Increased incidence of distal humeral fractures and surgical treatment in 0- to 18-year-old patients treated in Finland from 1987 to 2010

Background

Studies of pediatric and adolescent fractures in general report a significant increase in the incidence of upper-extremity fractures as well as in their surgical treatment. The aim of this study was to determine the trends of the incidence and treatment of distal humeral fractures in hospitalized 0- to 18-year-old patients in Finland.

Method

The study included the entire pediatric and adolescent (<19 years) population in Finland during the 24-year period from 1 January 1987 to 31 December 2010. Data on hospitalized patients were obtained from the nationwide National Hospital Discharge Registry where information is collected from all hospital categories (private, public, and other). Surgical treatment was categorized into three groups; (1) reposition with casting; (2) reposition or reduction and osteosynthesis; (3) reposition or reduction and external-fixation and other fixation methods. Patients were classified into three groups according to age: 0–6 years, 7–13 years, and 14–18 years. Annual incidences were calculated using the annual mid-year population census obtained from the Official Statistics of Finland.

Results

During the 24-year study period, there were a total of 12,590 hospitalizations with a main or secondary diagnosis of distal humeral fracture. In children aged 0–12 years the overall incidence of hospitalization increased 30 % during the 24-year study period, from 4.5 per 10,000 person-years in 1987 to 5.8 per 10,000 person-years in 2010. There were a total of 5,548 operations. During the study period, surgical treatment by repositioning or reduction with osteosynthesis due to a distal humeral fracture increased by fivefold in patients aged <6 years and by twofold in patients aged 7–12 years of age. The incidences of fracture and treatment in children older than 13 years did not change.

Conclusion

The incidence of distal humeral fractures and the incidence of repositioning with osteosynthesis increased remarkably in prepubertal children during the 24-year study period in Finland.     

Current Concepts in the Treatment of Gouty Arthritis

Gouty arthritis is an extremely painful condition that causes functional impairment. Gouty arthritis has become increasingly complex because of multiple comorbidities, iatrogenic factors and hyperuricemia that is refractory to treatment. In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares.     

Primary umbilical endometriosis. Case report and discussion on management options

INTRODUCTIONWe report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition.PRESENTATION OF CASEA 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months.DISCUSSIONUE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.CONCLUSIONLocal excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.     

Primary adenocarcinoma of the fourth portion of the duodenum: “A case report and literature review”

INTRODUCTIONPrimary adenocarcinoma of the 4th portion of the duodenum is reported less frequently than those other portions of the duodenum. Therefore, few reports discuss the diagnosis and treatment of this malignancy.PRESENTATION OF CASEA 54-year-old woman was admitted to our hospital with a complaint of nausea and vomiting after a meal. Upper gastrointestinal examination and a duodenogram revealed a Type 2 tumor of the 4th portion of the duodenum, which was diagnosed as well-differentiated tubular adenocarcinoma by endoscopic biopsy. Partial resection of the duodenum and jejunum was performed on the basis of intraoperative evaluation of negative lymph node metastasis around the pancreas and proximal duodenum with no macroscopic invasion toward the pancreas and proximal duodenal margin. Her postoperative course was uneventful without any sign of recurrence 5 years later.DISCUSSIONPrimary adenocarcinoma in the 4th portion is relatively less common. It is not easy to diagnose this disease. Patients with primary duodenal adenocaricinoma, who are medically fit to undergo surgery, should be given the option of aggressive resection. Duodeno-cephalo-pancreatectomy remains the standard treatment for adenocarcinomas of the 1st and 2nd portion of the duodenum. Partial resection is the preferred surgical method for patients with adenocarcinoma of the 3rd and 4th portions of the duodenum.CONCLUSIONThis report describes a rare case of primary adenocarcinoma of the 4th portion of the duodenum, successfully treated by partial resection of the duodenum and jejunum. However, larger studies are required to clarify the indications for the preferred surgical method for this malignancy.     

Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets: A prospective randomized clinical trial

Objective:To conduct a prospective and randomized study of the efficiency of orthodontic treatment with self-ligating edgewise brackets (SL; Time2 brand, American Orthodontics) and conventional edgewise twin brackets (CE; Gemini brand, 3M).Materials and Methods:One hundred consecutive patients were randomized to treatment with either SL or CE brackets. The participants were treated by one of three specialists in orthodontics and with continuous instructions alternately by five orthodontic assistants according to our normal treatment routine (ie, modified 0.022″ MBT preadjusted edgewise technique). The treatments were evaluated in terms of overall treatment time, number of visits, and treatment outcome using the Index of Complexity, Outcome and Need (ICON). The number of emergency appointments, number of archwires, overjet, relative space, and extractions at treatment start were noted.Results:After dropouts, the analyzed material consisted of 44 patients treated with SL (mean age 15.3 years, mean ICON 60.7, 70.4% female) and 46 patients treated with CE (mean age 15.0 years, mean ICON 56.5, 71.7% female). There were no statistically significant differences between the SL and CE groups in terms of mean treatment time in months (20.4 vs 18.2), mean number of visits (15.5 vs 14.1), mean ICON scores after treatment (13.2 vs 11.9), or mean ICON improvement grade (7.9 vs 9.1).Conclusion:Orthodontic treatment with SL brackets does not reduce treatment time or number of appointments and does not affect posttreatment ICON scores or ICON improvement grade compared with CE brackets.     

