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Anderson JM, Yoshizawa C, Winer EP, Watson D, Millward C, Tan V, Shak S, Baehner FL. Abstract P3-10-15: Quantitative Gene Expression by RT-PCR in Classic and Variant Forms of Lobular Carcinoma in Estrogen Receptor Positive Invasive Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-10-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Classic lobular carcinoma is characterized by a distinctive morphology, loss of E-cadherin commonly due to mutation or deletion of CDH1 on chromosome 16q, and a variable clinical course (Pestalozzi J Clin Oncol. 2008 26:3006). Variants (pleomorphic, solid and alveolar) with distinct morphologies and potential differences in outcome have been described (Rosen 2009). Herein we explore the patterns of quantitative gene expression as measured by the 21 gene Oncotype DX® assay observed between ductal NOS (DC) and classic and variant lobular carcinomas. Material and Methods: All tumors analyzed in the Genomic Health laboratory from 6/1/04-3/31/10 were included. Central path used WHO criteria for classification of classic lobular (CL), solid & alveolar lobular (SAL), and pleomorphic lobular (PL) carcinomas. Quantitative expression of 16 cancer related genes was measured on a scale from 0 to 15 (relative to reference genes) where a 1 unit increment is associated with an ∼2-fold change in expression. Descriptive statistics for RS & individual genes [ER, PR, invasion gene group (IGG) & proliferation gene group (PGG)] among the different subtypes were obtained. Comparisons of means among the subtypes were adjusted to control the overall error rate under any complete or partial null hypothesis.
Results: DC accounted for 90.4% of 133,234 cases, CL 8.2%, SAL 0.7% and PL 0.8%. For all types a continuous range of RS was observed. DC had the greatest percentage of high risk RS followed by SAL, PL and CL. DC had the highest RS and CL had the lowest RS. SAL had the highest ER expression and CL had the lowest expression, but these results may refect a submission bias and are not population based. The proportion with the ER+/PR-phenotype was slightly different among the subtypes: SAL (24.2%) and PL (19.5%) had a higher incidence compared to DC (15%) and CL (15.6%). SAL had the highest PGG expression; CL had the lowest. DC had the highest IGG; CL had the lowest.
Discussion: Classic lobular carcinoma and the lobular carcinoma variants are characterized by differential patterns of gene expression. Outlier cases are not infrequent within each of the special subtypes in this large observational cohort. The variation in gene expression, noted by histologic subtype, will be presented in detail.
RS Distributions in Ductal NOS, Lobular and Lobular Variants
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-15.
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Tan V, Seevanayagam S. Arytenoid subluxation after a difficult intubation treated successfully with voice therapy. Anaesth Intensive Care 2010; 37:843-6. [PMID: 19775054 DOI: 10.1177/0310057x0903700505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Arytenoid subluxation is a rare laryngeal injury that may follow instrumentation of the airway and present as hoarseness, vocal fatigue, stridor, dysphagia, odynophagia and sore throat. We report the case of an 88-year-old man with type 2 diabetes mellitus who developed this complication during a difficult intubation where a Macintosh laryngoscope and gum elastic bougie were used to facilitate intubation. Previously considered to play a minor role in treatment, voice therapy was used successfully in this patient to correct subluxation of the arytenoid, with prompt resolution of his symptoms.
