Clavicular fractures are some of the most common bone injuries in the paediatric population, yet the rates of nonunion are very low under 18 years. To the best of our knowledge, posttraumatic nonunion of the clavicle in a paediatric population is rarely reported. We report the case of an 11-year-old girl who presented with a nondislocated fracture of the midshaft to the proximal third of the right clavicle. Initial conservative treatment by sling immobilization demonstrated radiologically confirmed healing at 3 months. However, at 1-year follow-up, she presented with painful nonunion. Diagnostic MRI and CT exams confirmed a pseudoarthrosis, requiring elective open reduction and internal fixation with the aid of an ipsilateral iliac crest bone graft.
An atypical case of primary ciliary dyskinesia is presented in which the inheritance, rather than the classical autosomal recessive, appears to be transmitted as an autosomal dominant trait through the maternal line. The case involves two brothers of 29 and 30 years of age, married without children, with a history of infertility, frequent episodes of sinusitis, and recurrent pulmonary infections. Their mother and sister have chronic bronchopathy of unknown etiology. Their father is healthy without pulmonary problems or sinusitis. At physical exam, both brothers, sister and mother presented with bronchial rhonchi at lung auscultation. Blood analysis and pulmonary function, liver and renal tests were all normal. The ultraestructual study of the sperm flagellum by electron microscopy revealed that both brothers have the same anomaly. Namely, in the majority of the cross-sections, both dynein arms are missing. The nexin filament was present, as well as the radial spokes and the central pair of microtubules. In some sperm, besides the absence of dynein arms, there was also absence of the central pair of microtubules. Neither anomalies of the fibrous sheath nor of the dense fibers were found. In approximately 50% of the spermatozoa, the midpiece had a decreased number of mitochondria and extra non-aligned mitochondria. Other findings included extra peripheral microtubules in the axoneme.
Background:
Inadequate BP control leads to excess cardiovascular disease risk (CVD), especially in underserved communities. Patient-centered care tools including home monitoring of BP are key components in BP control and CVD risk reduction. We compared two communication methods to modify CVD risk in hypertensive patients. We also tested whether either strategy is more effective in stage I or II hypertension.
Methods:
388 asymptomatic subjects (59% white, 37% AA) with Framingham risk score >10% from one urban and one rural center completed our trial. 37% had StageI HTN (SBP 140-159 mmHg), and 24% StageII HTN (SBP≥160 mmHg). Subjects were randomized to nurse management (NM) with 4 visits/year, or nurse management plus Telemedicine (T). T group reported weight, BP, steps/day at least weekly via internet (average 6.3 reports/month). Periodic summaries were sent to patients and to their care providers
Results:
BP decreased substantially in both groups, with a significant difference in BP reduction between NM and T in patients with stageI HTN (P=0.037-see graph). T had a lower 8 month average BP compared to NM (T: 134.6 ± 15.0, NM: 140.4±16.9 mmHg, P<0.02). StageII HTN patients had significant reduction in BP with no difference between NM and T (P=.900). Risk score was reduced by 2.6±6.8% (P< 0.001), with no difference between NM and T (P=0.750)
Conclusion:
Telemedicine improved BP control in patients with StageI HTN more than with StageII HTN. It appears that SBP ≥160 is more likely to be immediately treated by care providers than SBP in the (140-159) range. StageI patients, therefore, had greater benefit from Telemedicine as it stimulated a more effective intervention by their care providers.
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