’VE LEARNED

2021 ◽  
Vol 37 (37) ◽  
pp. 63-69
Author(s):  
Mark A. Frankle ◽  
David E. Teytelbaum ◽  
Peter Simon ◽  
Jay S. Patel
Keyword(s):  
Patient Selection ◽  
Soft Tissues ◽  
Reverse Shoulder Arthroplasty ◽  
Structural Features ◽  
Press Fit ◽  
Bone Preservation ◽  
Patient Optimization ◽  
The Right ◽  
Shoulder Kinematics ◽  
Key Aspects

Introduction and aim This paper reports on 5 key aspects to consider when planning a successful RSA procedure, including patient selection, glenosphere positioning, glenoid fixation, humeral fixation, and soft tissue management/tensioning. Material, methods, results, and discussion Key in patient selection for RSA is understanding the relationship between indications, outcomes, patient mental state, and their expectations. When placing a glenosphere, prioritize sound principles of shoulder kinematics but always consider bone preservation and ease of placement. Glenoid fixation must take advantage of structural features of individual implant designs while factoring in specific-bone morphology/morphometry to optimize the resultant glenohumeral loading. For the stem, fixation prioritizes press-fit where bone quality and quantity permit. Always aim to achieve anatomical pivot point restoration with planning for stem position and avoid distalization that may lead to nerve injury and scapular spine fractures. Conclusions To increase the chances of a successful RSA procedure, a surgeon should emphasize picking the right patient, placing the implant in an optimum position, ensuring adequate glenoid and humeral fixation, and correctly balancing soft tissues. Keywords: reverse shoulder arthroplasty, surgeon education, patient optimization

scholarly journals Antebrachial microvascular flap for reconstruction of the pelvic limb: case report

2019 ◽  
Vol 7 (5) ◽  
pp. 1952
Author(s):  
Rodrigo Banegas-Ruiz ◽  
Alan I. Valderrama-Treviño ◽  
J. A. Rivas-Montero ◽  
F. F. Gómez-Mendoza ◽  
E. García-Martínez ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissues ◽  
High Energy ◽  
Healing Time ◽  
Surgical Approaches ◽  
High Energy Trauma ◽  
Microvascular Flap ◽  
Pelvic Limb ◽  
The Right ◽  
Key Aspects

Complex defects in the soft tissues of the foot and ankle caused by high-energy trauma, infection, cancer or diabetes require rapid and effective treatment which decreases the risk of infection, bone healing time, hospital stay and number total of surgical approaches. Authors report a clinical case of a 23-year-old female patient who suffers high-energy trauma due to a motorcycle accident which causes exposure of the distal third of the tibia, loss of the tibial joint face, and loss of tissue throughout the region of the malleolus medial of the right pelvic extremity. Tissue transfer to the pelvic limb is performed using left contralateral radial antebrachial free flap as donor area. This case report aims to emphasize the key aspects of the high energy trauma approach by using microvascular flaps, as well as the satisfactory evolution of the patient that directly affects the prognosis for life and function.

scholarly journals A Dynamic Model of Hip Joint Biomechanics: The Contribution of Soft Tissues

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Joseph F. Fetto
Keyword(s):  
Soft Tissues ◽  
The Body ◽  
Design Element ◽  
Implant Fixation ◽  
Stem Design ◽  
Complete Representation ◽  
Modeling Technology ◽  
Press Fit ◽  
Bone Preservation ◽  
Joint Biomechanics

Before recent advances in computer modeling technology, it has been nearly impossible to define the contribution of soft tissue structures when constructing models of the body, and in particular the lower extremity. For almost 100 years, the design and fixation of femoral components for total hip arthroplasty (THA), whether cemented or press fit, have been predicated on the Koch model of hip biomechanics. A more comprehensive model, which includes the dynamic contribution of soft tissues, has expanded the Koch’s static model. This new model has led to a more complete representation of reality and has become the basis for the inclusion of a new stem design element (a lateral flare), a new concept of implant fixation (rest fit), and consequent significant increase in bone preservation and implant stability.

The massive nodular cutaneous and soft tissues lesions of the right shoulder and the arm as the extramedullary manifestation of the advanced stage of multiple myeloma

Oncoreview ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 180-183
Author(s):  
Arkadiusz Drobiecki ◽  
Marcin Pasiarski ◽  
Agnieszka Stelmach-Gołdyś ◽  
Bartosz Garus
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissues ◽  
Advanced Stage ◽  
The Right

Process design and equipment selection for optimized steam and power concepts – the “zero” process steam sugar factory

2020 ◽  
pp. 40-50
Author(s):  
Boris Morgenroth ◽  
Thomas Stark ◽  
Julian Pelster ◽  
Harjeet Singh Bola
Keyword(s):  
Process Design ◽  
Sugar Industry ◽  
Electrical Power ◽  
Power Requirement ◽  
Equipment Selection ◽  
Good Potential ◽  
Set Up ◽  
The Right ◽  
Key Aspects ◽  
Steam Drying

