BackgroundAcromioclavicular joint dissociation may not be a common injury, yet it may cause limitations in activity. Types IV, V, and VI dissociations need operative repair. In this study, a simple technique is advocated to reduce and maintain reduction of the acromioclavicular joint using no. 5 nonabsorbable suture material while the resutured coracoclavicular (CC) ligament heals.Methods and methodsTwenty-one patients (16 men and five women) with types IV and V acromioclavicular joint dissociation were studied. In all cases, acromioclavicular joint was reduced and reduction was maintained using no. 5 nonabsorbable suture material passed as a loop under the knuckle of the coracoid process and through a tunnel drilled through the lateral third of the clavicle. The CC ligament was then resutured.ResultsPatients were followed up over a period of 6–9 years. At the final follow-up, all patients had returned to their preinjury level of activity, with significant improvement in the University of California Los Angeles (UCLA), American Shoulder and Elbow Surgeons Shoulder (ASES), and the Constant scores.ConclusionsThis technique provided good results with no loss of reduction, except in a single case, during the long follow-up period. We could not prove that the good results are due to the healing of the CC ligament. However, patients were able to return to their daily activities and even contact sports without any noticeable deformity, feeling of weakness, pain, or limitation of range of motion (compared with the contralateral side). This technique does not involve the use of metallic implants, which require another surgery to remove them, the use of expensive synthetic graft, or a graft harvested from a distant donor site.

Background and Objectives: Testicular sperm extraction (TESE) has been a useful diagnostic and therapeutic tool with sperm retrieval opportunity varying according to the pathological finding in azoospermic patients. Sonoelastography (SE) is an exciting radiologic method that can measure relative elasticity of different tissues in a selected region of interest (ROI) by depending on fast cross-correlation technique and a combined autocorrelation method. Real-time elastography (RTE) can be used for structural analysis of testicular tissue to detect pathological tissue alterations. We aimed in the current study to evaluate the efficacy of shear wave elastography (SWE) in predicting sperm retrieval in non-obstructive azoospermic (NOA) patients undergoing TESE. Patients and methods:This prospective study included 50 NOA patients who did two successive semen analyses with normal or elevated gonadotrophic hormones. All participants were subjected to SWE imaging on the testes by a radiologist. The measurements were recorded in terms of kPa using the SWE mode. They were done on each testis in the longest longitudinal plane. SWE images were viewed using dual mode: elasticity mode (kPa) and propagation (arrival time contour) mode then patients underwent TESE.Results: A significant difference in SWE values was observed between patients with successful sperm retrieval and those with negative sperm retrieval providing 94.7% negative predictive value and 50.0% positive predictive value for sperm retrieval in NOA patients undergoing TESE with 75.0% sensitivity and 85.71% specificity (p = 0.0001).Mean stiffness index measured by SWE correlated significantly with the histopathological types as 8 patients only were diagnosed as having severe hypospermatogenesis. Discussion and Conclusion:These prime data suggest that SWE as a non-invasive, easily applicable, and repeatable imaging method has a promising potential to be one of the reliable sonographic modalities that can be used as one of the predictors for sperm retrieval in NOA patients.

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Background Hand tendon injuries are recognized clinical entities that are frequently seen. Clinical examinations usually warrant radiological correlative studies for confirmation and as a postoperative screening test. Here is a prospective observational cohort study enrolling 30 patients who were diagnosed clinically to have hand tendon injuries either pre- or postoperative; their ages were ranging from 5 to 64 years with a mean ± SD of 31.43 ± 12.19 years; 23 male patients (76.7%) and 7 female patients (23.3%) were evaluated by high-resolution ultrasound examination and a correlative evaluation was done by either intra-operative assessment or MRI study as gold standards. Results High-resolution ultrasound (HRUS) findings were binned into seventeen cases (56%) that had tendon tears, of which 10 cases (33.3%) had a complete tear and 7 cases (23.3%) had a partial tear. Postoperative tendon integrity was present in 13 cases (43.3%), a tendon callus was found in 2 cases (6.66%), and a postoperative abnormal motion on the dynamic study was present in 15 cases (50%). Intra-tendinous foreign bodies were detected in two cases (6.66%), a gap between the torn ends was found in 10 cases (33.3%), and re-tear (rupture) of the repaired tendons was present in four cases (13.3%). Coexistent nerve injuries were seen in two cases (6.66%); for the forementioned findings, HRUS had gained high accuracy measures as correlated to the gold standards (100% sensitivity and 100% specificity). Conclusion High-resolution ultrasound serves as a highly accurate potential diagnostic modality for preoperative evaluation of hand tendon injuries and the postoperative follow-up.

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Aim of the work: To measure the extent of subclinical atherosclerosis in patients with systemic sclerosis, and to evaluate any potential vascular risk factors in these patients.Patients and methods: This study included 30 patients with systemic sclerosis diagnosed according to the American college of rheumatology criteria and 20 healthy individuals were also included as a control group. Non-invasive vascular tests including; carotid duplex scanning measuring common carotid arteries (CCA) intima-media thickness (IMT), and ankle brachial pressure index (ABPI) were performed. Traditional vascular risk factors such as blood pressure, blood sugar, lipid profiles, steroid usage and other immunosuppressive medications were assessed.Results: The mean IMT of CCA was higher in systemic sclerosis patients (right 0.67 ± 0.11 mm, left 0.67 ± 0.12 mm) when compared with the control group (right 0.48 ± 0.2 mm, left 0.54 ± 0.13 mm) (p < 0.001). Carotid plaques were found in 4 SSc patients. Mean IMT was correlated with patients' age (p < 0.001), disease duration (p < 0.001), systolic blood pressure (p < 0.05), and dyslipidemia (p < 0.01). Ankle brachial pressure index (ABPI) was significantly lower in SSc patients (0.94 ± 0.13) when compared with controls (1.16 ± 0.12) (p < 0.001). No difference was found between limited (n = 25) and diffuse (n = 5) disease subtypes in mean IMT, nor in mean ABPI. There was no significant correlation between mean IMT and steroid dose or other immunosuppressive intake.Conclusion: There is an increased risk of subclinical atherosclerosis and peripheral arterial disease in SSc patients. Increased systolic blood pressure, dyslipidemia, long disease duration and older age were possible risk factors.

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