Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit.

Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment.

Fracture in a Young Male Patient Leading to the Diagnosis of Wilson's Disease: A Case Report.

Wilson's disease is a rare genetic disorder that has abnormal copper metabolism. Although the disease's main problems are found in liver and brain, some studies revealed manifestation of various musculoskeletal problems in the patients. In this report, we encountered a young patient who had fracture in the forearm bone. Initially, exception to a previous history of fracture from a motorcycle accident, the patient did not have any medical or drug use history, and laboratory work-ups were insignificant. However, with suspicion on his bone's integrity, bone densitometry was recommended and revealed osteopenic change. To disclose a cause for the change, questions were made to recall any particular history or event, and his complaint of recent vision loss led to ophthalmologic consultation where under slit-lamp test found Kayser-Fleischer ring. Further laboratory work-up found low levels of serum copper and ceruloplasmin and high copper level in 24-hr urine sample that led to the diagnosis of Wilson's disease. Although Wilson's disease has been frequently noticed with considerable musculoskeletal manifestation, it rarity makes the diagnosis illusive to a physician. Hence, despite of its rarity, it is imperative to remember the disease's bony manifestation, and it should be suspected in young patients with demineralized bone when the reason for brittle bone cannot be answered with other better known conditions.

Experience with sandwich liner and its high rate of failure.

BACKGROUND: Composite ceramic with polyethylene backing was introduced to enhance the quality of ceramic articulation, but the liner's high rate of ceramic fracture has brought serious concern. In this study, the authors investigated the failure rate of sandwich liner in long-term follow-up patients at single institution. METHODS: In this series, we retrospectively reviewed 134 patients (143 hips), and six patients (6.2%) were found to have liner fracture. They were compared to nonfracture patients to identify the associating factors. General patient characteristics were obtained through review of charts. All patients were implanted with SPH Contact acetabular cup and sandwich liner. Function (Harris hip score) and activity (Devane score) were recorded preoperatively and at final follow-up. Radiologically, inclination and abduction angles were measured for comparison. RESULTS: The study did not show any statistical differences between fracture and nonfracture groups in age, weight or body mass index. Side, type of stem used and radiologic parameters were not also significantly different. The operation had significantly improved function and activity postoperatively in both groups, but no statistical significance was noted between the two groups exception to preoperative Harris hip score. On inspection, retrieved ceramic heads and liners showed substantial metal transfer on their surfaces, and linear wears were evident on the ceramic heads. CONCLUSIONS: Compared to other studies, our series also experienced high rate of sandwich liner fracture. Though its use was generally discontinued, it is worrisome to note that failure rate of the liner will substantially increase over time.

Intraosseous epidermoid cyst discovered in the distal phalanx of a thumb: a case report.

Intraosseous epidermoid cyst is considered a rare benign inclusion cyst found mainly in the skull and phalanges. Once the cyst is differentiated from other similar lesions, the cyst can be treated with simple curettage, seldom requiring additional managements. We experienced this rare case that had been treated successfully without complication.

RHEB expression in fibroadenomas of the breast.

Although fibroadenoma is one of the most common types of benign breast tumor, genes specific to the tumor have not been identified. Microarrays were used to identify differentially expressed genes between fibroadenoma and infiltrating ductal carcinoma. The comparative expression of one of the identified genes, RAS homolog enriched in the brain (RHEB), was further explored using reverse transcriptase-polymerase chain reaction (RT-PCR). Microarray analysis was performed on tissue samples from five patients with fibroadenoma. In the fibroadenoma samples, the genes HDAC1, ROS1, TNFRSF10A, WASP2, TYRP1, WEE1, and RHEB were expressed at levels more than twofold higher than in the normal tissues. RT-PCR for RHEB indicated increased expression of RHEB in fibroadenoma compared to breast cancer. When studied with real-time PCR, the average RHEB/beta-actin ratio in fibroadenoma samples was 1.99, 2.46-fold greater than the average RHEB/beta-actin ratio in breast carcinoma of 0.81 (P < 0.01). Immunohistochemistry and PCR followed by microdissection shows increased expression of RHEB in epithelial cells compared to the stromal cells of fibroadenoma. Therefore, RHEB could be used cytopathologically to distinguish fibroadenoma from malignant breast carcinomas as a secondary diagnostic tool.

Synchronous primary gastric mantle cell lymphoma and early gastric carcinoma: a case report.

Mantle cell lymphoma (MCL) commonly invades the gastrointestinal (GI) tract. However, primary GI MCL is rare. We experienced a case of synchronous early gastric cancer (EGC) with primary gastric MCL found as a single early lesion rather than as multiple lymphomatous polyposis. An EGC was found in the cardia of a 64-year-old male on a routine GI endoscopic examination. A specimen obtained by total gastrectomy revealed another slightly elevated lesion in the pylorus. Microscopically, monotonous small- to medium-sized atypical lymphocytes with angulated nuclei formed a mass beneath the gastric mucosa. On immunohistochemical staining, the tumor cells revealed strong positivity for cyclin D1, positivity for both CD20 and bcl-2, and weak positivity for CD5, suggesting MCL. Clinically, there was no lymphoma in any other part of the body. This is the first case of an EGC accompanying a primary gastric MCL. Further investigation of a relationship between MCL and EGC and of factors that may affect GI involvement of MCL is necessary.