Posterior remodeling of medial clavicle causing superior vena cava impingement.

Injuries involving the sternoclavicular region resulting in posterior displacement of the medial clavicle are rare, and those that occur prior to fusion of the medial epiphyseal growth plate are more often a result of physis fracture, rather than sternoclavicular joint dislocation. Medial clavicular physis fractures initially are treated by closed reduction with the expectation of normal osseous repair and remodeling. We report a case of a previously fractured medial clavicle physis that abnormally remodeled, was reinjured, and resulted in posterior displacement with superior vena cava impingement and brachioplexopathy.

Asymptomatic autoantibodies associate with future anti-glomerular basement membrane disease.

The pathophysiology of anti-glomerular basement membrane (anti-GBM) disease before clinical presentation is unknown. The presence of anti-GBM, anti-proteinase 3 (PR3), and anti-myeloperoxidase (MPO) antibodies associate with the disease at the time of diagnosis, but little is known about the presence of these autoantibodies before diagnosis. We used serum samples from the Department of Defense Serum Repository to conduct a case-control study involving 30 patients diagnosed with anti-GBM disease and 30 healthy controls matched for the age, gender, race, and age of the serum samples.

Care coordination in military traumatic brain injury.

Traumatic brain injury (TBI)-an injury to the brain that may or may not create lasting impairment for the survivor-has been recognized as a major public health problem by the Centers for Disease Control ( Langlois, Rutland-Brown, & Thomas, 2006 ). Ongoing conflicts in Iraq and Afghanistan have highlighted the problem for the military ( Warden, 2006 ). Many soldiers are exposed to severe impact to the head resulting in TBI.

Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries.

Background: Tumor stage at diagnosis often varies by racial/ethnic group, possibly because of inequitable health care access. Within the Department of Defense (DoD) Military Health System, beneficiaries have equal health care access. The objective of this study was to determine whether tumor stage differed between whites and blacks with breast, cervical, colorectal, and prostate cancers, which have effective screening regimens, based on data from the DoD Automated Cancer Tumor Registry from 1990 to 2003.

Current approach to the diagnosis of acute nonmassive pulmonary embolism.

Pulmonary embolism is a common and potentially lethal disease. Given the variable presentation and associated morbidity of this condition, an accurate and efficient diagnostic algorithm is required. Clinical pretest probability serves as the root of any diagnostic approach.

Psychogenic dystonia and peripheral trauma.

Dystonia in association with peripheral trauma is a well-described clinical syndrome. The syndrome goes by many names--"traumatic" dystonia, "fixed" dystonia, peripherally induced dystonia, or complex region pain syndrome (CRPS) dystonia. We reviewed the role of peripheral trauma in the development of dystonia, focusing on 4 subtypes--cervical dystonia, focal limb dystonia, CRPS dystonia, and psychogenic dystonia.

Does this patient have medical decision-making capacity?

Context: Evaluation of the capacity of a patient to make medical decisions should occur in the context of specific medical decisions when incapacity is considered.

Objective: To determine the prevalence of incapacity and assessment accuracy in adult medicine patients without severe mental illnesses.

Data Sources: MEDLINE and EMBASE (from their inception through April 2011) and bibliographies of retrieved articles.

Lyngbya dermatitis (toxic seaweed dermatitis).

Lyngbya dermatitis is an irritant contact dermatitis caused by the blue-green alga (or cyanobacterium), Lyngbya majuscula, commonly found in tropical and temperate waters worldwide. Lesions generally appear in a bathing suit distribution minutes to hours after exposure, initially with itching or burning, evolving into a blistering eruption which eventually desquamates leaving bright red, tender erosions that resolve spontaneously in about a week. Our case is of a 13-year-old female that presented with haphazard clusters of reddish-brown vesicles and papules on her abdomen one day after swimming in rough surf conditions on the shores of Oahu, Hawaii.

Effects of spectral smearing and temporal fine-structure distortion on the fluctuating-masker benefit for speech at a fixed signal-to-noise ratio.

Normal-hearing listeners receive less benefit from momentary dips in the level of a fluctuating masker for speech processed to degrade spectral detail or temporal fine structure (TFS) than for unprocessed speech. This has been interpreted as evidence that the magnitude of the fluctuating-masker benefit (FMB) reflects the ability to resolve spectral detail and TFS. However, the FMB for degraded speech is typically measured at a higher signal-to-noise ratio (SNR) to yield performance similar to normal speech for the baseline (stationary-noise) condition.

Aerodynamic evaluation of the postthyroidectomy voice.

