BACKGROUND: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. METHODS: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. RESULTS: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7–18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0–17 mm). The average UCLA score and Constant score were 33.6 (range: 25–35) and 92.5 (range: 65–100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. CONCLUSIONS: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.
California ; Clavicle* ; Joints ; Skin

No abstract available.
Blood Platelets ; Platelet-Rich Plasma ; Rotator Cuff ; Tears

Rotator cuff tear is a common cause of shoulder pain and disability in adults. Due to the various nature of progression of rotator cuff tears and the complex biomechanics of the shoulder joint, repair and treatment of large-to-massive tears are challenging for many surgeons. Despite the recent popularity of reverse total shoulder arthroplasty as a treatment option for large-to-massive irreparable rotator cuff tears, biological and mechanical repair augmentation has also shown promise as a viable treatment option. The purpose of this study was to briefly summarize and review current studies on the assessment and arthroscopic treatment of large-to-massive rotator cuff tears, whether repairable or irreparable, to aid in developing a consensus on future treatment directions.
Adult ; Arthroplasty ; Arthroscopy ; Consensus ; Humans ; Rotator Cuff ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Surgeons ; Tears

Milwaukee shoulder syndrome (MSS) is a rare disease in which joints are destroyed and occurs mainly in elderly women. We describe rapidly progressive MSS with complete destruction of the shoulder joint within 2 months. An 80-year-old woman visited the outpatient clinic with shoulder pain for 2 weeks. rotator cuff tear arthropathy was diagnosed, and nonsteroidal anti-inflammatory drugs were prescribed. Two months later, her shoulder pain worsened without trauma. Shoulder swelling and tenderness, and arm lifting inability were observed. Complete humeral head disruption was observed by radiography. We diagnosed MSS based on the presence of serohematic and noninflammatory joint effusion, periarticular calcific deposits, and rapid joint destruction, and initiated conservative treatment. When initially treating elderly patients with shoulder arthropathy, it is advisable to perform short-term follow-up and to consider the possibility of crystal-induced arthropathy.
Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; Arm ; Female ; Follow-Up Studies ; Humans ; Humeral Head ; Joints ; Lifting ; Radiography ; Rare Diseases ; Rotator Cuff ; Shoulder Joint ; Shoulder Pain ; Shoulder ; Tears

Despite the advances in total ankle replacement (TAR), TAR has emerged as a promising alternative to ankle arthrodesis, particularly in severe ankle arthritis. Restoring ankle stability and alignment is the most important technical consideration and the goal of TAR. Hence, additional procedures, such as soft tissue balancing and osteotomies, are often critical parts of surgical planning. This article reviews the basics of joint balancing, offering suggestions on procedure selection for ligamentous balancing and varus and valgus malalignment in TARs.

BACKGROUND: The Coapresta 2000 (Sekisui Medical CO., LTD, Japan) is a fully automated random-access multiparameter hemostasis coagulation analyzer, which is equipped with a photo-optical clot detection unit and a cap-piercing system. It is able to perform clotting time assays as well as colorimetric assays (synthetic substrate method and latex turbidimetric method). In this study, we evaluated the analytical performance of the Coapresta 2000 for coagulation test items and compared with that of the ACL-TOP (Instrumentation Laboratory, Lexingtion, MA, USA) analyzer, which is currently used for routine coagulation test items in our hospital. METHODS: The Coapresta 2000 was evaluated with respect to its technical characteristics in the determination of 8 routine coagulation test items: prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin-degradation product (FDP) antithrombin III, D-dimer, factors VIII and IX. Analyse-it (Analyse-it Software Ltd, UK) and SigmaStat (Systat Software, Inc., USA) were used for statistical analysis between items on the Coapresta 2000 and the ACL-TOP analyzer. RESULTS: The intra-assay and inter-assay coefficients of variation (CV) were below 5% for both groups of samples having values within the reference interval and outside the reference interval. Significant interference was observed with hemolytic and icteric samples. Carryover was not detected. The results obtained by Coapresta 2000 were well correlated with those obtained by the ACL-TOP analyzer (r2 in the range from 0.781 to 0.969). CONCLUSIONS: We concluded that Coapresta 2000 analyzer was well correlated with ACL-TOP analyzer for the routine coagulation test items tested.
Antithrombin III ; Fibrin Fibrinogen Degradation Products ; Fibrinogen ; Hemostasis ; Latex ; Partial Thromboplastin Time ; Prothrombin Time

BACKGROUND: Inter-observer and intra-observer variation in histologic tumor grading are well documented. To determine whether histologic disorderliness in the arrangement of tumor cells may serve as an objective criterion for grading, we tested the hypothesis the degree of disorderliness is related to the degree of tumor differentiation on which tumor grading is primarily based. METHODS: Borrowing from the statistical thermodynamic definition of entropy, we defined a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then analyzed a total of 51 photomicrographs of normal colorectal mucosa and colorectal adenocarcinoma with varying degrees of differentiation using our formula. RESULTS: A one-way analysis of variance followed by post hoc pairwise comparisons using Bonferroni correction indicated that the mean disorderliness score was the lowest for the normal colorectal mucosa and increased with decreasing tumor differentiation. CONCLUSIONS: Disorderliness, a pathologic feature of malignant tumors that originate from highly organized structures is useful as an objective tumor grading proxy in the field of digital pathology.
Adenocarcinoma ; Colonic Neoplasms ; Entropy ; Humans ; Mucous Membrane ; Neoplasm Grading ; Observer Variation ; Pathology ; Proxy ; Thermodynamics

Zaire Ebola virus (EBOV) is a fatal human pathogen, with a high case fatality rate (CFR) averaging up to 78%. In March 2014, the World Health Organization (WHO) was made aware of a ZEBOV outbreak in rural Guinea, West Africa. Epidemiologic investigation linked the clinical and laboratory confirmed cases with the presumed first fatality of the outbreak in December 2013. EBOV from Guinea is a separate clade from other ZEBOV strains reported from the Democratic Republic of Congo (DRC) and Gabon. Since the outbreak in March, ZEBOV was also reported in Conakry, Guinea's capital and spread to other neighboring countries. In its largest outbreak, ZEBOV disease expanded through Guinea, Liberia, Sierra Leone, and Nigeria and to Spain, the USA, and the UK. The WHO declared the 2013-2015 West African Ebola epidemic a public health emergency of international concern considering its presumable capacity for further international spread. Early manifestations of EVD (Ebola virus disease) include a high fever, body aches, malaise, and fatigue. Severe diarrhea and other gastrointestinal manifestations such as vomiting were common, while bleeding was a more sporadic finding. The fatality rate was 43% and highest in patients aged > or = 45 years and the overall fitted mean incubation period was 10.3 days (95% CI 9.9~10.7). We present a review of the literature on the emergence of Ebola, and the epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed in Sierra Leone, Guinea, Liberia, Mali, the USA, and Spain, its zoonotic origin, and the transmission of ZEBOV, as well as presenting original literature on the current Ebola outbreak.
Africa, Western* ; Congo ; Diarrhea ; Ebolavirus ; Emergencies ; Epidemiology ; Fatigue ; Fever ; Gabon ; Guinea ; Hemorrhage ; Humans ; Liberia ; Mali ; Mortality ; Nigeria ; Public Health ; Sierra Leone ; Spain ; Vomiting ; World Health Organization