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Newton, MA, United States

Bierry G.,University of Strasbourg | Simeone F.J.,Massachusetts General Hospital | Borg-Stein J.P.,Newton Wellesley Hospital | Clavert P.,University of Strasbourg | Palmer W.E.,Massachusetts General Hospital
Radiology | Year: 2014

Purpose: To evaluate continuity of the sacrotuberous ligament (STL) in normal and abnormal hamstring (HS) tendons on magnetic resonance (MR) images and to test the hypothesis that greater degrees of HS retraction are correlated with STL discontinuity. Materials and Methods: The institutional review board approved this retrospective HIPAA-compliant study and waived informed consent. Control cohort comprised 33 patients (mean age, 54.1 years) without HS abnormalities at hip MR arthrography. Study cohort comprised 100 patients (mean age, 55.3 years) with HS abnormalities at pelvic or hip MR imaging. Two musculoskeletal radiologists independently assessed STL continuity with the ischium and semimembranosus (SM) and conjoined biceps femoris and semitendinosus (BF-ST) tendons and evaluated these tendons for tendinopathy, partial tear, or rupture. A third musculoskeletal radiologist measured retraction of ruptured tendons. Inter- and intraobserver agreement was calculated with weighted κ or intraclass correlation coefficients. HS abnormalities in the cohorts were compared with Mann-Whitney test. In patients with tendon rupture, relationships between qualitative (STL and HS attachments) and quantitative (tendon retraction measurements) data were analyzed with analysis of variance and linear regression with Bonferroni correction. Results: STL was continuous with ischium in all patients. In control patients, STL was always continuous with BF-ST but never continuous with SM. In study patients, BF-ST tendon alone, SM tendon alone, and both BF-ST and SM tendons showed abnormalities in 17, six, and 77 patients, respectively. HS rupture occurred in 24 patients; it involved BF-ST tendon alone in 13 patients and both BF-ST and SM tendons in 11. STL was continuous with BF-ST tendon in 12 patients and discontinuous in 12 patients. Retraction of BF-ST tendon (mean, 33 mm; range, 5-81 mm) was independently correlated with STL continuity with BF-ST (P = .0001) and SM (P = .0004) tendon rupture. Retraction was significantly greater (P ≤ 0.01) when STL was discontinuous and SM tendon was ruptured. Inter- and intraobserver agreement was very good or excellent in categorization of HS abnormalities and measurement of retraction. Conclusion: STL showed continuity with both ischium and BF-ST tendon but not SM tendon. In HS rupture, tendon retraction was significantly less when STL remained attached to BF-ST tendon. © RSNA, 2013. Source

Friedman L.S.,Newton Wellesley Hospital
Transactions of the American Clinical and Climatological Association | Year: 2010

Surgery is performed in patients with liver disease more frequently now than in the past, in part because of the long-term survival of patients with cirrhosis. Recent work has focused on estimating perioperative risk in patients with liver disease. Hemodynamic instability in the perioperative period can worsen liver function in patients with liver disease. Operative risk correlates with the severity of the underlying liver disease and the nature of the surgical procedure. Thorough preoperative evaluation is necessary prior to elective surgery. Surgery is contraindicated in patients with certain conditions, such as acute hepatitis, acute liver failure, and alcoholic hepatitis. Estimation of perioperative mortality is inexact because of the retrospective nature of and biased patient selection in available clinical studies. The Child-Pugh classification (Child-Turcotte-Pugh score) and particulary the Model for End-Stage Liver Disease (MELD) score provide reasonable estimations of perioperative mortality but do not replace the need for careful preoperative preparation and postoperative monitoring, as early detection of complications is essential for improving outcomes. Medical therapy for specific manifestations of hepatic disease, including ascites, encephalopathy, and renal dysfunction, should be optimized preoperatively or, if necessary, administered in the postoperative period. Source

DeGroot H.,Newton Wellesley Hospital | Al-Omari A.A.,Jordan University of Science and Technology | El Ghazaly S.A.,Ain Shams University
Foot and Ankle International | Year: 2011

