Chronic locked posterior shoulder dislocation with severe head involvement

Arthroplasty is the treatment of choice for severely damaged humeral heads in chronic locked posterior dislocation of the shoulder. We retrospectively reviewed the results of 12 shoulder arthroplasties (11 patients) between 1999 and 2005. Mean follow-up was 37.4 ± 16.8 months. Mean postoperative Constant score (CS) was 59.4 ± 21.6 (normative age and gender-related CS 67.1 ± 24). There was a significant improvement in range of motion for flexion, abduction and external rotation. There was negative correlation (Pearson’s coefficient) between the related CS and number of previous operations, pain and duration of symptoms. One patient underwent revision surgery 36 months postoperatively with polyethylene insert exchange. There were two patients with mild and one with severe migration of the humeral head. Shoulder arthroplasty resulted in good midterm results for this patient group with benefits for range of motion, pain and patient satisfaction.     

Attitudes toward electroconvulsive therapy in Romanian psychiatrists

Use of electroconvulsive therapy (ECT) is influenced by the attitudes of the psychiatrists. The aim of this pilot survey was to assess the knowledge about and attitudes toward ECT in Romanian psychiatrists. Participants of a scientific meeting were requested to fill a 29-item questionnaire. Answers reflecting false concepts or negative attitudes toward ECT were more than 20% in 15 of 21 items, which highlights the urgent need to improve psychiatrists' education and training about ECT in Romania.     

Daytime sleep patterns in preschool children with autism, developmental delay, and typical development

The present study examined daytime sleep patterns in 3 groups of preschool-aged children: children with autism, children with developmental delay, and children who were developing typically. Sleep was assessed in 194 children via actigraphy and parent-report sleep diaries for 7 consecutive days on 3 separate occasions over 6 months. Children with autism napped less often and for shorter periods of time than children with developmental disability, with whom they were matched on chronologic age. Children with developmental disabilities napped more like children in the typically developing group, who were, on average, 6 months younger. Each group displayed an expected shift in daytime sleep as more children matured out of their naps.     

Local EHR Management Based on openEHR and EN13606

This article describes handling medical data in a healthcare system based on electronic healthcare records. At a medical unit level, data storage requires both accurate collecting and high security. The proposed information model complies with EN 13606, which is a European health data communication standard approved by the European Committee for Standardization (CEN) and partly approved by the International Organization for Standardization (ISO).     

Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study

The aim of this cadaveric study was to compare the transtibial versus the anteromedial portal with respect to the anatomic femoral positioning of the ACL attachment. Ten fresh frozen cadaveric knees were included in our study. A standard arthroscopy was performed and the normal ACL was partially cut through with arthroscopic scissors leaving a small footprint of 2 mm at the anatomical insertion area on the lateral femoral condyle. The femoral tunnel was drilled through the tibial tunnel and subsequently through the anteromedial portal. Using a probe with standard magnification, we measured the distances of the two femoral tunnels from the margin of ACL footprint arthroscopically. The femurs were then dissected and we measured the distances of the two tunnels from the posterior part of the lateral femoral condyle. The median arthroscopically measured distance of the centers of transtibial femoral tunnel and of the femoral tunnel through the anteromedial portal from the margin of the femoral ACL footprint were 6.20 mm and 2.80 mm respectively. The difference was statistically significant. After femoral dissection the median distance of the centers of the transtibial femoral tunnel and the femoral tunnel performed through the anteromedial portal from the border of the articular surface at the lateral femoral condyle was 6.10 mm and 5.25 mm respectively (p<0.001). Both measurements showed that ACL reconstruction technique through the anteromedial portal is more accurate compared to the transtibial technique.     

Influence of functional connectivity and structural MRI measures on episodic memory

Age-related memory decline is the consequence of multiple biological factors that lead to brain structural and functional change, including gray matter atrophy, white matter injury, and loss of functional coordination between regions. However, the independent roles that each of these brain changes play in mediating memory decline is not clear. Therefore, we used magnetic resonance imaging (MRI) to measure gray matter (GM) volume, white matter hyperintensity (WMH) volumes, and blood oxygen level-dependent (BOLD) functional magnetic resonance imaging-based functional connectivity among default mode network nodes in 76 cognitive normal older adults. We found that GM, WMH, and connectivity between left inferior parietal and medial prefrontal cortex (MPF_LIP) were independently associated with episodic memory performance. Within the group with GM volumes below the median, greater MPF_LIP connectivity was associated with better memory performance, whereas this association was not present for individuals with GM volume above the median. These findings confirm the heterogeneous nature of brain-behavior relationships in cognitive aging. In addition, the relationship between resting state functional connectivity and memory performance, particularly amongst those individuals with more brain atrophy, strongly suggests compensation against the effects of neuronal injury.     

Nestin and caveolin-1 in the diagnosis of GISTs

Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasias of the gastrointestinal tract, typically expressing c-kit (CD117) and CD34. Recently, it was reported that nestin and caveolin-1 are also expressed in some human sarcomas, GISTs included. We performed a retrospective study on formalin fixed, paraffin embedded samples from 81 cases of confirmed GISTs, aiming to characterize their immunohistochemical profile, including nestin and caveolin-1 expressions. Tissue samples were evaluated immunohistochemically for CD117, CD34, nestin and caveolin-1. The patients (M:F 36:45), aged 46 to 84 years, had spindle cell type GISTs in 56.7% of cases, epithelioid in 30.8% and mixed pattern in 12.3%. Immunohistochemically, CD117 was positive in 88.9% of GISTs, CD34 in 85.1%, nestin in 77.7% and caveolin-1 in 71.6% of the tumors. Of nine c-kit negative GISTs, 66.7% expressed nestin, the same as caveolin-1 and 44.5% expressed both nestin and caveolin-1. Statistical analysis using Kendall's and Spearman's tests revealed significant correlations between nestin and caveolin-1 expressions (p=0.024). Our results suggest that nestin and caveolin-1 could be considered sensitive markers in GISTs, together with CD117 and CD34, for diagnostic purposes. Their significant expression in CD117 negative GISTs could represent an immunohistochemical alternative in establishing the diagnosis of these tumors.