BACKGROUND: This study compared the clinical and radiological outcomes of the single calcar screw plate and Polarus nail techniques for the treatment of the proximal humerus fractures. METHODS: Seventy-two patients diagnosed with displaced proximal humerus fracture were enrolled for the study. Of these, 50 patients underwent the locking plate surgery with a single calcar screw (plate group), whereas 22 patients underwent the Polarus nail surgery (nail group). The plate group was further divided into plate 1 group (with medial support), and plate 2 group (without medial support). The radiological and functional results of both groups were compared to the nail group. RESULTS: The α angle 1 year after surgery was significantly different between plate 1 and plate 2, and plate 2 and nail groups (p=0.041, p=0.043, respectively). The ratio that does not satisfy the reference value of γ angle was 2.8% in plate 1, 7.1% in plate 2 and 22.7% in nail group (p=0.007); there was a significant difference between plate 1 and nail group, and plate 2 and nail group (p=0.014, p=0.033, respectively). CONCLUSIONS: No significant differences were observed in the clinical results between locking plate and Polarus nail. However, in the plate 2 group and nail group, the rate of failure to maintain reduction during the 1-year period after surgery was statistically and significantly higher than the plate 1 group (level of evidence: level IV, case series, treatment study).
Humans ; Humeral Fractures ; Humerus* ; Reference Values

In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head* ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

BACKGROUND: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. METHODS: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. RESULTS: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. CONCLUSIONS: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.
Bursitis* ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Postoperative Period ; Range of Motion, Articular

Acute myocardial infarction after a bee sting is a very rare process. Among proposed mechanisms, vasospasm of the coronary artery is the most probable mechanism. Many mediators are included in the venom of wasps, and those mediators have vasoconstrictive properties and may constrict the coronary artery. Furthemore, those mediators have thrombogenic properties that lead to thrombogenesis in the coronary artery and aggravate myocardial ischemia. Epinephrine, commonly used in the management of anaphylactic shock, may further aggravate myocardial ischemia. We experienced two cases of acute myocardial infarction after a bee sting. In the first case, we could find no underlying abnormalities of the coronary vessel because the patient died during coronary angiography. In the second case, the electrocardiogram showed inferior wall myocardial infarction, but only mild stenosis of the right coronary artery was seen in coronary angiography.
Anaphylaxis ; Bees* ; Bites and Stings* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Epinephrine ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Venoms ; Wasps

PURPOSE: The aim of this study was to evaluate the clinicopathologic characteristics and the results of surgical treatment for alveolar soft part sarcoma (ASPS). METHODS: The clinicopathologic characteristics and surgical treatment results were analyzed retrospectively by reviewing the medical records of 11 patients and interviewing them. Overall survival (OS) was calculated using the Kaplan-Meier method. RESULTS: Of the 11 patients, 5 men and 6 women, the median age at diagnosis was 27 years and the mean tumor diameter was 6.0+/-1.9 cm. Six patients without distant metastasis at the time of diagnosis were treated with radical resection, and the other 5 with distant metastasis underwent palliative surgery or biopsy only, followed by chemo-radiation therapy. The onset of distant metastasis (40.0+/-13.5 months) was similar to the onset of local recurrence (43.3+/-22.4 months) after a radical operation. The most common site of metastasis was the lung, followed by the brain and bone. The median survival was 52 months and the 5-year OS was 27.2%. The 2-year OS in stage IV disease was 27.7%. The 5-year OS and the disease free survival among the patients with localized disease were 53.3% and 0%, respectively (P=0.043). CONCLUSION: Complete resection is the primary therapeutic option for ASPS. Close, long-term follow-up is recommended in order to detect recurrence, particularly in the lung, bone and brain. Long term survival can be achieved with aggressive surgery for local recurrence and even distant metastasis.
Biopsy ; Brain ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lung ; Male ; Medical Records ; Neoplasm Metastasis ; Palliative Care ; Recurrence ; Retrospective Studies ; Sarcoma, Alveolar Soft Part* ; Viperidae

Subarachnoid hemorrhage from a ruptured intracranial aneurysm during pregnancy is rare but results in significant maternal and fetal mortality. The authors report 5 cases of anesthetic experience with pregnant patients undergoing a surgical aneurysmal clipping out of 2,100 patients with subarachnoid hemorrhages due to a ruptured cerebral aneurysm from 1972 until May 2001. All of the patients were diagnosed with a subarachnoid hemorrhage by a brain CT and cerebral angiography. Anesthetic modality and surgical timing should be adjusted by gestational age and the physiologic changes which accompany the pregnancy and the potential risks to the fetus from investigating and treating the mother. Anesthetic goals for this patient include maintenance of uteroplacental perfusion, and fetal as well as maternal well-being. We gave a general anesthesia with isoflurane-nitrous oxide and fentanyl. The patients were monitored with standard monitorings for surgical repair of a cerebral aneurysm and perioperative fetal heart monitoring. All of the five patients recovered well from the surgical aneurysmal repair. After surgical aneurysmal repair, 4 patients maintained their pregnancies and had their babies delivered at term through a cesarean section in 3 patients and transvagina in 1 patient. However, 1 patient who presented persisting hypertension experienced an intrauterine fetal death at 25 weeks of gestational age.
Anesthesia, General ; Aneurysm ; Brain ; Cerebral Angiography ; Cesarean Section ; Female ; Fentanyl ; Fetal Death ; Fetal Heart ; Fetal Mortality ; Fetus ; Gestational Age ; Humans ; Hypertension ; Intracranial Aneurysm* ; Mothers ; Perfusion ; Pregnancy* ; Rupture* ; Subarachnoid Hemorrhage

