Chronic locked posterior gleno-humeral dislocation: technical note on fibular grafting for restoration of humeral head sphericity

Background Reconstruction of reverse Hill-Sachs defect using osteo-chondral allograft has the advantages of spherical re-contouring and provision of smooth biological articular surface of the reconstructed humeral head. However, worldwide availability and risk of disease transmission of osteo-chondral allograft remain points of increasing concerns. As an alternative to lacking osteo-chondral allograft, the current technical note describes a reconstructive technique of reverse Hill-Sachs defect using autologous fibular grafting. Methods Following open reduction of the dislocated humeral head, reverse Hill-Sachs defect was reconstructed using 3–4 autologous fibular pieces (each is of 10 mm in length) fixed in flush with the articular cartilage using 4-mm cancellous screws. Defect reconstruction was then followed by modified McLaughlin’s transfer and posterior capsulorrhaphy. Results Spherical contour of the humeral head and gleno-humeral range of motion were restored. Intra-operative dynamic testing of the reconstruct revealed no residual posterior gleno-humeral instability. Conclusion Currently reported technique might offer advantages of graft availability, technical simplicity, familiarity and reproducibility, safety (i.e. no disease transmission) and bone preservation facilitating future revision management (if needed). Nevertheless, long-term outcomes of this technique should be investigated via further cohort clinical studies.

Laparoscopic Sleeve Gastrectomy for the Surgical Treatment of Obesity: Is It an Easy Procedure?

Laparoscopic sleeve gastrectomy (LSG) is currently the most performed bariatric procedure in the world. The 4th International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global registry report (2014-18) estimates 87,015 procedures, equal to 45.9% of all bariatric procedures. Initially performed as the first step of the duodenals witch (biliopancreatic diversion with duodenal switch (BPD-DS)), a very complex malabsorptive procedure invented by a Canadian Surgeon P. Marceau as an evolution of the BPD, invented by N. Scopinaro, an Italian surgeon, LSG established itself in the early 2000s as a stand alone procedure, especially following the observations of Michael Gagner, pioneer of bariatric surgery. Over the years LSG has grown rapidly. The reasons for this popularity are the relative technical simplicity compared to other procedures, efficacy, good quality. For these reasons there has been a real explosion of bariatric surgery: many surgeons, driven by the relative simplicity of the procedure (longitudinal gastrectomy on the guide of a probe), begun to propose this procedure. So is LSG really an effective simple procedure that is good for all patients? Absolutely not. Performing a longitudinal gastrectomy can be simple; performing a good LSG is not.

Molecular genetic methods in biomedical research. Part III: human gene diagnostics in clinical practice

Application of molecular genetic methods in the diagnosis and treatment of human diseases is extremely wide due to a huge amount of hereditary information contained in the human genome. Gene diagnostics allows establishing predisposition to diseases, identification of genetic abnormalities and prediction of pathological outcomes. In addition, gene diagnostics also enables prediction of the individual response to treatment in order to achieve the maximum therapeutic effect. Among all molecular genetic methods, polymerase chain reaction (PCR) diagnostics is a leading approach. Technical simplicity, low cost, high sensitivity and reliability of the method have made PCR diagnostics a routine modality for the risk assessment, diagnostics, and monitoring of the treatment efficiency. Here, we consider the application of PCR diagnostics for the abovementioned tasks and talk about the real-life examples of detecting mutations and chromosomal aberrations which may cause a disease. Further, we discuss the prospects of using a semi-quantitative PCR in medical practice and focus on pharmacogenetics as a key component of a personalised therapy. The lecture is aimed primarily at biomedical students and physicians and represents a continuation of the previous lectures published in Fundamental and Clinical Medicin.

Ligaments and muscles stabilizing the radio-ulno-carpal joint

The technical simplicity of the Darrach procedure may explain why it has been so popular. Excising the distal ulna, however, may have potentially undesired consequences to the biomechanics in two areas: the distal radioulnar and the ulno-carpal joints. These conjointly define the radio-ulno-carpal joint (RUCJ). The RUCJ is not a small and irrelevant articulation that can be removed without possibly paying a functional penalty. It is an important link of the antebrachial frame that provides stability to the distal forearm and the carpus. This article revisits the mechanisms by which some ligaments and muscles ensure that all forces about and within the RUCJ are dealt with efficiently.

