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An airplane pilot research to guage the effect of classroom-based high-fidelity simulator on midwifery students' self-efficacy within scientific lactation and observed language translation regarding expertise on the good care of the actual nursing your baby mother-infant dyad.
Introduction Combined achondroplasia and hereditary multiple exostosis (HME) syndrome is a rare autosomal dominant inherited skeletal dysplasia. We report, for the 1sttime, a complex primary hip arthroplasty in a patient with combined achondroplasia and HME syndrome. We emphasize to the femoral and acetabular surgical concerns and difficulties of the surgical exposure and soft tissue balancing for this complex procedure. Case report An ambulatory 66-year-old female Caucasian with achondroplasia and HME presented with the left hip pain, progressive walk disability and limited range of hip motion due to severe hip osteoarthritis. Full cemented primary total hip arthroplasty (THA) with an impaction grafting technique was performed; posterior lip augmentation device was implanted to improve stability. At 5 years follow-up, the patient remains ambulatory and pain-free with improved range of hip motion. No signs of aseptic loosening are present. Conclusions Cemented THA could be an efficient option to reconstruct the complex hip anatomy in patients with skeletal dysplasia.Introduction Proximal femoral fractures represent a health problem of global proportions. Iatrogenic vascular lesion in the treatment of these fractures is an unusual potentially lethal complication, reported in only 0.2% of trochanteric fractures treated with intramedullary implants. Superior gluteal artery injury is extremely rare, with only two cases reported in literature. Case report A 66-year-old Caucasian woman, with metastatic disease, was admitted with a right pertrochanteric fracture. She underwent closed reduction and long intramedullary nail fixation. Five days post-operatively, a sudden hemoglobin drop occurred. A computed tomography demonstrated an extensive hematoma. Angiography confirmed an arterial bleeding from the superior gluteal artery and subsequent selective embolization was successfully performed. Conclusion The presence of anemia and thigh hematoma that progressively worsens post-operatively should raise the diagnostic suspicion of an iatrogenic vascular injury. To the best of our knowledge, this is only the third case reported of superior gluteal artery injury after intramedullary fixation of a proximal femoral fracture. We describe the post-operative course and management strategy and hope this will contribute to the global knowledge and increase awareness of these rare injuries.Introduction We report a rare case of massive subacromial bursitis in Rheumatoid Arthritis (RA) patient. A solid tumor was initially suspected because it was very large with no apparent local sign of inflammation or infection in a 69-year-old patient. Isolated subacromial bursa is an uncommon and it is usually small in size. This bursa usually does not enlarge enough to mimic a neoplastic lesion. The presence of huge swelling around shoulder usually raises the suspicion of neoplastic lesion. However, even in the presence of huge swelling, a benign lesion such as infection, cyst, or bursitis should be considered. This case report presents that even if swelling is huge, the benign lesion must be considered as a differential diagnosis of swelling around shoulder joint. Case report We describe the clinical presentation, radiological investigations, and strategies for the management of a 69-year-old patient who was a known case of RA, and he was non-diabetic. Patient presented with massive swelling around shoulder for the past 6 years. We performed radiograms, a plain computed tomography, magnetic resonance imaging, a 99m Tc-MDP bone scintigram, and a 67Ga-citrate scintigram, which all indicated no evidence of tumor. It was treated by excision and no recurrence observed after 5 years. Conclusion Massive subacromial bursitis is rarely reported in medical literature. Even if swelling is massive, the benign lesion must be considered as a differential diagnosis of swelling around shoulder joint.Introduction Fibrous Dysplasia is a relatively rare Musculoskeletal disorders in which there is a defect in remodelling of immature bone to mature lamellar bone. Fibrous Dysplasia was first described by Von Recklinghausen in 1891, but it was Lichtenstein who labelled it polyostotic Fibrous Dysplasia in 1938. Union of Pathological Fractures in a bone affected by Fibrous Dysplasia poses a difficult set of Challenges for treating Physicians. Case report We Report a 24 year-old female patient with a Pathological Fracture of the Tibia in a Monostotic Anterior Cortical Fibrous Dysplasia Hybrid Fixation with a UnicorticalOsteoperisoteal Non Vascularized Fibula Graft with a follow up until the union of fracture site on computed tomography scan and complete integration of unicorticalosteoperiosteal fibular graft . Conclusion We provide additional and independent evidence that removal of the diseased cortex which were parts of the proximal and distal fragment and reconstruction of the defect in the cortex with a press- fitunicortical Non vascularized osteoperiosteal fibular strut graft with a hybrid fixation is a good treatment modality for monostotic fibrous dysplasia. Hybrid fixation includes retrograde intramedullary transarticular rodding extending across the subtalar and ankle joint into the tibia and augmentation of the primary fixation with a mono-planar rail Fixation in compression mode.Introduction Morel-Lavallée lesions (MLLs) are a post-traumatic degloving injury which the superficial fascia and skin are separated from the deep fascia through shearing forces. This process leads to the development of a potential space in which blood products and necrotic material can collect, potentially resulting in abscesses, cellulitis, or osteomyelitis. Most of these cases occur at the greater trochanter, gluteal musculature, proximal femur, and around the knee. However, there have been few reports of MLLs occurring in the lumbar region. In this report, we seek to present our experience with a case of a lumbar MLL and