WUTH publication: Partial tear of the distal biceps tendon: Current concepts

Citation: Journal of Orthopaedics. 2022, 32, 18-24
Author: Zaid Hamoodi , Joanna Winton, Vijaya Bhalaik 
Abstract: Background: Patients with partial rupture of the distal biceps tendon can present with vague elbow pain and weakness. Understanding of the anatomy and aetiology of this disease is essential to management. Patients can present with a single or multiple traumatic events or with a chronic degenerative history. On clinical examination, patients will have an intact tendon making the diagnosis more challenging. Clinicians, therefore, should have a high index of suspicion and should actively look for this pathology.
Objectives and rationale: This review aims to discuss the current evidence in managing partial rupture of the distal biceps tendon with a suggested treatment algorithm.
Conclusion: Several clinical tests have been described in the literature including resisted hook test, biceps provocation test, and TILT sign. However, the diagnosis is usually confirmed by a magnetic resonance scan with the arm positioned in elbow flexion, shoulder abduction, and forearm supination and commonly known as FABS MR. Partial tendon tears that involve less than 50% of the tendon can be successfully managed conservatively. Tears that include more than 50% of the tendon are more likely to fail conservative management and would benefit from surgical intervention. It is crucial, however, to involve the patient in the decision making, which is based on their objectives and needs.
Keywords: Anatomy; Diagnosis; Distal biceps tendon; Management; Partial tear.

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WUTH publication: Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Citation: European Heart Journal. 2022 May 13, ehac245. Online ahead of print.
Author: Gregory Y H Lip, Deirdre A Lane, Radosław Lenarczyk, Giuseppe Boriani, Wolfram Doehner, Laura A Benjamin, Marc Fisher, Deborah Lowe, Ralph L Sacco, Renate Schnabel, Caroline Watkins, George Ntaios, Tatjana Potpara
Abstract: The management of patients with stroke is often multidisciplinary, involving various specialties and healthcare professionals. Given the common shared risk factors for stroke and cardiovascular disease, input may also be required from the cardiovascular teams, as well as patient caregivers and next-of-kin. Ultimately, the patient is central to all this, requiring a coordinated and uniform approach to the priorities of post-stroke management, which can be consistently implemented by different multidisciplinary healthcare professionals, as part of the patient 'journey' or 'patient pathway,' supported by appropriate education and tele-medicine approaches. All these aspects would ultimately aid delivery of care and improve patient (and caregiver) engagement and empowerment. Given the need to address the multidisciplinary approach to holistic or integrated care of patients with heart disease and stroke, the European Society of Cardiology Council on Stroke convened a Task Force, with the remit to propose a consensus on Integrated care management for optimizing the management of stroke and associated heart disease. The present position paper summarizes the available evidence and proposes consensus statements that may help to define evidence gaps and simple practical approaches to assist in everyday clinical practice. A post-stroke ABC pathway is proposed, as a more holistic approach to integrated stroke care, would include three pillars of management: • A: Appropriate Antithrombotic therapy. • B: Better functional and psychological status. • C: Cardiovascular risk factors and Comorbidity optimization (including lifestyle changes).
Keywords: Delivery of care; Heart disease; Integrated care; Patient pathways; Stroke.

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WUTH publication: Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Citation: Obesity Surgery. 2022 May 5, 1-13. Online ahead of print
Author: Rishi Singhal, Islam Omar, Brijesh Madhok, Yashasvi Rajeev, Yitka Graham, Abd A Tahrani, Christian Ludwig, Tom Wiggins, Kamal Mahawar, GENEVA Collaborators
Abstract: Background: Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.
Methods: We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.
Results: There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.
Conclusions: Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups.
Keywords: Metabolic surgery; Obesity; Older patients; Resuming elective surgery; SARS-CoV-2.

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