Reproducibility of the modified Neer classification defining displacement with respect to the humeral head fragment for proximal humeral fractures.

BACKGROUND: Although the Neer classification is widely used for the assessment of proximal humeral fractures, its reproducibility has been challenged. The purpose of this study was to evaluate the reproducibility of the conventional Neer classification and a modified classification that defined fracture displacement with respect to the humeral head fragment. METHODS: The fracture patterns in 80 cases of proximal humeral fractures were independently assessed by 6 observers. The cases were grouped according to the conventional Neer classification using radiographs followed by computed tomography (CT) scans by each examiner twice with a 1-month interval. The fractures were then classified with the modified Neer classification, which defined displacement of the fragment as separation of more than 1 cm or angulation of more than 45° from the humeral head fragment, twice with a 1-month interval. Kappa coefficients of the conventional and modified Neer classifications were compared. RESULTS: The modified classification showed significantly higher intra-observer agreement than the conventional classification, both for radiographs (P = .028) and for CT scans (P = .043). Intra-observer agreement was also significantly higher for the modified classification than for the conventional classification, both for radiographs (P = .001) and for CT scans (P < .001). CONCLUSIONS: The present study showed that agreement for the Neer classification could be improved when fracture displacement was defined as separation or angulation from the humeral head. Considering vascularity to the humeral head, furthermore, the modified method might be more helpful for predicting patients' prognosis than the conventional Neer classification.

High-sensitivity cardiac troponin I detection for 2 types of drug-induced cardiotoxicity in patients with breast cancer.

BACKGROUND: Breast cancer treatment with trastuzumab, a monoclonal antibody that targets human epidermal growth factor receptor type 2 (HER2), has largely been successful in improving the prognosis of HER2-positive disease. However, a critical issue associated with trastuzumab treatment is its cardiotoxic adverse effects, including cardiac insufficiency. METHODS: We measured levels of cardiac troponin I, a marker of myocardial damage, with a highly sensitive method (hs-cTnI) using a fully automated chemiluminescent immunoassay system (ADVIA Centaur(®) XP) in breast cancer patients and examined the relationship between administration of trastuzumab and epirubicin and concentrations of hs-cTnI. RESULTS: The coefficient of variation for within-run repeatability was 1.34-5.93 %, using plasma pools and controls of 3 concentrations, and that for between-run reproducibility was 3.99-8.79 %, indicating high precision of the assay. In a dilutional linearity test with highly concentrated specimens, hs-cTnI values could be measured up to 50 ng/mL with linearity. No influence from coexisting substances was observed. The concentration of hs-cTnI was at or above the reference range (0.04 ng/mL) in 9 of 214 total breast cancer cases (4.2 %). The hs-cTnI concentration was at or above the reference range in 4 of 49 cases (8.2 %) that were administered trastuzumab, and in 5 of 165 cases (3.0 %) that were not. Trastuzumab did not cause elevation of hs-cTnI when not administered in combination with epirubicin. CONCLUSIONS: These results suggest that epirubicin and trastuzumab cause cardiotoxicity through different mechanisms. Epirubicin can cause myocardial necrosis, while trastuzumab can cause cardiomyopathy without myocardial necrosis.

A comparative clinical evaluation of the assay of serum extracellular domain of HER2 protein using a chemiluminescent immunoassay method in breast cancer patients with or without HER2 protein expression in immunohistochemistry.

OBJECTIVE: The human epidermal growth factor receptor type 2 (HER2) protein has been used as a biomarker for breast cancer. A new method based on chemiluminescent immunoassay for measuring the serum levels of the extracellular domain of HER2 protein (sHER2-ECD) has been developed. Its clinical usefulness has not been clearly established. We studied the clinical usefulness of sHER2-ECD in monitoring breast cancer patients. METHODS: We examined the clinical effectiveness of sHER2-ECD using the ADVIA Centaur XP System in comparison with conventional tumor markers (CA15-3 and CEA) in 148 patients with breast cancer with or without trastuzumab treatment. RESULTS: The positive rate for sHER2-ECD, CA15-3, and CEA in trastuzumab patients (36) was 25.0%, 19.4%, and 16.7%, and that in non-trastuzumab patients (112) was 20.5%, 22.3%, and 22.3%, respectively. Twenty-three out of 112(20.5%) non-trastuzumab patients were found positive for sHER2-ECD in spite of the negative IHC. Measurement of sHER2-ECD and CA15-3 showed no difference in the expression profile among different clinical stages. During long-term observation in patients negative for HER2 protein by immunohistochemistry, sHER2-ECD was found to be a relatively sensitive indicator of metastasis to distant organs, such as liver and bone, as compared with CA15-3. CONCLUSION: sHER2-ECD testing may be a useful tumor marker for monitoring breast cancer patients, even in those with negative IHC for the HER2 protein.

Shelf syndrome of the knee in elderly people: a report of three cases.

Shelf syndrome occurs mainly in younger people (particularly athletes) and rarely in elderly people. We report on 3 elderly patients with a medial synovial plica causing severe pain and locked knees. They had had no symptoms in their early or middle life. After removal of the shelf, the symptoms improved considerably. Although shelf syndrome is rare in the elderly, it should be suspected whenever severe pain and a locked knee are present.