Distance between the supraspinatus and long head of the biceps tendon on sagittal MRI: a new tool to identify anterior supraspinatus insertion injury

Purpose Anterior insertion of the supraspinatus muscle plays an essential role in rotator cuff tissue. We aimed to determine whether the distance between the midpoints of the supraspinatus central tendon and long head of the biceps tendon on a sagittal shoulder magnetic resonance imaging scan can help to preoperatively diagnose an injury of the anterior insertion of the supraspinatus. Method This retrospective study reviewed 103 patients with a full-thickness supraspinatus tendon tear: 50 patients with (injured group) and 53 patients without (intact group) anterior supraspinatus insertion tear. The inter-tendon distance was measured based on an oblique sagittal magnetic resonance imaging scan. SPSS was used for statistical analyses. Two independent samples t-test and receiver operating curve analysis were also performed. Results The measurements of inter-tendon distance revealed good intra- and inter-observer reliabilities with intra-class correlation coefficients of 0.92 and 0.97, respectively. The inter-tendon distance of the injured group was significantly greater than that of the intact group (10.1 ± 2.7 vs 8.0 ± 2.3 mm, P < 0.001). The diagnostic ability of the inter-tendon distance was fair (area under the curve = 0.745), and a threshold of 9 mm had a specificity of 73% and sensitivity of 74%. Conclusion The distance between the supraspinatus central tendon and long head of the biceps tendon on magnetic resonance imaging was greater in patients with anterior supraspinatus insertion injury than those without the injury. A distance of 9 mm may be the cut-off value and a good diagnosis marker for anterior supraspinatus insertion injury. Level of evidence Level III, diagnostic case–control study.

A rare case of traumatic proximal corpus cavernosal fracture that presented only with perineal haematoma

We report a rare case of traumatic proximal corpus cavernosal tear following sexual intercourse that presented only with perineal haematoma and represents only the third reported similar case. The patient underwent a magnetic resonance imaging scan of the pelvis and penis due to the atypical presentation and was subsequently taken to theatre for exploration and repair of the injury. Although uncommon, clinicians should be aware of this clinical condition, as early recognition with early surgical treatment can potentially decrease the incidence of late complications of fibrosis, angulation and impotence.

Primary Undifferentiated Pericardial Sarcoma after Radiоtherapy for Hodgkin Lymphoma

Various types of sarcomas arise as a result of postradiation chronic fibrous pericarditis. A primary undifferentiated spindle cell pericardial sarcoma is a rare type of sarcoma after radiotherapy. The risk of sarcoma increases with time after treatment of cancer. A 55-year-old woman underwent successful radiation and chemotherapy for Hodgkin lymphoma 20 years ago. She was hospitalized with typical manifestations of severe heart failure. Echocardiography, сomputed tomography of the chest and magnetic resonance imaging scan of the heart detected neoplastic formations of the pericardium. A biopsy of the pericardium was performed. Histological, immunohistochemical, and genetic studies showed a primary undifferentiated spindle cell pericardial sarcoma (an extremely rare type of sarcoma).

Ex utero intrapartum treatment to extracorporeal membrane oxygenation: lifesaving management of a giant cervical teratoma

BackgroundEx utero intrapartum treatment (‘EXIT’ procedure) is a well described method for maintaining maternal–fetal circulation in the setting of airway obstruction from compressive neck masses. When ex utero intrapartum treatment to airway is not feasible, ex utero intrapartum treatment to extracorporeal membrane oxygenation (‘ECMO’) has been described in fetal cardiopulmonary abnormalities.ObjectiveThis paper presents the case of a massively compressive midline neck teratoma managed with ex utero intrapartum treatment to extracorporeal membrane oxygenation, allowing for neonatal survival, with controlled airway management and subsequent resection.Case reportA 34-year-old-female presented with a fetal magnetic resonance imaging scan demonstrating a 15 cm compressive midline neck teratoma. Concern for failure of ex utero intrapartum treatment to airway was high. The addition of the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure provided time for the planned subsequent resection of the mass and tracheostomy.ConclusionEx utero intrapartum treatment procedures allow for securement of the difficult neonatal airway, while maintaining a supply of oxygenated blood to the newborn. Ex utero intrapartum treatment circulation lasts on average less than 30 minutes. The arrival of extracorporeal membrane oxygenation has enabled the survival of neonates with disease processes previously incompatible with life.

Ontogeny and evolution of the sound-generating structures in the infraorder Delphinida (Odontoceti: Delphinida)

The ontogeny of the structures involved in sound generation and modulation in dolphins was investigated through a comparison of the soft nasal structures of foetal, perinatal, neonatal and adult specimens of Pontoporiidae, Phocoenidae and Delphinidae. Foetal samples were sectioned at 10 µm in the saggital and coronal planes, and stained for histological examination. Computed tomography and magentic resonance imaging scan series were combined with new data to represent the ontogenetic stages of the three groups. The images were analysed in 3D-Slicer to characterize the general head topography. The origins of the melon and the vestibular air sac were detected between Carnegie stages C16 and F22. The three groups analysed showed distinct formation of the nasal plug and nasal plug muscles, mainly with regard to the loss of fat pathways (or their maintenance in Pontoporiidae) and the development of the nasal plug muscles on both sides (during perinatal development of Phocoenidae) or just on the left side (during postnatal development in Delphinidae). Broadband vocalizing delphinidans might have evolved under heterochronic events acting on the formation of sound-generating structures such as the rostrum and vestibular air sacs, and on the transformation of the branches of the melon, probably leading to a reduced directionality of the sonar beam.