Background: The rarity and complexity of trans-ulnar basal coronoid fracture-dislocations pose significant challenges in treatment. This study aimed to categorize these fractures based on coronoid fracture patterns and propose tailored surgical approaches for each type. Additionally, we evaluated the functional and radiological outcomes among the patients managed using our treatment algorithm. Methods: A total of 19 patients who underwent open reduction and internal fixation for trans-ulnar basal coronoid fracture-dislocations between March 2018 and October 2022 were enrolled in this study. These patients were classified based on the coronoid fracture patterns associated with olecranon fractures: type 1 involved anteromedial facet (AMF) fractures, type 2 encompassed coronoid base and body fractures, and type 3 involved a combination of types 1 and 2. We made a midline longitudinal dorsal incision to facilitate the provisional fixation of the olecranon fragment to the distal metaphysis using a locking plate. Subsequently, we employed the over-the-top (type 1) and Taylor–Scham (type 3) approaches for direct coronoid process fixation with buttress plating.Type 2 fractures were approached via medial fascial exposure from the posterior ulnar cortex or through the olecranon fractures, and subsequently fixed with miniplates and screws. Bony union and joint articulation were assessed via plain radiographs, and functional outcomes were evaluated using range of motion and the Mayo Elbow Performance Score. Results: Among the 19 patients, 3 had type 1 fractures, 14 had type 2 fractures, and 2 had type 3 fractures. All fractures exhibited solid osseous union without subluxation or dislocation. The average flexion and extension arc was 119.47° ± 20.88°, with a mean flexion of 127.37° ± 13.37° and an average flexion contracture of 7.89° ± 10.04°. The average Mayo Elbow Performance Score was 82.63 ± 12.51 points. Qualitatively, patient outcomes were excellent in 5 patients, good in 9, and fair in 5. Conclusions Most of our patients presented with easily approachable coronoid base and body fractures. However, in AMF fractures of the coronoid process, a direct medial approach is required for buttress plating. We believe our study helps provide useful guidelines for making appropriate decisions in trans-ulnar basal coronoid fracture-dislocations .

Background: The rarity and complexity of trans-ulnar basal coronoid fracture-dislocations pose significant challenges in treatment. This study aimed to categorize these fractures based on coronoid fracture patterns and propose tailored surgical approaches for each type. Additionally, we evaluated the functional and radiological outcomes among the patients managed using our treatment algorithm. Methods: A total of 19 patients who underwent open reduction and internal fixation for trans-ulnar basal coronoid fracture-dislocations between March 2018 and October 2022 were enrolled in this study. These patients were classified based on the coronoid fracture patterns associated with olecranon fractures: type 1 involved anteromedial facet (AMF) fractures, type 2 encompassed coronoid base and body fractures, and type 3 involved a combination of types 1 and 2. We made a midline longitudinal dorsal incision to facilitate the provisional fixation of the olecranon fragment to the distal metaphysis using a locking plate. Subsequently, we employed the over-the-top (type 1) and Taylor–Scham (type 3) approaches for direct coronoid process fixation with buttress plating.Type 2 fractures were approached via medial fascial exposure from the posterior ulnar cortex or through the olecranon fractures, and subsequently fixed with miniplates and screws. Bony union and joint articulation were assessed via plain radiographs, and functional outcomes were evaluated using range of motion and the Mayo Elbow Performance Score. Results: Among the 19 patients, 3 had type 1 fractures, 14 had type 2 fractures, and 2 had type 3 fractures. All fractures exhibited solid osseous union without subluxation or dislocation. The average flexion and extension arc was 119.47° ± 20.88°, with a mean flexion of 127.37° ± 13.37° and an average flexion contracture of 7.89° ± 10.04°. The average Mayo Elbow Performance Score was 82.63 ± 12.51 points. Qualitatively, patient outcomes were excellent in 5 patients, good in 9, and fair in 5. Conclusions Most of our patients presented with easily approachable coronoid base and body fractures. However, in AMF fractures of the coronoid process, a direct medial approach is required for buttress plating. We believe our study helps provide useful guidelines for making appropriate decisions in trans-ulnar basal coronoid fracture-dislocations .