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Tan V, Lee S, Goh B, Chung A, Sebastian M, Yong W, Wong W. Feasibility and Accuracy of Sentinel Lymph Node Biopsy in Clinically Node Negative Patients after Neoadjuvant Chemotherapy for Breast Cancer – A Systematic Review and Metaanalysis. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BackgroundThe sentinel lymph node biopsy (SLNB) has become an accepted alternative to the axillary lymph node dissection (ALND) for pathologic evaluation of the axillary lymph node status in patients with early breast cancer and a clinically negative axilla. Patients with a negative sentinel lymph node are spared the ALND and its associated morbidities.Currently, there is insufficient evidence to recommend the use of SLNB in patients who have received neoadjuvant chemotherapy (NAC), and treatment of the axilla after neoadjuvant chemotherapy is an ALND.The use of neoadjuvant chemotherapy is increasing, and NAC has been shown to downstage both the primary tumour and axillary lymph nodes. Potentially, an additional proportion of patients who are node negative after NAC may be spared a full ALND and its attendant morbidities.AimsTo determine the feasibility and accuracy of SLNB in patients who have a clinically negative axilla after neoadjuvant chemotherapy for breast cancer.MethodsA systematic review of the English literature of SLNB in patients who have had neoadjuvant chemotherapy (NAC) was conducted and meta analyses performed. Studies selected had an identifiable group of patients with breast cancer who received neoadjuvant chemotherapy and were clinically node negative. These patients had a SLNB prior to the standard ALND regardless of outcome of the SLNB.ResultsTen studies that met the eligibility criteria were identified. A total of 449 patients were studied. Pooled analysis using the fixed effects model was used to calculate successful identification rate and accuracy parameters. The summary rate of identification of SLN was 94% [95% CI: 91.6% – 96.7%]. The pooled sensitivity of SLNB after NAC was 93% [95% CI: 88.5% – 96.8%] and the false negative rate 7.0% [95% CI: 3.2% – 11.5%].ConclusionSLNB in patients with a clinically node negative axilla after neoadjuvant chemotherapy is feasible and accurate.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1013.
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Capo JT, Accousti K, Jacob G, Tan V. The effect of rotational malalignment on X-rays of the wrist. J Hand Surg Eur Vol 2009; 34:166-72. [PMID: 19129357 DOI: 10.1177/1753193408090393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study evaluates the effect of rotational malposition of the wrist on measured radiographic parameters of the distal radius and carpus. Ten wrists from five healthy volunteers were imaged in varying degrees of rotation. The wrists were placed in a custom, calibrated jig and images were taken in 5 degrees increments to a maximum pronation and supination of 20 degrees . The results demonstrate the following: a steady decrease in the scapholunate and radioscaphoid angles with extremes of supination; an increase in palmar tilt with supination and a decrease in palmar tilt with pronation. The palmar tilt varied from -4 degrees to 15 degrees and the scapholunate angle ranged from 48 degrees to 29 degrees at the extremes of rotation. These results demonstrate how malrotation in X-ray positioning can have a significant effect on the apparent alignment of the distal radius and carpal bones. Measurements taken from poor X-rays typically fall outside the normal range and could adversely effect treatment decisions.
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Kwok W, Roti M, Delong J, Tan V, James E, Robinson D. A New Approach for Identifying the Specificity, Frequency and Phenotype of CD4 + Allergen-reactive T Cells. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Delong J, Till S, Roti M, Tan V, James E, Robinson D, Kwok W. Investigation of Group 5 Grass Allergen T Cell Cross-reactivity by Multi-tetramer Analysis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tan V, Stella D, Frydenberg H, Mow C, Nandurkar S, Gibson PR. Hypoalbuminaemia and coeliac disease. Gut 2008; 57:922, 930. [PMID: 18559385 DOI: 10.1136/gut.2007.122770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Chheng P, Tamhane A, Natpratan C, Tan V, Lay V, Sar B, Kimerling ME. Pulmonary tuberculosis among patients visiting a voluntary confidential counseling and testing center, Cambodia. Int J Tuberc Lung Dis 2008; 12:54-62. [PMID: 18302824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING Voluntary counseling and confidential testing center (VCCT), Battambang District, Cambodia. OBJECTIVES To determine newly diagnosed pulmonary tuberculosis (PTB) prevalence and predicting factors, and assess the utility of TB-related symptoms and yield of sputum microscopy and culture. DESIGN Cross-sectional survey using interview, sputum smears and cultures and human immunodeficiency virus (HIV) testing. RESULTS Of 496 participants, 29 (5.8%) had culture-confirmed PTB while 19 (65.5%) were acid-fast bacilli (AFB) smear-positive. PTB prevalence was higher (P < 0.001) in HIV-positives (20/124, 16.1%) than in HIV-negatives (9/372, 2.4%). On multivariable analysis, being HIV-positive, underweight (body mass index <18.5 kg/m(2)), rapid weight loss and age > or =35 years were predictors of PTB. Fever (93%) and hemoptysis (86%) had the highest sensitivity and specificity, respectively. The symptom complex of rapid weight loss, fever and hemoptysis detected all PTB cases (sensitivity 100%). Examination of three sputum smears with culture of the first sample detected 95% (19/20) of the HIV-associated PTB cases and 90% (26/29) overall. CONCLUSIONS TB is common in the VCCT setting, regardless of HIV status. The high prevalence of HIV and PTB among the participants warrants consideration of TB screening for all HIV suspects. Such screening through VCCT is feasible. Adding a single culture test to the evaluation of an initial sputum sample set will substantially increase case detection.