Objectives/hypotheses: Changes in vocal function before and after thyroidectomy were examined using aerodynamic and related assessments. Laryngeal airway resistance (R(law)) and phonation threshold pressure (PTP) were hypothesized to be sensitive to changes in laryngeal function that may occur after thyroidectomy separate from changes that may occur from endotracheal intubation alone.

Study Design: Prospective longitudinal clinical trial with comparison group.

The seroprevalence and seroincidence of dengue virus infection in western Kenya.

Epidemics of dengue fever have been documented throughout the African continent over the past several decades, however little is known about the prevalence or incidence of dengue virus infection in the absence of an outbreak. No studies have analyzed the prevalence of dengue infection in western Kenya to date. This study describes the seroincidence and seroprevalence of dengue infection in western Kenya.

Reproducibility of endocervical curettage diagnoses.

Objective: To estimate overall interobserver variability of histopathology diagnoses on endocervical curettage (ECC) specimens.

Methods: Five study pathologists, blinded to the original diagnosis, reviewed archived ECC specimens initially interpreted as normal, low-grade dysplasia, and high-grade dysplasia. We assessed interobserver agreement and agreement between pathologists using the κ statistic and analyzed the effect of reducing diagnostic choices to two categories (one method using "normal and dysplasia" and another method using "normal and low-grade" and "high-grade or worse").

Experience with a patient-friendly, mandatory, single-blastocyst transfer policy: the power of one.

Objective: To determine whether a mandatory single-blastocyst transfer (mSBT) algorithm reduced multiple gestation rates without sacrificing clinical pregnancy rates.

Design: Retrospective review.

Setting: U.

Racial variation in breast cancer treatment among Department of Defense beneficiaries.

Background: Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care.

Ear asymmetries and asymmetric directional microphone hearing aid fittings.

Purpose: To determine whether an asymmetry between ears for speech understanding in noise was related to performance with, or preference for, 1 of 2 asymmetric microphone fittings in which omnidirectional processing was provided to 1 ear and directional processing to the other.

Method: Twenty-eight adults with symmetric sensorineural hearing impairment were recruited from the clinic population. Sixteen individuals had symmetric hearing-in-noise ability between their right and left ears, and 12 participants had an asymmetry for speech understanding in noise between ears.

Rosiglitazone versus rosiglitazone and metformin versus rosiglitazone and losartan in the treatment of nonalcoholic steatohepatitis in humans: a 12-month randomized, prospective, open- label trial.

Unlabelled: Medication combinations that improve the efficacy of thiazolidinediones or ameliorate weight-gain side effects of therapy represent an attractive potential treatment for (NASH). The aim of this randomized, open-label trial was to assess the efficacy of rosiglitazone and metformin in combination versus rosiglitazone and losartan, compared to rosiglitazone alone, after 48 weeks of therapy. A total of 137 subjects with biopsy-proven NASH were enrolled and randomly assigned to receive either 4 mg twice-daily of rosiglitazone, 4 mg of rosiglitazone and 500 mg of metformin twice-daily, or 4 mg of rosiglitazone twice-daily and 50 mg of losartan once-daily for 48 weeks.

Racial disparities in histopathologic characteristics of uterine cancer are present in older, not younger blacks in an equal-access environment.

Objective: We sought to determine whether racial disparities in tumor characteristics among uterine cancer patients persisted, and varied by age, in an equal-access healthcare population.

Methods: The distributions of tumor histology, stage and grade by race were compared for uterine cancers diagnosed from 1990 to 2003 using data from the U.S.

Malaria caused by Plasmodium vivax complicated by acalculous cholecystitis.

We report the first adult cases of acute acalculous cholecystitis (AAC) exclusively caused by infections with Plasmodium vivax. We reviewed the previous cases of AAC occurring during malaria, compared and contrasted the variables of previously reported cases with the cases reported here, examined the pathogenic link between malaria and AAC, and considered the diagnostic pitfalls and treatment implications as they applied to clinical outcomes in patients with this serious and potentially underrecognized illness.

Adjacent vertebral body osteolysis with bone morphogenetic protein use in transforaminal lumbar interbody fusion.

Background Context: Recent studies have demonstrated cases of adjacent vertebral body osteolysis when assessing the effect of bone morphogenetic protein (BMP) on fusion rates. However, no study to date has evaluated the course of osteolysis at different periods.

Purpose: To determine the incidence and resolution of osteolysis associated with BMP used in transforaminal lumbar interbody fusions (TLIF).