Two hundred ten specimens (420 scapulas) from the Hamann-Todd Osteological Collection at the Cleveland Museum of Natural History were evaluated to determine the influence of age on acromial morphologic condition. Equal numbers of specimens from female and male and black and white subjects were evaluated. The length, width, and anterior thickness of the acromion and the acromial facet of the acromioclavicular joint were measured with digital calipers, examined visually, and evaluated radiographically. Distribution of acromial morphologic types was type I, (flat) 32%, type II (curved), 42%, and type III (hooked), 26%. Analysis of the data revealed no consistent, statistically significant impact of age on morphologic condition. The incidence of os acromiale was 8% (17 of 210), with 7 (41%) of 17 specimens having bilateral involvement. Mean acromial dimensions in men were length = 48.5 mm, width = 19.5 mm, and anterior thickness = 7.7 mm. Mean dimensions in women were length = 40.6 mm, width = 18.4 mm, and thickness = 6.7 mm. Multiple regression analysis revealed no significant changes in any dimension with increasing age. Observation of the acromial facet of the acromioclavicular joint revealed 49% were medially inclined, 48% were vertically inclined, and only 3% were laterally inclined in relationship to the sagittal plane. A statistically significant age-related increase in degenerative changes was noted. Anterior acromial spur formation as determined by visual inspection of the acromion was observed in 7% of specimens from patients younger than 50 years compared with 30% of specimens from patients older than 50 years (p < 0.05). Spur formation on the anterior acromion is an age-dependent process. Acromial morphologic condition as evaluated by outlet radiographs is independent of age and appears to be a primary anatomic characteristic. The variations seen in acromial morphologic condition are not acquired from age-related changes and spur formation and thus contribute to impingement disease independent of and in addition to age-related processes.

Acromioclavicular Joint↗

PubMedDate not supplied

Evolution of hemodynamics after orthotopic heart and heart-lung transplantation: early restrictive patterns persisting in occult fashion.

Though successfully transplanted hearts respond in such a way that individuals remain remarkably asymptomatic, they do not function normally. Characterization of early hemodynamic patterns and their evolvement has not been done. The evolution of hemodynamic indices in 20 patients receiving orthotopic heart (n = 17) or combined heart-lung (n = 3) transplants is therefore documented. In 15 isolated heart recipients, right heart catheterization was performed at 24 to 48 hours, 1 to 2 weeks, 4 to 8 weeks, and greater than 3 months after surgery at the time of routine endomyocardial biopsy. Early, patients had elevated mean blood pressure (96 +/- 14 mm Hg, mean +/- standard deviation), mean right atrial pressure (15 +/- 6 mm Hg), right ventricular end-diastolic pressure (16 +/- 7 mm Hg), mean pulmonary artery pressure (30 +/- 7 mm Hg), and mean pulmonary capillary wedge pressure (19 +/- 6 mm Hg), but normal resting heart rate (96 +/- 14 beats/min) and cardiac output (5.6 +/- 1.6 L/min). Heart rate, blood pressure, and output did not change during follow-up, but right atrial pressure decreased dramatically (4 +/- 2 mm Hg at 3 months), as did right ventricular end-diastolic pressure (4 +/- 4 mm Hg), mean pulmonary artery pressure (21 +/- 8 mm Hg), and pulmonary capillary wedge pressure (11 +/- 4 mm Hg). Analysis of right heart filling dynamics revealed an abnormal inspiratory rise in mean right atrial pressure (15 +/- 6 and 27 +/- 7 mm Hg at 24 to 48 hours) that subsequently resolved. In eight patients whose resting follow-up right heart pressures normalized, rapid volume challenge uncovered occult restrictive right atrial pressure patterns that increased from 4 +/- 4 to 9 +/- 4 mm Hg after infusion of saline solution. Kussmaul's response was not apparent with prevolume infusion, but volume expansion caused appearance of this hemodynamic pattern. All patients had early evidence of tricuspid insufficiency, but in two patients, the Doppler regurgitant fraction was over 50%. These two individuals had hemodynamics similar to the other 15 patients initially, but in contrast, their right heart filling pressures did not change during follow-up. Other significant echocardiographic findings included enlarged atria and increased left ventricular mass in all patients. In two of three combined heart-lung transplant patients, similar hemodynamic patterns were evident. Rejection indices did not correlate with hemodynamic observations. Thus a characteristic evolvement of hemodynamics in heart and heart-lung transplants that mimic dynamics associated with restrictive myocardial disease is documented.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