Pagets disease is common in Western countries but is very rare in Chinese populations. Although bisphosphonate has been widely used to treat symptomatic Pagets disease, prolonged use may be associated with insufficiency fracture. We highlight this rare case of Pagets disease in a Chinese lady who presented with an insufficiency fracture following long term use of bisphosphonate.
Orthopaedic

<p>INTRODUCTIONThe aim of the study is to investigate the effect of using Automated External Defibrillator (AED) audiovisual feedback on the quality of cardiopulmonary resuscitation (CPR) in a manikin training setting.p><p>MATERIALS AND METHODSFive cycles of 30 chest compressions were performed on a manikin without CPR prompts. After an interval of at least 5 minutes, the participants performed another 5 cycles with the use of real time audiovisual feedback via the ZOLL E-Series defibrillator. Performance data were obtained and analysed.p><p>RESULTSA total of 209 dialysis centre staff participated in the study. Using a feedback system resulted in a statistically significant improvement from 39.57% to 46.94% (P=0.009) of the participants being within the target compression depth of 4 cm to 5 cm and a reduction in those below target from 16.45% to 11.05% (P=0.004). The use of feedback also produced a significant improvement in achieving the target for rate of chest compression (90 to 110 compressions per minute) from 41.27% to 53.49%; (P<0.001). The mean depth of chest compressions was 4.85 cm (SD=0.79) without audiovisual feedback and 4.91 (SD=0.69) with feedback. For rate of chest compressions, it was 104.89 (SD=13.74) vs 101.65 (SD=10.21) respectively. The mean depth of chest compression was less in males than in females (4.61 cm vs 4.93 cm, P=0.011), and this trend was reversed with the use of feedback.p><p>CONCLUSIONIn conclusion, the use of feedback devices helps to improve the quality of CPR during training. However more studies involving cardiac arrest patients requiring CPR need to be done to determine if these devices improve survival.p>
Adult ; Audiovisual Aids ; Cardiopulmonary Resuscitation ; instrumentation ; methods ; Defibrillators ; Feedback ; Female ; Humans ; Male ; Manikins ; Middle Aged ; Pressure ; Prospective Studies ; Thorax ; Young Adult

Background: Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. Methods: A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. Results: One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39–90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. Conclusions TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting.Level of evidence: IV.

Amyoplasia is the most common form of arthrogryposis (multiple congenital contracture). It has an estimated incidence of one in 10,000 live births. Lower limb-amyoplasia is a specii c subtype with an estimated incidence of 1 in 75,000 - 100,000 live births. There are only 85 cases of lower limb amyoplasia identii ed in literature, and there are no published cases from the Philippines. We discuss a rare case of lower limb amyoplasia in an 11-year-old Filipino female presenting with additional unique features of severe scoliosis (managed with spine correction surgery) and multiple skin dimples in the gluteal area. The study was performed according to the CARE guidelines for case reports.
Arthrogryposis ; Scoliosis

INTRODUCTION: Primary peritoneal carcinoma (PPC) is an uncommon malignancy and is often misdiagnosed as peritoneal carcinomatosis from metastatic gastrointestinal carcinoma and more frequently from ovarian carcinomas due to a common embryonic origin of the ovary and the peritoneum. Its diagnosis is a challenge for clinicians. Herein, we report a rare case of PPC in a 72-year-old woman who was initially suspected with metastatic ovarian malignancy, and emphasizes points that help differentiate PPC from primary ovarian cancer. CASE: This a case of a 72-year-old female with abdominal discomfort and distension, initially diagnosed with ovarian carcinoma, with abdominal CT scan revealing thickening of the omentum multiple enhancing nodules in the left adnexa, within the pouch of Douglas and subdiaphragmatic region compatible with malignancy such as metastases from carcinoma. Cancer antigen (CA) 125 (3476 u/mL) and CA 15-3 (45.94 u/mL) were elevated. The patient underwent dilation and curettage and diagnostic laparoscopy and biopsy with frozen section, which revealed metastatic clear cell adenocarcinoma, favoring primary ovarian carcinoma. The patient then underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy with bilateral lymph node dissection, and omentectomy. Further histopathological findings later confirmed that the patient had carcinoma primarily from the peritoneum instead of from the ovary. The patient was discharged, improved and underwent chemotherapy post-operation. CONCLUSION: This report emphasizes how to distinguish primary malignancy from the peritoneum from that in the ovary, preventing misdiagnosis. The emphasis in considering primary peritoneal cancer as a differential diagnosis in patients with abdominal symptoms suspected due to malignancy should be noted.
Peritoneal Neoplasms Carcinoma, Ovarian Epithelial ; Ovarian Neoplasms ; Carcinoma

Proton-pump inhibitors (PPIs) are among the most widely used drugs worldwide. PPI use has recently been linked to adverse changes in semen quality in healthy men; however, the effects of PPI use on semen parameters remain largely unknown specifically in cases with male factor infertility. We examined whether PPI use was associated with detrimental effects on semen parameters in a large population of subfertile men. We retrospectively reviewed data from 12 257 subfertile men who had visited our fertility clinic from 2003 to 2013. Patients who reported using any PPIs for >3 months before semen sample collection were included; 7698 subfertile men taking no medication served as controls. Data were gathered on patient age, medication use, and conventional semen parameters; patients taking any known spermatotoxic medication were excluded. Linear mixed-effect regression models were used to test the effect of PPI use on semen parameters adjusting for age. A total of 248 patients (258 samples) used PPIs for at least 3 months before semen collection. In regression models, PPI use (either as the only medication or when used in combination with other nonspermatotoxic medications) was not associated with statistically significant changes in semen parameters. To our knowledge, this is the largest study to compare PPI use with semen parameters in subfertile men. Using PPIs was not associated with detrimental effects on semen quality in this retrospective study.
Adult ; Case-Control Studies ; Humans ; Infertility, Male/epidemiology* ; Male ; Proton Pump Inhibitors/therapeutic use* ; Retrospective Studies ; Semen Analysis ; Sperm Count ; Sperm Motility/drug effects* ; Spermatozoa/drug effects*