Is vitamin K2 a treatment choice for atypical femoral fractures in patients with secondary osteoporosis?

An atypical femoral fracture (AFF) is a rare complication associated with excessive inhibition of osteoclast expression during treatment of osteoporosis. We herein describe a patient who had been treated with alendronate for more than 10 years and subsequently developed an AFF that healed after treatment with vitamin K2 (VK2). We also discuss the potential beneficial effects of VK2 on the healing of AFFs. A 48-year-old Asian man with secondary osteoporosis was treated with alendronate for more than 10 years. The patient underwent surgical treatment for a complete AFF of the right femur. Six months postoperatively, he complained of pain in his left thigh. X-ray examination revealed an incomplete AFF of the left femoral shaft. He was then treated with VK2. After 4 months of VK2 treatment, the patient reported that the pain in his left thigh had decreased, and follow-up X-ray examination demonstrated healing of the left AFF line. This case report indicates that VK2 may be a potential direction for pharmacological treatment of AFFs in future research.

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Violation of consolidation of the femur after untimely dynamization of the intramedullary blocking rod

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872021169-72 ◽

2021 ◽

pp. 69-72

Author(s):

Diomyd Chabanenko ◽

Oleksandr Polіvoda

Keyword(s):

Femoral Fracture ◽

Distal Part ◽

Weight Bearing ◽

Femoral Fractures ◽

Femoral Shaft ◽

Joint Control ◽

Posterior View ◽

Intramedullary Osteosynthesis ◽

Fracture Consolidation ◽

The Right

Violation of femoral fracture consolidation after blocking intramedullary osteosynthesis is a fairly common pathology, and requires the attention of physicians due to its prevalence. There are several reasons for this complication: it is the instability in the system «bone-implant», and the untimely dynamization of the locking nail. Methods. This article presents a case of fracture violated consolidation after blocking intramedullary osteosynthesis caused a nonunion due to nail failure. Results. Patient was injured on 29.12.2018, as a result of a traffic accident. 01.15.2019, the surgery was performed: closed reduction, blocking intramedullary osteosynthesis of the fracture of the middle shaft of the right thigh, static fixation of the nail. Next visit to the clinic was on 02.01.2020, because of pain in the middle third of the thigh, problems with axial weight-bearing on the right leg, limitation of the flexion in the right knee joint. Control radiographs demonstrated no signs of consolidation of the femoral shaft fracture, and migration of the distal locking screw. 08.01.2020 revision surgical treatment was performed. Given the presence of 5 mutually perpendicular holes in the distal part of the nail, two of them were locked in the anterio-posterior view by the free hand method, the migrated screw in the distal part of the nail was replaced, and the nail was dynamized in the proximal part taking into account its design features. Conclusions. To normalize the consolidation processes in patients with nonunion femoral fractures, bone physiology and the positive effect of autocompression should be considered. The described case demonstrates the necessity for timely dynamization of the blocking nail, which confirms our own observations and literature data. Despite the fact that the dynamization of the nail was performed 1 year after blocking intramedullary osteosynthesis, fracture consolidation occurred 5 months after its implementation. Key words. Femoral fracture, blocked intramedullary osteosynthesis, disorders consolidation, dynamization of the construction.

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Clavicular Metastasis as an Initial Presentation of Papillary Thyroid Cancer

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1808 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A885-A886

Author(s):

Russell K Fung ◽

Madeline Fasen ◽

Firas Warda ◽

Patrick Natter ◽

Stacey Nedrud ◽

...

Keyword(s):