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Tan V, Bartlett M, Hosking P, Gibson PR. Annular purpura and ulcerative colitis: response to infliximab. Dig Liver Dis 2007; 39:488-9. [PMID: 17383245 DOI: 10.1016/j.dld.2006.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Accepted: 10/25/2006] [Indexed: 12/11/2022]
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Bouktsi M, Tan V, Hanna M, Quinn N, Cordivari C. P24.1 An unusual case of dystonia of peripheral origin. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guyette TM, Tan V, Weiland A. Technique and preliminary results of a new low contour plating system for distal radius fractures. Tech Hand Up Extrem Surg 2006; 5:153-6. [PMID: 16520590 DOI: 10.1097/00130911-200109000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tan EK, Yeo AP, Tan V, Pavanni R, Wong MC. Prescribing pattern in Parkinson's disease: are cost and efficacy overriding factors? Int J Clin Pract 2005; 59:511-4. [PMID: 15857344 DOI: 10.1111/j.1368-5031.2005.00426.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Information on prescribing pattern of antiparkinsonian medications and factors influencing neurologists' choice of such drugs are important considerations in evaluating healthcare cost of Parkinson's disease (PD). We surveyed neurologists' perceived factors influencing their choice of drugs and actual prescribing pattern in PD. Three hundred and six patients at a tertiary hospital, diagnosed with idiopathic PD and who were dispensed antiparkinsonian drugs during a 6-month period were randomly selected. Patient demographics, type and dose of medications were analysed. A questionnaire survey evaluating the factors influencing choice of medications was administered to neurologists who practiced at the institution. The study population had a mean age of 64.4 years (SD +/- 9.9 years), and more than 80% were at Hoehn & Yahr stage 2-3. 92.3% of the study population were receiving levodopa and monotherapy, with levodopa being the most common treatment regimen. Patients who were prescribed levodopa were significantly older and at a later stage of disease compared to those without levodopa (p < 0.05). Only 26.8% of patients were prescribed dopamine agonists. In the survey, the neurologists cited severity of symptoms, and patients' intolerance of side effects, and efficacy as the most important factors influencing their choice of drugs. However, the actual prescribing pattern revealed a strong positive correlation of drug usage with cost subsidy by the institution. While factors affecting drug usage in PD are well recognised, cost and efficacy of a drug appear to be overriding practical factors in influencing usage pattern in clinical practice.
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Tay MX, Nath A, Tan V, Feng ZW. Nuclear factor kappa B transcription profiling of genes protect against nitric oxide-induced neuronal apoptosis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2004; 33:S64-6. [PMID: 15651214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Xanthos M, Tan V, Ponnusamy A. Measurement of melt viscoelastic properties of polyethylenes and their blends?a comparison of experimental techniques. POLYM ENG SCI 2004. [DOI: 10.1002/pen.11755] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Feng ZW, Tan V, Khoo KS, Leck KJ. NF-kappa B plays a protective role in nitric oxide-induced neuronal apoptosis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2003; 32:S30-1. [PMID: 14968726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Sultan PG, Tan V, Lai M, Garino JP. Independent contribution of elevated-rim acetabular liner and femoral head size to the stability of total hip implants. J Arthroplasty 2002; 17:289-92. [PMID: 11938503 DOI: 10.1054/arth.2002.30415] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The use of an elevated-rim acetabular liner in total hip arthroplasty is widely accepted. We sought to determine quantitatively the amount of additional stability provided by the elevated-rim liner compared with the standard nonelevated liner. The stability of the hip with a 32-mm femoral head was compared with the standard 28-mm head. Our results show that a 15 degrees elevated-rim acetabular liner placed in the posterior quadrant increased hip stability by an additional 8.9 degrees of internal rotation. Similarly the 32-mm head provided 8.1 degrees of additional internal rotation. The increases were statistically significant (P<.0001). We did not encounter increased anterior dislocation intraoperatively. The findings of this study indicate that the 32-mm head may contribute to hip stability in primary total hip arthroplasty, and in instances in which a posterior approach is used, an elevated-rim liner placed in the posterior quadrant may contribute independently to hip stability.