PURPOSE: This study is to report clinical and radiological results of high-flexion total knee arthroplasty (TKA) using NexGen LPS-flex system at a minimum 5-year follow-up, and to analyze the implant survivorship based on the results. MATERIALS AND METHODS: A total of 80 patients (118 knees) who underwent patellar preserving TKA using NexGen LPS-flex implant between February 2007 and February 2008 and could be followed for minimum 5 years were reviewed. The range of motion (ROM), hip-knee-ankle angle, Knee Society Knee score (KSKS), and Knee Society Function score (KSFS) were assessed preoperatively and at the last follow-up and analyzed. Implant position of the femoral and tibial components on the immediate postoperative and last follow-up X-rays were compared. RESULTS: The mean ROM was 110.2degrees+/-14.5degrees (range, 60degrees to 140degrees) preoperatively and 132.4degrees+/-5.2degrees (range, 90degrees to 145degrees) at the last follow-up. KSKS was 36.9degrees+/-6.4degrees preoperatively and 94.2degrees+/-3.2degrees at the last follow-up. KSFS was 30.5degrees+/-5.7degrees preoperatively and 93.7degrees+/-4.1degrees at the last follow-up. There was no statistically significant change in the implant position measured as alpha, beta, gamma, and delta angles at the last follow-up compared to the immediate postoperative values. Radiolucent lines were observed in 13 knees (11%) on the last follow-up X-rays. Revision TKA was performed due to aseptic implant loosening in 1 knee (0.84%), and the survival rate at the 5th postoperative year was 99.2%. CONCLUSIONS: The clinical and radiological outcomes of high-flexion TKA using NexGen LPS-Flex implant design were satisfactory with 99.2% implant survival rate after 5 years of protected activities of daily living.
Activities of Daily Living ; Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Prosthesis Design ; Range of Motion, Articular ; Survival Rate

This study evaluated the influence of the type of restoration and the amount of interdental spacing on the stress distribution in maxillary central incisors restored by means of porcelain laminate veneers and direct composite resin restorations. Three-dimensional finite element models were fabricated to represent different types of restorations. Four clinical situations were considered. Type I, closing diastema using composite resin. Labial border of composite resin was extended just enough to cover the interdental space; Type II, closing diastema using composite resin without reduction of labial surface. Labial border of composite resin was extended distally to cover the half of the total labial surface; Type III, closing diastema using composite resin with reduction of labial surface. Labial border of the preparation and restored composite resin was extended distally two-thirds of the total labial surface; Type IV, closing diastema using porcelain laminate veneer with a feathered-edge preparation technique. Four different interdental spaces (1.0, 2.0, 3.0, 4.0 mm) were applied for each type of restorations. For all types of restoration, adding the width of free extension of the porcelain laminate veneer and composite resin increased the stress occurred at the bonding layer. The maximum stress values observed at the bonding layer of Type IV were higher than that of Type I, II and III. However, the increasing rate of maximum stress value of Type IV was lower than that of Type I, II and III.
Dental Porcelain ; Diastema ; Incisor

Chin ; Discrimination (Psychology) ; Genioplasty ; Humans ; Hypesthesia ; Lip ; Mandibular Nerve ; Mandibular Osteotomy ; Nociception ; Sensation

Laser treatment for scars has improved over the past three decades. Autologous platelet-rich plasma (PRP) derived from whole blood is immunologically inert and contains a proper ratio of growth factors and cytokines. Here we describe the case of a 29-year-old female patient with a hypertrophic scar on her right shoulder caused by an operation performed in 2012. The patient underwent 11 laser therapy sessions with a fractional carbon dioxide (CO2) ablative laser system (LineXel) and two PRP injections. Her scar was evaluated with the Vancouver Scar Scale (VSS), and the baseline and post-treatment scores were 11 and 3, respectively. After treatment, the dimensions and volume of the scar were diminished, and contour, texture, and pigmentation had also improved compared to baseline. The patient reported less pain, swelling, and pigmentation following PRP combination ablative laser therapy. This case provides further evidence of the potential benefits of PRP as an adjuvant to fractional laser in reducing hypertrophic scars.
Adult ; Blood Platelets* ; Carbon Dioxide* ; Carbon* ; Cicatrix ; Cicatrix, Hypertrophic* ; Cytokines ; Female ; Humans ; Intercellular Signaling Peptides and Proteins ; Laser Therapy ; Lasers, Gas* ; Pigmentation ; Platelet-Rich Plasma* ; Shoulder*