Thyroid Cancer ◽

Soft Tissue ◽

Bone Metastases ◽

Papillary Thyroid Cancer ◽

Papillary Thyroid ◽

Thyroid Malignancy ◽

Fine Needle ◽

X Ray ◽

Patient Reported ◽

The Right

Abstract Background: Papillary thyroid cancer (PTC) metastases to the clavicular bone is rare. While the lung is considered the most common site of metastases from thyroid malignancy, osseous metastases, if seen, are usually observed at sites such as humerus, pelvis, radius, and scapula. Clinical Case: A 44-year-old man presented with an enlarging right neck mass for six months after light trauma to that area. Other than mild pain in the described area, the patient reported 20 lbs of weight loss. Initial x-ray revealed a large soft tissue density mass that extended to the midline of the right proximal clavicle. Soft-tissue neck ultrasound noted a 5.4 x 3.6 cm mass extending from the thyroid with findings of increased vascularity and calcification. CT scan of the neck depicted the extension of the mass into the adjacent sternoclavicular junction with osteolysis of the middle third of the clavicle as well as the superior aspect of the sternal body. A fine needle aspiration of the mass revealed thyroid neoplasm with follicular features and positive immunostaining consistent with thyroid carcinoma. Chest CT showed invasion into the right proximal clavicle, tracheal deviation and extension into the mediastinum. The patient underwent a composite resection of the tumor, including a segmental osteotomy of approximately two-thirds of the medial clavicle. Post surgically the patient’s serum calcium was low at 7.9 mg/dL with a concurrently low PTH of 9 pg/mL and a low 25-hydroxyvitamin D of 16.8 ng/mL. Thyroglobulin was markedly high at 15655.0 ng/mL (confirmed on dilution), and thyroglobulin antibody < 1.0 IU/mL. Pathology report confirmed PTC with extra-thyroidal extension and involvement of clavicle (staged pT4a pN0), however margins and lymph nodes were negative for carcinoma with further genomic findings showing positive KRAS mutation. The patient’s post-operative course was complicated by a large expanding left neck hematoma after a fall; he was immediately readmitted with the hematoma subsequently safely evacuated. Levothyroxine has been held at this time with plans for radioactive iodine treatment eight weeks after surgery. Conclusion: Bone metastases from differentiated thyroid cancer is rare, especially clavicular metastasis arising from PTC. Bone scintigraphy, x-ray and fine needle biopsy are some of the widely utilized methods employed in the evaluation of bone metastasis in the setting of thyroid malignancy. The prospect of recovery is generally favorable in cases of bone metastases, however various factors can affect prognosis and long-term outcomes. Reference: Krishnamurthy A. Clavicle metastasis from carcinoma thyroid- an atypical skeletal event and a management dilemma. Indian J Surg Oncol. 2015;6(3):267-270. doi:10.1007/s13193-015-0387-y

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Misplacement of Tracheostomy Tube in the Right Main Bronchus: a Rare Complication

Case Reports in Surgery ◽

10.1155/2020/3597901 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Armin Amirian ◽

Reza Shahriarirad ◽

Bizhan Ziaian ◽

Parviz Mardani ◽

Amirhossein Erfani

Keyword(s):

Squamous Cell Carcinoma ◽

Tracheostomy Tube ◽

Pressure Effect ◽

Main Bronchus ◽

Rare Complication ◽

Fiberoptic Bronchoscopy ◽

X Ray ◽

Metastatic Squamous Cell Carcinoma ◽

Chest X Ray ◽

The Right

A 38-year-old woman known case of metastatic squamous cell carcinoma of the cervical esophagus due to increasing dyspnea and stridor attributed to the pressure effect of the primary mass was scheduled for tracheostomy, which ended up in the right main bronchus. This rare complication occurred using a tracheostomy tube number 7.5 via a vertical tracheotomy over 4th and 5th tracheal rings. The misplacement was confirmed by chest X-ray and fiberoptic bronchoscopy, and the tracheostomy tube was successfully repositioned in a nonoperative approach.

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A rare complication of ventriculoperitoneal shunt: Pleural effusion without intrathoracic ventriculoperitoneal shunt catheter

Surgical Neurology International ◽

10.25259/sni_57_2020 ◽

2020 ◽

Vol 11 ◽

pp. 291

Author(s):

Said Hilmani ◽

Tarek Mesbahi ◽

Abderrahman Bouaggad ◽

Abdelhakim Lakhdar

Keyword(s):

Pleural Effusion ◽

Ventriculoperitoneal Shunt ◽

Rare Complication ◽

Peritoneal Catheter ◽

X Ray ◽

Thoracic Drainage ◽

Repeat Chest ◽

Chest X Ray ◽

The Right ◽

Catheter Replacement

Background: Symptomatic pleural effusion following ventriculoperitoneal shunt (VPS) insertion is very rare and poorly understood in the literature in contrary to other mechanical complications. Case Description: We report a case of 15 month-year-old girl who had VP shunt for congenital hydrocephalus. Twelve months after surgery, she was diagnosed with massive hydrothorax. Chest X-ray and thoracoabdominal CT scan confirmed the right pleurisy and showed the tip of the peritoneal catheter in the general peritoneal cavity. We made thoracic drainage of the transudative pleural effusion. When we released the chest tube, 24 h after, the girl showed a respiratory distress again and the effusion resumed at the X-ray control. Her symptoms abated after the realization of a ventriculoatrial shunt “VAS.” Repeat chest X-ray confirmed the resolution of the hydrothorax. Conclusion: Despite the not yet well-understood mechanism of this rare and important VPS complication, management is simple based on X-ray confirmation, thoracentesis with biological analysis, and catheter replacement, especially in atrium “VAS.”