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Abstract
In-line skating has remained a popular recreational activity all over the world. The number of injuries seemingly reached a plateau in the late 1990s. However, there are still more injuries caused by in-line skating than from skateboarding, hockey or lacrosse and rugby. In 1997, the estimated annual cost of medical treatment for these injuries in the US was over $US4 billion. Adolescence still represents the largest group of skaters, both in participation and injury. Although 10- to 14-year-olds account for 60% of injuries, in 1996 the US Consumer Product Safety Commission reported nearly 1500 injuries in individuals 65 years and over. Risk factors for injury include inexperience, aggressive skating and amount of time spent skating. There are also more recent data to suggest that self-reported expert skaters are more likely to sustain an injury. Reluctance to use personal protective equipment (PPE) by in-line skaters remains high. The general consensus is that PPE is effective in reducing the incidence and severity of in-line skating injuries. Therefore, efforts should be made to increase awareness of risk factors for injury in all skaters; to increase use of safety equipment; to provide safe environments for skating; and to legislate skating laws that will protect skaters from injuries.
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Tan V, Seldes RM, Katz MA, Freedhand AM, Klimkiewicz JJ, Fitzgerald RH. Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadavera. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2001; 30:809-12. [PMID: 11757858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The purpose of our study was to describe the gross anatomy of the adult acetabular labrum and to determine its contribution to the depth, surface area, and volume of the acetabulum. Fifty-five embalmed hips were studied. Each hip was disarticulated, and standardized measurements were taken. Calculations of the acetabular articulating surface area and volume, with and without the labrum, were performed based on these measurements. Average width of the acetabular labrum was 5.3 mm (SD, 2.6 mm). The labrum was wider anteriorly and superiorly than posteriorly. The surface area of the acetabulum without the labrum was 28.8 cm2; with the labrum, it was 36.8 cm2 (P < .0001). The volume of the acetabulum without the labrum was 31.5 cm3; with the labrum, it was 41.1 cm3 (P < .0001). There was no side-to-side difference in contribution of the labrum to either surface area or volume between right and left hips. Comparison of these indices for males and females showed statistically significant differences in absolute but not relative increases.
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Williams GR, Wong KL, Pepe MD, Tan V, Silverberg D, Ramsey ML, Karduna A, Iannotti JP. The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement. J Shoulder Elbow Surg 2001; 10:399-409. [PMID: 11641695 DOI: 10.1067/mse.2001.116871] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The articular surface of the normal humeral head has a variable posterior and medial offset with respect to the central axis of the humeral shaft. Recreation of the normal humeral head shaft offset is postulated to be an important consideration during shoulder arthroplasty. However, the effect of humeral head malposition is unknown. The purpose of this study was to determine the effect of articular malposition after total shoulder arthroplasty on glenohumeral translation, range of motion, and subacromial impingement. Twenty-one human cadavers were dissected and tested with the use of an active or passive shoulder model. Range of motion and translation were recorded by means of an electromagnetic tracking device. The experiment was performed in 2 phases. For kinematics study, 11 cadaver shoulders were positioned both passively and actively from maximum internal rotation to maximum external rotation at 90 degrees of total elevation in the scapular plane. Three rotator cuff and 3 deltoid muscle lines of action were simulated for active joint positioning. Passive joint positioning was accomplished with the use of a torque wrench and a nominal centering force. The testing protocol was used for the natural joint as well as for 9 prosthetic head locations: centered and 2- and 4-mm offsets in the anterior, posterior, inferior, and superior directions. Repeated-measures