Progression to a hooked acromion could be an adaptation to an already damaged, poorly balanced rotator cuff with resultant stress on the coracoacromial arch. Other anatomical factors include an os acromiale and acromial spurs. Environmental factors include age, shoulder overuse, smoking, and medical conditions that affect circulation or impair the inflammatory and healing response, such as diabetes mellitus. Intrinsic factors
Intrinsic factors refer to injury mechanisms that occur within the rotator cuff itself. The principal is a degenerative-microtrauma model, which supposes that age-related tendon damage compounded by chronic microtrauma results in partial tendon tears that then develop into full rotator cuff tears. As a result of repetitive microtrauma in the setting of a degenerative rotator cuff tendon, inflammatory mediators alter the local environment, and oxidative stress induces tenocyte apoptosis causing further rotator cuff tendon degeneration. A neural theory also exists that suggests neural overstimulation leads to the recruitment of inflammatory cells and may also contribute to tendon degeneration. Surgical considerations
Depending upon the diagnosis, several treatment alternatives are available. They include revision repair, non-anatomic repair, tendon transfer and arthroplasty. When possible, surgeons make tension-free repairs in which they use grafted tissues rather than stitching to reconnect tendon segments. This can result in a complete repair. Other options are a partial repair, and reconstruction involving a bridge of biologic or synthetic substances. Partial repairs typically are performed on retracted cuff tears.Tendon transfers are prescribed for young, active cuff-tear individual who experience weakness and decreased range of motion, but little pain.
Gelesis100, sold under the brand name Plenity, is an oral hydrogel used to treat overweight and obesity. It absorbs water and expands in the stomach and small bowel thereby increasing feelings of fullness. Possible side effects include primarily gastrointestinal symptoms, such as diarrhea, abdominal distention, infrequent bowel movements, constipation, abdominal pain, and flatulence. It is contraindicated in pregnancy, chronic malabsorption syndromes, and cholestasis. The US Food and Drug Administration approved it in 2019 as a medical device. Gelesis100 was developed by the company Gelesis. History
The US Food and Drug Administration approved the use of Gelesis100 in April 2019 as a medical device. Gelesis100 is the first treatment of its kind for overweight and obesity. Uses
Gelesis100 is used to treat obesity and overweight. Gelesis100 is taken as a pill before meals and with water. Mechanism and physiology
Gelesis100 is an oral superabsorbent hydrogel, which is produced from carboxymethylcellulose and citric acid. The cross-linked product forms a hydrophilic matrix, which absorbs water. Taken in capsule form by mouth, as Gelesis100 absorbs water, it expands in the stomach and small intestine. After absorbing water, a semisolid gel structure forms, which may promote satiety and result in weight loss. Contraindications
Gelesis100 is contraindicated in pregnancy, chronic malabsorption syndromes, and cholestasis. Side effects
Side effects consist of minor gastrointestinal symptoms, including diarrhea, abdominal distention, infrequent bowel movements, constipation, abdominal pain, and flatulence. Gelesis100 is not associated with any severe adverse events. However, long-term safety data beyond 24 weeks is not available. References
External links
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