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Spontaneous fetal femoral fracture: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060517744923 ◽

2018 ◽

Vol 46 (3) ◽

pp. 1282-1287 ◽

Cited By ~ 1

Author(s):

Mingming Yu ◽

Dapeng Xu ◽

Aiguo Zhang ◽

Jun Shen

Keyword(s):

Case Report ◽

Caesarean Section ◽

Femoral Fracture ◽

Femoral Fractures ◽

Timely Manner ◽

Left Femur ◽

X Ray ◽

Clinical Presentations ◽

The Right

Spontaneous fetal femoral fractures are uncommon in the paediatric setting. The major clinical presentations of a spontaneous fetal femoral fracture are femoral angulation, shortness of the femur and even a marked fracture line. This case report describes a spontaneous fetal femoral fracture of the right femur, which was detected by routine ultrasonography during the 19th week of gestation in a 24-year-old woman. On routine follow-up visits, the angulation of the right femur in the fetus gradually improved. A caesarean section was undertaken at 39 weeks +5 days of gestation and an X-ray was taken on the second day after birth, which showed that the fracture had healed and the callus had been absorbed. The lengths of the two femurs of the baby were not equal; the right femur was 84 mm, which was 11 mm shorter than the left femur. In cases like this, postnatal follow-up is essential so that an operation can be carried out in a timely manner when the deformity is apparent.

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A rare lethal complication of larynxopharynx injuries by a foreign body

Kazan medical journal ◽

10.17816/kmj2020-570 ◽

2020 ◽

Vol 101 (4) ◽

pp. 570-573

Author(s):

A V Fedin ◽

V S Poyarkova ◽

L A Aschina ◽

N A Shkurova

Keyword(s):

Cause Of Death ◽

Foreign Bodies ◽

Clinical Observation ◽

Scientific Literature ◽

Pulmonary Thromboembolism ◽

Rare Complication ◽

External Jugular Vein ◽

X Ray ◽

Sharp Edges ◽

The Right

A lethal complication of laryngopharynx injuries by foreign bodies is a rare phenomenon. Among foreign bodies are ingested together with food, fishbones are the most common. They can injure the mucous membrane of the larynx and pharynx due to the sharp edges, thereby causing inflammation, resulting in edema occurs, hyperemia and increased pain. Besides, foreign bodies can provoke complications such as bleeding, cervical phlegmon, subcutaneous emphysema, esophageal perforation, sepsis and others, which can lead to the death of patients. However, due to timely diagnosis, according to the scientific literature, such cases are extremely rare. Because the visualization of foreign bodies in the area of the larynx is difficult (especially when localized in the pyriform sinuses), laryngoscopy is used for diagnosis. Moreover, in some cases, X-ray examination and computed tomography are indicated. The paper presents a clinical observation of a 57-year-old patient M., whose cause of death was a rare complication of laryngopharynx injuries with a fishbone. When the patient was admitted to the department, the basic clinical diagnosis was established: laryngopharyngeal injury complicated by right parapharyngeal abscess. The patient underwent antibacterial, infusion, anti-inflammatory and antihypertensive therapy. At 20 hours after hospital admission, the patient had an abrupt loss of consciousness and cardiac arrest, then death. Based on the clinical picture, it was concluded that pulmonary thromboembolism was the probable cause of death. The autopsy revealed injury of the right external jugular vein, as a result of which develop thrombophlebitis, and then pulmonary artery thromboembolism, which caused the patient's death. No similar clinical descriptions were found in the available scientific literature.

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Craniocerebral gunshot injury bullet migration to the cardiac right ventricle

Surgical Neurology International ◽

10.25259/sni_221_2021 ◽

2021 ◽

Vol 12 ◽

pp. 491

Author(s):

Taylor Duda ◽

Euan Zhang ◽

Kesava Reddy

Keyword(s):

Rare Complication ◽

Clinical Status ◽

Paradoxical Embolism ◽

High Rate ◽

X Ray ◽

Cardiac Ventricle ◽

Slow Velocity ◽

Close Range ◽

Chest X Ray ◽

The Right

Background: Missile embolism is the process of slow velocity projectiles penetrating into vascular spaces followed by arterial, venous, or paradoxical embolism of the fragments. This is a rare complication in craniocerebral gunshot injuries (CGI), with only five other cases previously published demonstrating pulmonary or arterial emboli from these injuries. There is a high rate of mortality from these injuries. Case Description: A patient presented with a CGI from an occipital trajectory, causing penetrating fragments into the venous sinus system. The weapon was a Glock Model 17M 9 mm with a hollow-point bullet, fired close range. Initial chest X-ray demonstrated only atelectasis. After stabilization, 18 min from the initial chest X-ray, subsequent computed tomography (CT) imaging demonstrated extensive intracranial injuries and fragmentation of the bullet with the expected devastating intracranial injuries. Unexpectedly, chest CT revealed metallic fragments in the right cardiac ventricle which was redemonstrated on follow-up chest X-ray. Unfortunately, his extensive intracranial injuries and poor clinical status were nonsurvivable, and thus the family elected to discontinue supportive measures. Conclusion: This case demonstrates radiographic imaging of a metallic intravascular fragment from CGI through presumed transvenous mechanisms. The imaging provides a consistent timeline demonstrating migration can occur in the acute phase. This study additionally supports the presumed mechanism for pulmonary of migration through the right heart. Fragment embolization should be considered in cases of acute deterioration in this patient population.