analysis of variance was used to test for significant differences in the range of motion and translation between active and passive positioning of the natural joint as well as all prosthetic head positions. (2) For impingement study, 10 cadaver shoulders were used in a passive model, loading the tendons of the rotator cuff with a 30-N centering force. The humerus was passively rotated from maximum internal rotation (1500 Nmm) to maximum external rotation (1500 Nmm) by means of a continuous-recording digital torque wrench. Trials were performed with the use of centered, 4-, 6-, and 8-mm offset heads in the anterior, posterior, superior, and inferior positions before and after removal of the acromion and coracoacromial ligament. The relation between change in mean peak torque (with and without acromion), passive range of motion, and humeral head offset was analyzed by means of repeated-measures analysis of variance. In the kinematics study, total range of motion and all humeral translations were greater with passive joint positioning than with active positioning (P =.01) except for total superior-inferior translation and superior-inferior translation in external rotation. Anterior to posterior humeral head offset was associated with statistically significant changes in total range of motion (P =.02), range of internal rotation (P =.02), range of external rotation (P =.0001), and total anterior-posterior translation (P =.01). Superior to inferior humeral head offset resulted in statistically significant changes in total range of motion (P =.02), range of internal rotation (P =.0001), anterior-posterior translation during external rotation (P =.01), and total superior-inferior translation (P =.03). In the impingement study, there was a significant increase in torque from centered to 4-mm inferior offset (P =.006), 6-mm inferior offset (P <.001), and 8-mm inferior offset (P <.001). There was no significant increase in torque with superior, anterior, and posterior offsets. Glenohumeral motion significantly decreased from 129 degrees for centered head to 119 degrees for 8-mm superior (P =.002), 119 degrees for 8-mm anterior (P =.014), 118 degrees for 8-mm inferior (P <.001), and 114 degrees for 8-mm posterior (P =.001). Humeral articular malposition of 4 mm or less during prosthetic arthroplasty of the glenohumeral joint may lead to small alterations in humeral translations and range of motion. Inferior malposition of greater than 4 mm can lead to increased subacromial contact; offset of 8 mm in any direction results in significant decreases in passive range of motion. Therefore if subacromial contact is to be minimized and glenohumeral motion maximized after shoulder replacement, anatomic reconstruction of the humeral head-humeral shaft offset to within 4 mm is desirable.
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Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 2001:232-40. [PMID: 11153993 DOI: 10.1097/00003086-200101000-00031] [Citation(s) in RCA: 457] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Acetabular labrum tears have been implicated as a cause of hip pain in adult patients. Few studies describe the anatomy, histologic features, and microvasculature of the acetabular labrum and labral tears. Fifty-five embalmed and 12 fresh-frozen adult hips with a mean age of 78 years (range, 61-98 years) were studied. Of these, 96 % (53 of 55) of the hips had labral tears, with 74% of the tears located in the anterosuperior quadrant. Histologically, the fibrocartilaginous labrum was contiguous with the acetabular articular cartilage through a 1- to 2-mm zone of transition. A consistent projection of bone extends from the bony acetabulum into the substance of the labrum that is attached via a zone of calcified cartilage with a well-defined tidemark. Two distinct types of tears of the labrum were identified histologically. The first consisted of a detachment of the fibrocartilaginous labrum from the articular hyaline cartilage at the transition zone. The second consisted of one or more cleavage planes of variable depth within the substance of the labrum. Both types of labral tears were associated with increased microvessel formation seen within the tear. The acetabular labrum tear appears to be an acquired condition that is highly prevalent in aging adult hips. Labral tears occur early in the arthritic process of the hip and may be one of the causes of degenerative hip disease.