Subacromial resurfacing with fascia lata autograft for irreparable cuff tears

Massive and irreparable rotator cuff tears remain a major challenge for orthopaedic surgeons and several surgical options have been accepted for different patterns of irreparable cuff tears. However, the high-cost and technical complexity of some surgeries and the inconsistent clinical results of others, leave room for the search for surgical options that can offer a good balance between technical simplicity, a lower cost and an acceptable clinical result.The rationale behind some available techniques includes lowering the humeral head, which enables a more efficient balance of the force couples around the shoulder during rehabilitation. The interpositional arthroplasty with a biodegradable balloon, the Superior Capsule Reconstruction and, more recently, subacromial resurfacing with a dermal allograft have been presented as valid options to address that purpose.This technical note presents Subacromial Resurfacing with fascia lata as an option for the treatment of irreparable rotator cuff tears in the elderly population. Its low-cost and reasonable technical demand, along with the need for further elucidation of the ideal indications and technical optimization of other available techniques may open up room for the success of this option.

Solid State NMR for Nonexperts: An Overview of Simple but General Practical Methods

There are varieties of methods available for the exploration of solids using nuclear magnetic resonance (NMR) spectroscopy. Some of these methods are quite sophisticated, others require specialized equipment. This review is addressed to those for whom NMR is not the main research method. It discusses simple methods that can be applied to solids with little or no adaptation to a specific system. Despite their technical simplicity and ease of use, these methods are powerful analytical tools that provide unique insights into the structure, dynamics, and noncovalent interactions in homo- and heterogeneous systems. Particular attention is paid to the characterization of porous materials and solids containing phosphorus. 31P NMR of organometallic compounds has been used as an example of how theoretical calculations can help in deeper analysis of experimental data.

The difficulties of radiological diagnosis phenomen of dysregeneration long bones fractures based on clinical cases

Research objectives data analysis of the radiological methods different types of dysregenerations, based on the clinical cases.Material and methods. Literature review about radiation semiotics regeneration and dysregeneration phenomena, applicability of different types of radiological methods has been done. A review of 2 cases of delayed union and 5 cases of fracture nonunion is presented.Conclusion. Despite the improvement and technical simplicity of visualizing the phenomena of dysregeneration, it is difficult to differentiate delayed union from nonunion using only by radiological methods, respectively, a consensus of an orthopedic surgeon and a radiologist is required in each individual case. The clinician chooses the treatment tactics based on the complex data set, including radiological methods.

Novel chemiluminescent immunoassay to measure plasma aldosterone and plasma active renin concentrations for the diagnosis of primary aldosteronism

Determination of plasma aldosterone concentrations (PAC) and plasma active renin concentrations (ARC) is essential for the diagnosis of primary aldosteronism (PA). In Japan, although PAC and ARC are measured by radioimmunoassay and immunoradiometric assay, respectively, non-radioisotopic methods with better detection sensitivity, measurement accuracy, and technical simplicity are needed. We developed two-site sandwich chemiluminescent enzyme immunoassays (CLEIAs) to measure both PAC and ARC using monoclonal antibodies immobilized onto ferrite particles. The results of both assays are obtained simultaneously from a single plasma sample within 30 min using a fully automated system. The novel CLEIAs were validated using plasma samples from patients with PA (n = 52) and essential hypertension (n = 23). The PAC determined by the CLEIA was significantly correlated with that measured by liquid chromatography/mass spectrometry or conventional radioimmunoassay. The ARC determined by the CLEIA was significantly correlated with that measured by immunoradiometric assay. The limits of detection of the CLEIAs for PAC and ARC were 0.1 ng/dl and 0.04 pg/ml, respectively, which were better than those of conventional methods (PAC: 2.5 ng/dl; ARC: 5 pg/ml). The PAC and PAC/ARC ratio (ARR) were significantly higher, and the ARC significantly lower, in patients with PA than in those with essential hypertension. An ARR cut-off of 1.31 ng/dl per pg/ml showed a sensitivity of 96.2% and specificity of 78.3% for PA screening. The newly developed CLEIAs for measuring PAC and ARC could provide a clinically powerful alternative to conventional methods used for hypertension screening in clinical practice.

Change Management

The present markets affect organizations by triggering the need for change. However, in addition to flexibility, it is considered the implementation of procedures to alleviate the ‘weather'. So, change management is fundamental in organizations that move in innovative and disruptive environments. The present work seeks to provide a tool that will allow the collection and structuring of the constituent data necessary for the management of new projects/products, creating relevant information to strategic decision makers, stating that the exploratory cycle of the process intends to create organizational knowledge that will 'situate' all team members within the various projects. It will consist of a literary review followed by the presentation of a case study, which can be applied in an SME due to its technical simplicity. The objective is to support the proposal as a promoter of information and knowledge management. The work ends with a critical analysis of the contents, exposure of limitations, and suggestions for possible future work associated with the current theme.