Background: The rarity and complexity of trans-ulnar basal coronoid fracture-dislocations pose significant challenges in treatment. This study aimed to categorize these fractures based on coronoid fracture patterns and propose tailored surgical approaches for each type. Additionally, we evaluated the functional and radiological outcomes among the patients managed using our treatment algorithm. Methods: A total of 19 patients who underwent open reduction and internal fixation for trans-ulnar basal coronoid fracture-dislocations between March 2018 and October 2022 were enrolled in this study. These patients were classified based on the coronoid fracture patterns associated with olecranon fractures: type 1 involved anteromedial facet (AMF) fractures, type 2 encompassed coronoid base and body fractures, and type 3 involved a combination of types 1 and 2. We made a midline longitudinal dorsal incision to facilitate the provisional fixation of the olecranon fragment to the distal metaphysis using a locking plate. Subsequently, we employed the over-the-top (type 1) and Taylor–Scham (type 3) approaches for direct coronoid process fixation with buttress plating.Type 2 fractures were approached via medial fascial exposure from the posterior ulnar cortex or through the olecranon fractures, and subsequently fixed with miniplates and screws. Bony union and joint articulation were assessed via plain radiographs, and functional outcomes were evaluated using range of motion and the Mayo Elbow Performance Score. Results: Among the 19 patients, 3 had type 1 fractures, 14 had type 2 fractures, and 2 had type 3 fractures. All fractures exhibited solid osseous union without subluxation or dislocation. The average flexion and extension arc was 119.47° ± 20.88°, with a mean flexion of 127.37° ± 13.37° and an average flexion contracture of 7.89° ± 10.04°. The average Mayo Elbow Performance Score was 82.63 ± 12.51 points. Qualitatively, patient outcomes were excellent in 5 patients, good in 9, and fair in 5. Conclusions Most of our patients presented with easily approachable coronoid base and body fractures. However, in AMF fractures of the coronoid process, a direct medial approach is required for buttress plating. We believe our study helps provide useful guidelines for making appropriate decisions in trans-ulnar basal coronoid fracture-dislocations .

Background: The rarity and complexity of trans-ulnar basal coronoid fracture-dislocations pose significant challenges in treatment. This study aimed to categorize these fractures based on coronoid fracture patterns and propose tailored surgical approaches for each type. Additionally, we evaluated the functional and radiological outcomes among the patients managed using our treatment algorithm. Methods: A total of 19 patients who underwent open reduction and internal fixation for trans-ulnar basal coronoid fracture-dislocations between March 2018 and October 2022 were enrolled in this study. These patients were classified based on the coronoid fracture patterns associated with olecranon fractures: type 1 involved anteromedial facet (AMF) fractures, type 2 encompassed coronoid base and body fractures, and type 3 involved a combination of types 1 and 2. We made a midline longitudinal dorsal incision to facilitate the provisional fixation of the olecranon fragment to the distal metaphysis using a locking plate. Subsequently, we employed the over-the-top (type 1) and Taylor–Scham (type 3) approaches for direct coronoid process fixation with buttress plating.Type 2 fractures were approached via medial fascial exposure from the posterior ulnar cortex or through the olecranon fractures, and subsequently fixed with miniplates and screws. Bony union and joint articulation were assessed via plain radiographs, and functional outcomes were evaluated using range of motion and the Mayo Elbow Performance Score. Results: Among the 19 patients, 3 had type 1 fractures, 14 had type 2 fractures, and 2 had type 3 fractures. All fractures exhibited solid osseous union without subluxation or dislocation. The average flexion and extension arc was 119.47° ± 20.88°, with a mean flexion of 127.37° ± 13.37° and an average flexion contracture of 7.89° ± 10.04°. The average Mayo Elbow Performance Score was 82.63 ± 12.51 points. Qualitatively, patient outcomes were excellent in 5 patients, good in 9, and fair in 5. Conclusions Most of our patients presented with easily approachable coronoid base and body fractures. However, in AMF fractures of the coronoid process, a direct medial approach is required for buttress plating. We believe our study helps provide useful guidelines for making appropriate decisions in trans-ulnar basal coronoid fracture-dislocations .

Purpose: The prognosis of young colorectal cancer (CRC) patients has not fully been addressed. The prognostic significance of systemic inflammatory markers was examined in those patients. Methods: A total of 965 patients with resectable CRC were divided into young (≤ 50 years, n = 101) and old groups (>51 years, n = 864). Neutrophil-to-lymphocyte ratio (NLR) > 5, derived NLR (dNLR) > 3, lymphocyte-to-monocyte ratio (LMR) < 2, platelet-to-lymphocyte ratio (PLR) > 150, and prognostic nutritional index (PNI) < 45 were analyzed for prognosis.Overall survival (OS) and progression-free survival (PFS) were compared using the log-rank test. A multivariate analysis was performed using a Cox proportional hazards regression model. Results: In the young group, NLR > 5, LMR < 2, and PNI < 45 were significantly associated with OS with univariate analyses. dNLR > 3 and those markers showed significance for PFS. LMR < 2 was a significant marker for poor PFS (hazard ratio [HR], 5.81; P = 0.020) in the multivariate analysis. In the old group, all inflammatory markers were significantly associated with OS and PFS with univariate analyses. LMR < 2 (HR, 2.66; P = 0.016) and PNI < 45 (HR, 2.14; P = 0.016) were independently associated with OS in multivariate analyses. PLR > 150 (HR, 1.45; P = 0.036) and PNI < 45 (HR, 1.73; P = 0.002) were significant markers for PFS. Conclusion Systemic inflammation might be one of biologic factors that influence on prognosis of young CRC.