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Abstract
Ageing workers can be found in almost all occupations. Assessment of fitness to work in these workers is important, as it aims to match their functional capacity (which is reduced compared to younger workers), to the demands of their work (which may remain the same as that for younger workers). This outcome of assessment is influenced by the interaction between functional capacity, state of health, the nature of work, and possibilities for work accommodation. The assessment of functional capacity should include physical, mental and social capacity, as well as assessment of any disability. In addition to clinical or laboratory measurements, several authors have suggested the use of a 'work ability index' for specific occupations as a practical means of selecting the appropriate worker for the job. This index can also be used for monitoring functional capacity. In addition, as for any fitness to work assessment, a good understanding of the nature of the work and the work environment is required, and possibilities for work accommodations considered. While changes in the work environment and working conditions can be made to suit the functional capacity of the ageing worker, the maintenance of functional capacity is another important issue. There is a place for a greater role for disease screening and health promotion for such workers.
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Abstract
OBJECTIVES To characterize the injury pattern and economic impact of major pediatric hand trauma secondary to fireworks. DESIGN Retrospective. SETTING Pediatric Level I trauma center. INTERVENTION N/A MAIN OUTCOME MEASUREMENTS: Fractures, amputations, soft tissue defects, length of hospitalization, number and type of procedures performed were obtained from charts, radiographs, and operative reports. Hospital charges were obtained from the billing office. PATIENTS/PARTICIPANTS Records of patients with a diagnosis of fireworks-related injuries admitted over a period of ten years were reviewed. Twenty-two patients were identified to have sustained twenty-two hand injuries. The group consisted of nineteen boys and three girls, with an average age of 9.3 years (range, 4 to 17 years). RESULTS There were thirty-one fractures, nineteen amputations, and one dislocation. The nineteen amputations occurred in nine hands. Local skin graft or flap coverage was required in six hands acutely, and delayed soft tissue procedures were performed on four hands. Four hands had digital neurovascular injuries; two required microsurgical repairs at the time of injury, and two were irreparable. Resource use included: average hospital stay of 4.3 days (range, 0 to 20), average number of trips to the operating room, 1.2 (range, 0 to 3), and average hospital charges of $11,582 (range, $1,035 to $39,489). CONCLUSIONS This study illustrates the severity of pediatric hand injuries associated with fireworks and the significant burden placed on medical resources in treating these injuries. Efforts toward public education and legislative reforms may help to prevent these unnecessary injuries.
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Yilmazer U, Xanthos M, Bayram G, Tan V. Viscoelastic characteristics of chain extended/branched and linear polyethylene terephthalate resins. J Appl Polym Sci 2000. [DOI: 10.1002/(sici)1097-4628(20000314)75:11<1371::aid-app8>3.0.co;2-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tan V, Pepe MD, Glaser DL, Seldes RM, Heppenstall RB, Esterhai JL. Well-leg compartment pressures during hemilithotomy position for fracture fixation. J Orthop Trauma 2000; 14:157-61. [PMID: 10791664 DOI: 10.1097/00005131-200003000-00001] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the relationship between the well-leg compartment pressures and time during hemilithotomy position for fracture fixation. DESIGN Prospective. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Ten patients who underwent intramedullary nailing of a fractured femur in the hemilithotomy position (with a well-leg holder). INTERVENTION Continuous pressure monitoring was achieved with in-dwelling slit catheters inserted into the calf compartments of the well leg. Baseline measurements were obtained in the supine position. After the leg was placed in the hemilithotomy position, compartment pressures were monitored throughout surgery. MAIN OUTCOME MEASUREMENTS Calf compartment pressures at baseline, during hemilithotomy position, and post-hemilithotomy were compared. The association between body mass index and compartment pressure was analyzed. RESULTS A consistent pattern was observed between compartment pressures and time. The curve was that of a step function in which the pressure increased as soon as the leg was placed in the well-leg holder and remained elevated until the leg was taken down. The pressure jumped from a baseline of 9.2 to 27.3 millimeters of mercury (mm Hg) (p<0.0001). While in the hemilithotomy position, the leg pressure trended slightly upward. Once the leg was taken down, the pressure immediately returned to a near-baseline level of 8.1 mm Hg (p<0.0001). A significant correlation was also found between the body mass index and leg pressure (R2 = 0.713; F = 0.002). CONCLUSIONS The use of the well-leg holder to maintain hemilithotomy position increases the calf compartment pressures dramatically and significantly. Therefore, we recommend avoiding this position for fracture fixation in at-risk patients.
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