outline the diagnostic and operative management utilized. Case report A 48-year-old female presented to our clinic with complaints of persistent low back and swelling 1 month after sustaining a fall from stand resulting in an L5 transverse process fracture. The patient was treated non-operatively but continued to have swelling noted to the lower back. A computed tomography scan demonstrat of fluid as described in this case.Introduction Giant cell tumor (GCT) or osteoclastoma is an osteolytic, mostly benign but locally aggressive tumor occurring in young adults at the meta-epiphyseal region of long bones such as lower end of the femur, upper end of the tibia, and lower end of the radius, and proximal humerus in descending order of frequency. Only 2% of all GCT of bone occur in hand. GCT of metacarpal (MC) has different characteristics than that of other long bones. It has more aggressive behavior with involvement of entire length of MC with soft tissue extension. Case report We are reporting a case of GCT of the 3rdMC in a 19-year-old female. She presented to us with a painful, firm, ovoid, and gradually progressive swelling measuring 4 cm × 3 cm over the dorsum of the left (non-dominant)hand, since past 6 months. Fine-needle aspiration cytology was suggestive of GCT of the tendon sheath. Pre-operative magnetic resonance imaging and computed tomography scan revealed the extent of the lesion with no neurovascular involvement. Although various reconstructive procedures to salvage the affected Ray have been reported in literature, we planned for a surgical resection of the lesion leaving behind 1 cm of healthy MC base which appeared to be normal radiologically and intraoperatively. Reconstruction of the defect was done using non-vascularized contoured fibular strut graft, fixed with 2.5 mm mini reconstruction plate, along with reconstruction of the collateral ligaments of the metacarpophalangeal joint. The histopathological study confirmed the diagnosis of GCT. Conclusion GCT of hand is a rare tumor, due to its relatively more aggressive behavior and high chance of recurrence it, nevertheless, provokes quite difficult issue to solve. Prognosis, treatment, and results are directly dependent on early diagnosis and adequate therapy.Introduction Medial dislocation of the long head of the biceps tendon (LHBT) is classically known as a pathognomonic finding for a subscapularis or at least a rotator cuff (RC) injury. However, this case report outlines a young active individual with symptomatic medial dislocation of the long head of the biceps with associated posterior instability, without a corresponding RC injury. Case report An 18-year-old male complained of the left shoulder pain and crepitus after a shoulder injury while playing hockey a year prior. Magnetic resonance imaging demonstrated medial dislocation of the LHBT without subscapularis or supraspinatus tendon injury. The patient complained of instability in the shoulder and exam findings supported posterior instability of the glenohumeral joint. Arthroscopic debridement of the glenohumeral joint with arthroscopic posterior capsulorrhaphy and open biceps tenodesis was performed. The patient regained full and painless range of motion at 2-year follow-up. Conclusion Medial dislocation of the LHBT can occur without injury to the subscapularis tendon. Furthermore, a capsulorrhaphy with open biceps tenodesis and closure of the rotator interval may provide a successful outcome for this rare injury pattern.Introduction Aneurysmal bone cyst is a rare benign solitary tumor of the long tubular bones, pelvis, and vertebrae which rarely affects the clavicle. It is common in the adolescent age group and rare in old age. The characteristic radiological suggests and histopathological picture confirms its diagnosis. This case is of interest because there are only a few cases of aneurysmal bone cyst of the clavicle reported to date. Case report An 11-year-old boy presented with a history of pain in the right clavicular area for 3 months associated with swelling which gradually increased in size. The radiograph showed an expansile bony mass at the lateral fourth of the right clavicle with internal septations with thinning of the cortex and no evidence of periosteal reaction. The affected part of the lateral part of the clavicle was resected leaving the thick periosteum intact. Histologically, section revealed solid and cystic areas. The cysts were separated by septa and filled with hemorrhage and beneath the surface showed osteoid bone formation and multinucleated giant cells. Stroma showed loosely arranged spindle cells which had vesicular nuclei, inconspicuous to prominent nucleoli, and moderate amount of eosinophilic cytoplasm. Prominent blood vessel proliferation was evident. Pleomorphism and mitotic figures were not seen in the specimen. The overall histological picture was that of an aneurysmal bone cyst. Conclusion Aneurysmal bone cyst occurring in this age group is not so common in the clavicle. This is a rare case which requires mention in literature. Our case was treated by marginal resection. On regular follow-up,the regeneration of the bone within the intact periosteum can be seen.Antibody repertoire sequencing provides a molecular fingerprint of current and past pathogens encountered by the immune system. Most repertoire studies in humans require measuring the B cell response in the blood, resulting in a large bias to the IgM isotype. TL13-112 The extent to which the circulating IgM antibody repertoire correlates to lymphoid tissue-resident B cells in the setting of viral infection remains largely uncharacterized. Therefore, we compared the IgM repertoires from both blood and bone marrow (BM) plasma cells (PCs) following acute or chronic lymphocytic choriomeningitis virus (LCMV) infection in mice. Despite previously reported serum alterations between acute and chronic infection, IgM repertoire signatures based on clonal diversity metrics, public clones, network, and phylogenetic analysis were largely unable to distinguish infection cohorts. Our findings, however, revealed mouse-specific repertoire fingerprints between the blood and PC repertoires irrespective of infection status.
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