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Biomedical subjects

B S Shaffer

Publications and source records attributed to B S Shaffer.

7 recordsLinked to original sources
PubMed1999

Arthroscopic shoulder instability surgery. Complications.

Complications associated with arthroscopic shoulder stabilization are relatively common. Excluding recurrence, complications are rarely disabling. Current statistics undoubtedly underestimate the true incidence of complications. Many complications, including neurovascular injuries and articular damage, are preventable and can be minimized through familiarity with anatomy, proper surgical technique and instrumentation, and clinical experience. Nevertheless, despite these efforts, a few complications, including recurrent instability, persist. Despite careful patient selection and attention to labral pathology and capsular laxity, arthroscopic repairs continue to have success rates lower than those achieved through open means. While cautiously proceeding toward a more complete understanding of the instability continuum, surgeons must maintain a high index of suspicion for new techniques that purport to "solve" the problem of arthroscopic shoulder stabilization, lest the history of enthusiastic but ultimately unsubstantiated claims is repeated. Outcomes must withstand the rigors of scientific scrutiny and the test of time. Without this cautious vigilance, the appeal of today's solutions becomes the fodder of tomorrow's articles about the complications of arthroscopic shoulder stabilization.

Arthroscopes↗
PubMed1994

Second-generation delivery systems for laser prostatic ablation.

OBJECTIVE: To assess the effectiveness of a second-generation laser delivery system (Side-Fire) in the treatment of benign prostatic hyperplasia (BPH). METHODS: Thirty-three patients with documented BPH were treated and evaluated pre- and post-operatively with a follow-up period of twelve to thirty-six weeks. RESULTS: There was marked improvement demonstrated at three months post lasing in all patient outcome parameters (symptom score, flow rate, and post-void residual volume) using the new Side-Fire right-angled delivery system. CONCLUSION: Side-Fire catheter laser ablation therapy produces an excellent transition zone ablation in established BPH.

Aged↗
PubMedDate not supplied

Use of reconstructed small intestine submucosa for urinary tract replacement.

We used reconstructed SIS (ReSIS), a photocrosslinked biomaterial, to create grafts in various shapes and sizes. Sheets of ReSIS were placed in 14 swine to repair bladder defects, and ReSIS tubes were placed in six swine to replace a segment of excised ureter. Histologic analysis of the bladder repair revealed transitional urothelial cells lining the ReSIS by 1 week. After 2 weeks, fibroblasts and mononuclear cells had infiltrated the ReSIS, neovascularization had occurred, and the urothelial lining was more complex, containing multiple cell layers. After 4 weeks, a definite submucosa was present and the ReSIS was starting to degrade. An initial muscular regeneration was demonstrated at 12 weeks. No foreign body reaction, calcification, or sedimentation was noted in any animal. The ureteral implants showed identical histologic changes, without obstruction or leakage of the replaced segment. The ReSIS allowed rapid urothelial regeneration, ingrowth of new blood vessels, and the orderly deposition and organization of new collagen. Our study demonstrates that the photocrosslinking technique used to create larger sheets and tubes of this biomaterial (ReSIS) does not detract from the positive attributes of the SIS and should improve its usefulness in accomplishing larger bladder augmentations and ureter replacements.

Animals↗
PubMedDate not supplied

Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon.

The purpose of this study was to determine if use of the midthird patellar tendon autograft contributes to or causes patellar tendon shortening or patella baja in anterior cruciate ligament reconstruction. Thirty-six patients undergoing arthroscopically assisted midthird patellar tendon autograft anterior cruciate ligament reconstruction were studied prospectively. Intraoperative patellar tendon length changes were measured. Half of the patients had the tendon defect closed and half had it left open (closing peritenon only). Radiographic tendon length changes and patella baja were assessed using Insall-Salvati and Blackburne-Peel ratios measured on 45 degrees lateral knee radiographs using an adjustable polypropylene jig. Bilateral films were obtained preoperatively and at 2 weeks, 3 months, and 6 months postoperatively. No patients demonstrated evidence of patellar tendon shortening greater than the 5.5% measurement error. Tendon defect closure resulted in negligible tendon shortening intraoperatively, averaging 2.28% (1.11 mm). Of the 18 patients whose defects were closed, 5 showed no shortening. The remaining 13 patients had measurable tendon shortening less than 4% (2 mm). No patients developed patella baja.

Adolescent↗
PubMedDate not supplied

Infraspinatus muscle-splitting incision in posterior shoulder surgery. An anatomic and electromyographic study.

Standard posterior shoulder surgical approaches include infraspinatus tendon detachment and infraspinatus-teres minor interval development. Cadaveric and clinical investigation of a new infraspinatus-splitting approach to the posterior glenohumeral joint was undertaken to assess efficacy in providing exposure, preserving tendon attachment, and avoiding neurologic compromise. Infraspinatus musculotendinous and neural anatomy was examined in 20 cadavers. Four patients with posterior shoulder instability underwent posterior capsulorrhaphy through this infraspinatus-splitting approach, followed by electrodiagnostic testing. Infraspinatus muscle was bipennate in all specimens, the tendinous interval an average 14 mm inferior to the scapular spine at the glenoid rim. The infraspinatus-splitting interval bisected the posterior glenoid rim at its midpoint, whereas the infraspinatusteres minor interval crossed the glenoid rim's lower quarter. The suprascapular nerve provided sole innervation to the infraspinatus muscle in all specimens, entering the infraspinous fossa at the notch as a single trunk 22 mm medial to the glenoid rim. Minimum branching variability was observed. Electrodiagnostic testing showed no evidence of axonal damage or muscle denervation in either infraspinatus pennate bundle. Limiting infraspinatus-splitting dissection medially to 1.5 cm from the posterior glenoid rim prevents damage to any interval-crossing suprascapular nerve branches. Posterior shoulder surgery through a horizontal, longitudinal infraspinatus tendon-splitting approach provides excellent exposure of posterior capsule, labrum, and glenoid, without requiring tendon detachment or causing neurologic compromise.

Acromion↗
PubMedDate not supplied

Painful conditions of the acromioclavicular joint.

The acromioclavicular (AC) joint may be affected by a number of pathologic processes, most commonly osteoarthritis, posttraumatic arthritis, and distal clavicle osteolysis. The correct diagnosis of a problem can usually be deduced from a thorough history, physical examination, and radiologic evaluation. Asymptomatic AC joint degeneration is frequent and does not always correlate with the presence of symptoms. Selective lidocaine injection enhances diagnostic accuracy and may correlate with surgical outcome. Nonoperative treatment is helpful for most patients, although those with osteolysis may have to modify their activities. In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms. Recent biomechanical and clinical data emphasize the importance of capsular preservation and minimization of bone resection; however, the optimal amount of distal clavicle resection remains elusive. Patients with AC joint instability have poor results after distal clavicle resection.

Acromioclavicular Joint↗