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Low temperature x-ray microanalysis of frozen-hydrated tobacco leaves

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100111537 ◽

1984 ◽

Vol 42 ◽

pp. 284-285

Author(s):

S. Edith Taylor ◽

Patrick Echlin ◽

May McKoon ◽

Thomas L. Hayes

Keyword(s):

Low Temperature ◽

Lemna Minor ◽

Root Tips ◽

Tobacco Leaves ◽

X Ray ◽

Whole Cells ◽

Carbon Coated ◽

The Right ◽

Beam Currents ◽

The University

Low temperature x-ray microanalysis (LTXM) of solid biological materials has been documented for Lemna minor L. root tips. This discussion will be limited to a demonstration of LTXM for measuring relative elemental distributions of P,S,Cl and K species within whole cells of tobacco leaves.Mature Wisconsin-38 tobacco was grown in the greenhouse at the University of California, Berkeley and picked daily from the mid-stalk position (leaf #9). The tissue was excised from the right of the mid rib and rapidly frozen in liquid nitrogen slush. It was then placed into an Amray biochamber and maintained at 103K. Fracture faces of the tissue were prepared and carbon-coated in the biochamber. The prepared sample was transferred from the biochamber to the Amray 1000A SEM equipped with a cold stage to maintain low temperatures at 103K. Analyses were performed using a tungsten source with accelerating voltages of 17.5 to 20 KV and beam currents from 1-2nA.

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CLINICAL CASE OF A MALIGNANT PECOMA OF THE LUNG

Problems in oncology ◽

10.37469/0507-3758-2019-65-5-756-759 ◽

2019 ◽

Vol 65 (5) ◽

pp. 756-759

Author(s):

Mikhail Postolov ◽

Nadezhda Kovalenko ◽

K. Babina ◽

Stanislav Panin ◽

Yelena Levchenko ◽

...

Keyword(s):

Good Condition ◽

Lung Neoplasm ◽

Rare Condition ◽

Epithelioid Cell ◽

X Ray ◽

Perivascular Epithelioid Cell ◽

Mesenchymal Neoplasm ◽

Preoperative Ct ◽

Lymph Duct ◽

The Right

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm characterized by expression of both mela-nocytic and smooth muscle markers. Only 10 primary malignant lung PEComas have been reported up to date. We report a 59-year-old male who presented with a lung neoplasm, found during the routine X-ray examination. Preoperative CT-scan revealed the 3,5-cm-sized mass, located at the border of the upper, middle and lower lobes of the right lung. Patient underwent a thoracotomy, resection of the upper, middle and lower lobes of the right lung accompanied with mediastinal lymphadenectomy. After surgery, chylothorax was revealed. Conservative treatment was unsuccessful, so we performed laparoscopic clipping of the thoracic lymph duct. Patient was dismissed from hospital on the 10-th day after the second operation in good condition. In this report, we intend to increase the limited knowledge relating to natural history and optimal treatment of such a rare condition as a primary malignant lung PEComa.

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Transferrin-Conjugated Nanocarriers as Active-Targeted Drug Delivery Platforms for Cancer Therapy

Current Pharmaceutical Design ◽

10.2174/1381612822666161026162347 ◽

2017 ◽

Vol 23 (3) ◽

pp. 454-466 ◽

Cited By ~ 16

Author(s):

Daniele R. Nogueira-Librelotto ◽

Cristiane F. Codevilla ◽

Ammad Farooqi ◽

Clarice M. B. Rolim

Keyword(s):

Drug Delivery ◽

Cancer Therapy ◽

Tumor Cells ◽

Therapeutic Benefit ◽

Active Targeting ◽

Future Research ◽

Passive Targeting ◽

The Right ◽

Review Current ◽

Target Effects

A lot of effort has been devoted to achieving active targeting for cancer therapy in order to reach the right cells. Hence, increasingly it is being realized that active-targeted nanocarriers notably reduce off-target effects, mainly because of targeted localization in tumors and active cellular uptake. In this context, by taking advantage of the overexpression of transferrin receptors on the surface of tumor cells, transferrin-conjugated nanodevices have been designed, in hope that the biomarker grafting would help to maximize the therapeutic benefit and to minimize the side effects. Notably, active targeting nanoparticles have shown improved therapeutic performances in different tumor models as compared to their passive targeting counterparts. In this review, current development of nano-based devices conjugated with transferrin for active tumor-targeting drug delivery are highlighted and discussed. The main objective of this review is to provide a summary of the vast types of nanomaterials that have been used to deliver different chemotherapeutics into tumor cells, and to ultimately evaluate the progression on the strategies for cancer therapy in view of the future research.

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