Clinical and radiographic evaluation of Bio-Gen with biocollagen compared with Bio-Gen with connective tissue in the treatment of class II furcation defects: a randomized clinical trial

Objective

Treatment of furcation defects are thought to be challenging. The purpose of this study was to evaluate the clinical and radiographic parameters of Bio-Gen with Biocollagen compared with Bio-Gen with connective tissue in the treatment of Class II furcation defects.

Material and Methods

In this clinical trial, 24 patients with Class II furcation defect on a buccal or lingual mandibular molar were recruited. After oral hygiene instruction, scaling and root planing and achievement of acceptable plaque control, the patients were randomly chosen to receive either connective tissue and Bio-Gen (case group) or Biocollagen and Bio-Gen (control group). The following parameters were recorded before the first and re-entry surgery (six months later): vertical clinical attachment level (VCAL), gingival index (GI), plaque index (PI), horizontal probing depth (HPD), vertical probing depth (VPD), gingival recession (GR), furcation vertical component (FVC), furcation to alveolar crest (FAC), fornix to base of defect (FBD), and furcation horizontal component (FHC) were calculated at the time of first surgery and during re-entry. A digital periapical radiograph was taken in parallel before first surgery and re-entry. The radiographs were then analyzed by digital subtraction. The differences with p value <0.05 were considered significant.

Results

Only the mean changes of FAC, FHC, mean of FHC, FBD in re-entry revealed statistically significant differences between the two groups. HPD, VPD, FBD, FAC, and FHC showed statistically significant differences after 6 months in the case group. However, in the control group, statistically significant differences were found in GR and HPD. We did not observe any significant difference in radiographic changes among the two groups.

Conclusion

The results of this trial indicate that better clinical outcomes can be obtained with connective tissue grafts in combination with bone material compared with a resorbable barrier with bone material. The differences in radiographic changes between the two groups, however, were not statistically significant.     

Drug trajectories among youth undergoing treatment: The influence of psychological problems and delinquency

Previous research has documented associations of addiction with delinquency and psychological problems. However, few studies have evaluated their influence on adolescent's drug use trajectories. The current study aims to examine the influence of these factors on the recovery trajectories of 199 youths aged 15.6 years on average admitted to inpatient and outpatient addiction treatment centers, followed up three and six months later. Results indicate that youth who show higher severity of drug abuse exhibit greater improvement than youth with a lower severity of drug abuse at the onset of treatment. Although psychological problems were associated with baseline drug use, they did not influence drug use trajectory over time. Only delinquency influenced the recovery trajectories of these youth. Results suggest that a high level of delinquency can have a significant effect on the drug recovery process of adolescents and that interventions should attempt to reduce both drug use and delinquency.     

Social Competence Intervention Program (SCIP): A pilot study of a creative drama program for youth with social difficulties

This study explored the effects of participation in the Social Competence Intervention Program (SCIP), an innovative creative drama-based group intervention, of children diagnosed with autism spectrum disorder (ASD), nonverbal learning disability (NLD) and/or attention deficit hyperactivity disorder (ADHD). Eighteen participants in SCIP were compared to a clinical control group of 16 on changes in measures of social perception, social competence, and naturalistic observed social behavior. Hierarchical multiple regression model was used for all primary quantitative analyses. Interviews were conducted post-treatment to provide qualitative data. The treatment group showed significant improvement in key domains of observed social behavior in a natural setting compared to the clinical control group. Parents and children in the SCIP condition reported multiple positive changes in social functioning. These findings provide preliminary support for the use of a creative drama program for children with social competence deficits related to social perception problems.     

Production and integrated training of adjectives in three individuals with nonfluent aphasia

Background: Current research in theoretical linguistics, experimental psychology, and clinical aphasiology suggests that adjective training may facilitate unique aspects of language production and functional communication in persons with aphasia. Although considerable research has been devoted to treatments targeting nouns and verbs, there has been relatively little treatment research directed towards adjectives.

Aims: The goal of this study was to further investigate the viability of adjective training in aphasia by applying an integrated treatment approach targeting adjective production in the context of single word, sentence, and discourse levels of communication. Specific objectives were to quantify baseline adjective production, acquisition of target structures, and treatment generalisation effects.

Method: A single-participant multiple-baseline design was used to evaluate treatment effects in three individuals with nonfluent chronic aphasia. A battery of experimental measures and standardised tests was also administered pre- and post-treatment to assess baseline performance and generalisation effects extending to adjectives, other parts of speech, sentence processing, and discourse production.

Outcomes & Results: Two of the three participants acquired the target structures and maintained criterion performance levels 1 month after treatment. In spite of differences in baseline performance and responsiveness to treatment, all three participants demonstrated significant gains on standardised measures of language production.

Conclusions: Findings add to existing literature supporting the viability of adjective training for individuals with aphasia. Participant characteristics and treatment factors that may contribute to variable outcomes are also discussed.