The three-dimensional anatomy of proximal humeral fractures.

Hypothesis: Three-dimensional (3D) computed tomography (CT) reconstructions have the potential to convey the anatomy of proximal humeral fractures more realistically than do standard 2D images.

Material And Methods: Proximal humeral fractures in 248 adult patients were examined prospectively using 3D CT reconstructions. To our knowledge, this represents the largest reported series of such fractures examined by this method.

Natural history of complex fractures of the proximal humerus using a three-dimensional classification system.

We studied the nonoperative treatment of proximal humeral fractures in severe injuries usually treated surgically. The natural history of 63 patients was followed prospectively for 2 to 9 years (mean, 42 months) with a nonrandomized protocol. A 3-dimensional classification system based on computed tomography scans was used to categorize the fractures.

Periodontal care may improve endothelial function.

Background: Periodontitis is a chronic, infectious, insidious disease of the tooth-supporting structures that causes a general inflammatory response. The aims of this study were to determine whether periodontitis is associated with endothelial dysfunction leading to cardiovascular events and whether proper management of periodontal disease would improve endothelial function and prevent cardiovascular events in the future.

Methods: Twenty-two patients (12 women, 10 men; 40+/-5 years old) took part in the study.

CASE REPORTS: unusual lateral clavicle fracture dislocation: case reports and museum specimens.

We present two clinical cases and four museum specimens of a type of lateral clavicle fracture dislocation that has not been detailed in any of the commonly accepted classification systems. With this injury, the major clavicular element is displaced downward and backward into the supraspinatus outlet and may cause symptomatic impingement. A method for surgical correction is described.

Varicella zoster infection and pulmonary complications.

A 34-year-old immunocompetent man with varicella zoster (VZ) infection developed deep vein thrombosis and pulmonary embolism after suffering severe pneumonitis. He recovered after treatment with acyclovir, high-dose steroids, and ventilatory support. The endothelial damage could be a direct link between VZ pneumonitis and pulmonary emboli.

Endothelial function in patients with sickle cell anemia during and after sickle cell crises.

Background: Prior studies have demonstrated increased adherence of sickle cell erythrocytes to vascular endothelial cells. While decreased production of nitric oxide and increased production of adhesion molecules have been implicated in this pathophysiology, the relative contribution of these mechanisms during acute sickle cell crises as compared to steady state conditions have not been elucidated.

Methods And Results: We studied 10 consecutive young adult patients presenting with a sickle cell crisis.

A three-dimensional classification for fractures of the proximal humerus.

Existing classifications of fractures of the head of the humerus are inadequate in terms of interobserver reliability and the predictability of the clinical outcome. From a combined study of 73 fracture specimens in museums and 84 CT-three-dimensional reconstructions in patients, we have devised a classification which appears to be more useful clinically. Common patterns of fracture and a plausible mechanism of injury were observed.

Effects of soy protein on endothelium-dependent vasodilatation and lipid profile in postmenopausal women with mild hypercholesterolemia.

Background: Estrogens appear to improve endothelium-dependent systemic and coronary vasodilator function, perhaps by increasing nitric oxide levels and the subsequent effect of nitric oxide on endothelial function and smooth-muscle relaxation. Because soybean foods contain phytoestrogens, we evaluated the effect of orally administered soy proteins on vascular responsiveness.

Methods: This double-blind, placebo-controlled crossover study involved 24 postmenopausal women (mean age 55 yr) who were hypercholesterolemic, who were not taking hormone replacement therapy and had not taken antioxidants or lipid-lowering agents in the preceding 2 months.

Effects of oral soy protein on markers of inflammation in postmenopausal women with mild hypercholesterolemia.

Background: Nitric oxide (NO) may protect arteries against atherosclerosis, as suggested by experimental studies. Estrogen therapy enhances the bioactivity of NO in the vasculature of healthy postmenopausal women, but is not acceptable for long-term use by many women. Observational studies have demonstrated beneficial cardiovascular effects of soy protein in premenopausal and postmenopausal women.

Bony changes at the lateral epicondyle of possible significance in tennis elbow syndrome.

Examination of a large number (1232) of elbows from skeletal specimens revealed that 16% displayed a characteristic pattern of bone formation exactly underlying the area of exquisite point tenderness at the lateral humeral epicondyle found in clinical cases of tennis elbow. These changes are usually not seen on standard roentgenograms and can be missed, even at the time of surgery, because this area is not commonly exposed in standard tennis elbow approaches. In a group of clinical cases of tennis elbow (20 patients), similar bony changes could be demonstrated in the majority (60%) of patients with chronic tennis elbow symptoms by the use of specialized x-ray techniques-most notably, coronal reconstructions with computed axial tomography.

[Pulmonary sequestration detected by ultrasound].

Pulmonary sequestration is part of the spectrum of bronchopulmonary foregut anomaly. It is a rare type of congenital malformation in which a mass of pulmonary tissue is separate from the normal lung and receives its arterial supply directly from the systemic circulation. Angiographic demonstration of a systemic artery leading to the sequestrated lung has usually been used to diagnose this condition.