PURPOSE: Because data as a basis for the determination of proper age and modality for screening of colorectal neoplasms is lacking, we evaluated detection rates and anatomical distribution of colorectal neoplasms according to age in healthy individuals who underwent total colonoscopy for health checkup. METHODS: A total of 16,100 cases that had received the colonoscopic examination from January to December in 2014 were analyzed. The total number of individuals who received total colonoscopy were divided by the number of individuals harboring colorectal adenoma to calculate the detection rate of colorectal adenoma. Individuals ≤50 years old were classified as young-age group and aged >50 were old-age group. Differences in anatomical locations of colorectal neoplasms were analyzed in the 2 age groups by chi-square test. Risk factors for colorectal adenoma in each age group were analyzed using univariate and multivariate logistic regression analyses. RESULTS: Detection rates of colorectal adenoma were 13.7% in all cases and 12.8% for those in their 40′s. The main anatomical location of colorectal adenoma was proximal colon in both age groups (P < 0.001). Hyperplastic polyp was mainly distributed to the distal colon in both age groups (P < 0.001). Distal colon was the major site for colorectal cancer in the old-age group (P = 0.001). Proximal location of neoplasms was a risk factor for colorectal adenoma in both age groups with multivariate analysis. CONCLUSION: These data could be the bases for earlier initiation of screening for colorectal neoplasms with total colonoscopy to detect clinically significant colorectal polyps.
Adenoma ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Logistic Models ; Mass Screening ; Multivariate Analysis ; Polyps ; Risk Factors

OBJECTIVETo evaluate the clinical efficacy of electrical stimulation (ES) of auricular acupressure on reducing the ocular symptoms and signs before and after treatment for dry eye.

METHODSThe inclusion criteria were the tear film break-up time (TFBUT) below 5 s and a Schirmer test-I below 5 mm in dry eyes with ocular symptoms for at least 6 months. Subjects were randomized into a treatment group (50 cases) with continuous low frequency ES under auricular acupressure at acupoints and a no ES under auricular acupressure (no-ES, control group, 50 cases) on the same acupoints. Auricular acupressure were stimulated with ES at 4 master points of both ears, which were performed twice a week for 4 weeks at each point for 30 s. The ocular symptoms, the TFBUT, and Schirmer test-I were evaluated before and after this procedure.

RESULTSThere were significantly better scores in TFBUT (P=0.032), the Schirmer test-I (P=0.044) and ocular symptoms (P=0.029) at 3 months post-treatment in the treatment group than in the control group. The total effective rate in the treatment group was accomplished in 41 (82%) of the 50 cases of dry eye.

CONCLUSIONSAuricular acupressure with ES at auricular acupoint improves ocular symptoms and signs of dry eye for a period of at least 3 months.

PURPOSE: This study focused on implementation of a prognostic scoring index based on clinico-laboratory parameters measured routinely on admission in metastatic pancreatic cancer patients. MATERIALS AND METHODS: Records from 403 patients of metastatic disease were analyzed retrospectively. Continuous variables were dichotomized according to the normal range or the best cut-off values statistically determined by Contal and O’Quigley method, and then analyzed in association with prognosis—overall survival (OS), using Cox's proportional hazard model. Scores were calculated by summing the rounded chi-square scores for the factors that emerged in the multivariate analysis. RESULTS: Performance status, hemoglobin, leucocyte count, neutrophil-lymphocyte ratio, and carcinoembryonic antigen were independent factors for OS. When patients were divided into three risk groups according to these factors, median survival was 11.7, 6.2, and 1.3 months for the low, intermediate, and high-risk groups, respectively (p < 0.001). Palliative chemotherapy has a significant survival benefit for low and intermediate-risk patients (median OS; 12.5 months vs. 5.9 months, p < 0.001 and 8.0 months vs. 2.0 months, p < 0.001, respectively). CONCLUSION: We advocate the use of a multivariable approach with continuous variables for prognostic modeling. Our index is helpful in accurate patient risk stratification and may aid in treatment selection.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Drug Therapy ; Humans ; Methods ; Multivariate Analysis ; Pancreatic Neoplasms ; Prognosis ; Proportional Hazards Models ; Reference Values ; Research Design ; Retrospective Studies