Background: Recently, a suture button device has been advocated as a simple and effective method of repairing the syndesmosis. Proponents of the device have cited earlier weightbearing and elimination of the need for device removal as potential advantages over metallic screws. However, the available reports generally have short followup. With longer followup, some concerns about the suture button device have surfaced. Materials and Methods: We reviewed the clinical and radiographic results of 24 patients with acute injuries to the distal tibiofibular syndesmosis who were treated with suture button fixation. Average followup was 20 months. The primary outcomes measure was the AOFAS ankle hindfoot score. Secondary outcomes measures included a calibrated measurement of the tibiofibular clear space and tibiofibular overlap. Results: The average AOFAS score was 94 points. Syndesmotic parameters returned to normal after surgery and remained normal throughout the followup period. One in four patients required removal of the suture endobutton device due to local irritation or lack of motion. Osteolysis of the bone and subsidence of the device into the bone was observed in four patients. Three patients developed heterotopic ossification within the syndesmotic ligament, one mild, one moderate, and one who had a nearly complete syndesmotic fusion. Conclusion: The suture button device is an effective way to repair the syndesmosis. In our series, the reduction of the syndesmosis was maintained throughout the followup period. However, reoperation for device removal was more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur. Copyright © 2011 by the American Orthopaedic Foot & Ankle Society. Source

Huckins D.S.,Newton Wellesley Hospital
American Journal of Emergency Medicine | Year: 2015

I would like to submit a correction to our previously published manuscript [1]. In this manuscript, we reported the diagnostic characteristics of a new algorithm comprised of white blood cell (WBC), Creactive protein (CRP), and myeloid-related protein 8/14 levels for identifying pediatric emergency department patients with abdominal pain who are at low risk of acute appendicitis. In this article, we compared the diagnostic accuracy of the algorithm to the combination of normalWBC and CRP as excerpted below: © 2015 Published by Elsevier Inc. Source

Demircay E.,Baskent University | Hornicek Jr. F.J.,Harvard University | Mankin H.J.,Harvard University | Degroot III H.,Newton Wellesley Hospital
Clinical Orthopaedics and Related Research | Year: 2013

Background: Lymphoma of bone is uncommon. As a result of this, many aspects of primary lymphoma of bone (PLB) are controversial: the definition, treatment strategies, response criteria, and prognostic factors. Questions/purposes: We sought to determine the following in an analysis from a single center over a four-decade period: (1) 5-year disease-free survival of patients with PLB as well as those with systemic lymphoma with bone involvement; and (2) whether prognostic factors (sex, site of tumor, age) were associated with 5-year survival. Methods: A total of 119 patients with lymphoma involving the musculoskeletal system were retrospectively evaluated. Among these, 94 patients who had a minimum followup of 6 months (mean, 67 months; range, 6 months to 34 years) were further analyzed for the skeletal site of involvement, the orthopaedic intervention(s) needed, and survival. The overall median age was 45 years (range, 7-87 years). The female-to-male ratio was 1:1.53. There were 70 (65 unifocal, five multifocal) patients with PLB. The femur was the most frequent site involved. Appendicular skeleton involvement was substantially higher in patients with PLB. Thirty-four (36%) patients had at least one surgical intervention. Fourteen patients (41%) needed more than one major surgical intervention. Results: The disease-free 5-year survival for patients with PLB was 81% and for the patients with systemic lymphoma with bone involvement, it was 44%. The disease-free 5-year survival of the patients with PLB younger than 60 years old and 60 years old or older was 90% and 62%, respectively. Age was the only prognostic factor on survival of patients with PLB. Conclusions: Orthopaedic intervention was usually needed for pathologic fractures, avascular necrosis, spinal cord compression, or for the lesions of the weightbearing bones compromising stability or joint motion. The potential for long-term survival suggests the use of implants and techniques that have the best chance of long-term success. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®. Source

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