Optimization of process steam requirement in order to maximize sugar recovery and export power along with manpower optimization is a must for sugar factories to survive under difficult conditions and to earn additional revenues. The process steam demand of greenfield and revamped plants has been reduced to levels of 32–38% from originally more than 50% steam on cane in the case of the brownfield plants. In addition, significant improvement in the power requirement of the plants has been achieved. Bagasse drying offers a good potential to improve the power export. Different available concepts are compared with a focus on bagasse steam drying and low temperature bagasse drying. In order to set up an optimized highly efficient plant or to optimize an existing plant to achieve competitive benchmarks, good process design and the right equipment selection are very important. Experience has been gained with multiple stage or double effect crystallization in the beet sugar industry offering further steam optimization potential. Vapour recompression is also an option to substitute live steam by electrical power. This even provides options to reduce the steam demand from the power plant for the sugar process down to zero. Key aspects concerning the process design and equipment selection are described.

scholarly journals Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110196
Author(s):  
Xiaotong Peng ◽  
Zhi Duan ◽  
Hongling Yin ◽  
Furong Dai ◽  
Huining Liu
Keyword(s):  
Adverse Events ◽  
Soft Tissues ◽  
Malignant Tumors ◽  
Cystic Teratoma ◽  
Abdominal Distension ◽  
Epithelioid Angiosarcoma ◽  
History Of ◽  
New Ideas ◽  
The Right ◽  
Clinical Awareness

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

scholarly journals Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

2021 ◽  
Author(s):  
Sergey Dydykin ◽  
Friedrich Paulsen ◽  
Tatyana Khorobykh ◽  
Natalya Mishchenko ◽  
Marina Kapitonova ◽  
...  
Keyword(s):  
Prone Position ◽  
Anatomical Study ◽  
Structural Features ◽  
Posterior Mediastinum ◽  
Visual Navigation ◽  
Anatomical Landmarks ◽  
Video Assisted ◽  
Before And After ◽  
Human Cadavers ◽  
The Right

Abstract Purpose There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum’s fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. Methods The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. Results For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. Conclusion The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.

scholarly journals Primitive Neuroectodermal Tumor of the Liver: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eduardo Cambruzzi ◽  
Enilde Eloena Guerra ◽  
Hamilton Cardoso Hilgert ◽  
Herbert Jorge Schmitz ◽  
Vinícius Lopes Silva ◽  
...  
Keyword(s):  
Primitive Neuroectodermal Tumor ◽  
Soft Tissues ◽  
Young Patients ◽  
Neuroectodermal Tumor ◽  
Solid Mass ◽  
Resected Liver ◽  
The Central Nervous System ◽  
Right Lobe ◽  
Upper Abdominal ◽  
The Right

Primary liver sarcomas represent a rare group of neoplasias, with angiosarcoma being the most common histological type. Primitive neuroectodermal tumor (PNET) represents a high malignant neoplasia that usually affects the central nervous system and soft tissues. An 18-year-old male patient was admitted with clinical complains of pain in the right upper abdominal quadrant. The clinical evaluation revealed a solid mass in the right hepatic lobe. On the gross examination of the resected liver specimen, the right lobe of the liver was replaced by a yellow-red solid mass measuring 21 cm in its largest dimension. On the histopathology, a tumor composed of small round blue cells with little cytoplasm and round nuclei was identified. The lesion revealed positive immunoexpression for vimentin and CD99 and negative immunostaining for desmin, CD45, cytokeratin, and neuroblastoma protein, suggesting, then, the diagnosis of PNET. Although it is an unusual tumor, it should be considered in the differential diagnosis of liver masses, especially in young patients.

NECROTISING SOFT TISSUE INFECTION OF BILATERAL UPPER LIMB CAUSED BY THE INJECTION OF ORAL BACTERIA: A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 243-246 ◽  
Author(s):  
Yuichi Yoshii ◽  
Tomoo Ishii ◽  
Shinsuke Sakai
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Soft Tissue Infection ◽  
Soft Tissues ◽  
Biceps Brachii ◽  
Subcutaneous Tissue ◽  
Oral Bacteria ◽  
Tissue Infection ◽  
Left Elbow ◽  
The Right

Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.

Atypical Form of Cervicofacial Actinomycosis Involving the Skull Base and Temporal Bone

2018 ◽  
Vol 128 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Adam McCann ◽  
Sameer A. Alvi ◽  
Jessica Newman ◽  
Kiran Kakarala ◽  
Hinrich Staecker ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skull Base ◽  
Temporal Bone ◽  
Soft Tissues ◽  
Trauma Surgery ◽  
Oral Antibiotic ◽  
Facial Skeleton ◽  
Atypical Form ◽  
Unsuccessful Treatment ◽  
The Right

Background: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. Methods: Case report with literature review. Results: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. Conclusions: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.

scholarly journals Mandibular Bone and Soft Tissues Necrosis Caused by an Arsenical Endodontic Preparation Treated with Piezoelectric Device

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
A. Giudice ◽  
M. G. Cristofaro ◽  
I. Barca ◽  
D. Novembre ◽  
M. Giudice
Keyword(s):  
Soft Tissues ◽  
Mandibular Bone ◽  
Bone Necrosis ◽  
Second Molar ◽  
Piezoelectric Device ◽  
The Right

This paper describes a case of wide mandibular bone necrosis associated with significant soft tissues injury after using an arsenical endodontic preparation in the right lower second molar for endodontic purpose. Authors debate about the hazardous effects of the arsenic paste and the usefulness of piezosurgery for treatment of this drug related bone necrosis.

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