Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high.

Intoxication by Karwinskia humboldtiana (buckthorn) fruit presents a neurological picture similar to that of Guillain-Barré syndrome. In this report, we describe an experimental animal model of peripheral neuropathy induced by buckthorn fruit. Four groups of Wistar rats received one oral dose of 1.5 g/kg followed by oral doses of 0.5 g/kg at days 3, 7, 10, and 14 of dried and ground buckthorn fruit in aqueous suspension. Rats were sacrificed at 24, 48, 58, and 112 days after initial dose. Treated animals developed progressive paralysis through 58 days, then completely recovered by 112 days. Sciatic nerves showed segmental demyelination and cellular infiltrates until 58 days after exposure and then remyelinating changes at 112 days. This experimental model for peripheral neuropathy is reproducible and easy to handle. Its manipulation is relatively innocuous and allows us to study reversible peripheral nerve damage. This model can be developed in other animal species and may be useful to test new therapies for peripheral neuropathy.

Chronic Budd-Chiari syndrome can present with cirrhosis and signs and symptoms similar to those of other chronic liver diseases. We present a case of Budd-Chiari syndrome discovered during attempted transjugular intrahepatic portosystemic shunting in a patient with decompensated cirrhosis believed to be secondary to hepatitis C. Although the patient had hepatocellular carcinoma, the Budd-Chiari syndrome was a primary disease due to hepatic venous webs. Angioplasty was performed in this case, which resolved the patient's symptoms related to portal hypertension. Follow-up venography 5 months after angioplasty demonstrated continued patency of the hepatic veins. A biopsy was obtained in the same setting, which showed centrilobular fibrosis indicating that venous occlusion was indeed the cause of cirrhosis. It is important to consider a second disease when treating a patient with difficult to manage portal hypertension.

We report on identical traumatic injuries in a pair of monozygotic (identical) twins treated at the same unit, one year apart. Both had sustained a complete tear of the patellar tendon and were treated surgically.

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Background: High rates of orthopaedic injury in Uganda place large burdens on its few orthopaedic surgeons.Although "task-shifting" of procedures to other providers is practiced, its specific role in orthopaedic surgical care is not well documented. The current study assessed the prevalence of orthopaedic task-shifting, and its impact on time-to-surgery, at the Mbarara Regional Referral Hospital (MRRH) in Western Uganda. Methods: A retrospective cohort study was conducted. All orthopaedic cases recorded in the MRRH operating theatre logbook were analyzed (October 2018 to July 2019). Surgical indication, type of procedure, and operator were recorded. Permanent hospital records, when available, were used to verify logbook data and identify the initial date of hospital admission for each patient. Results: There were 203 patients who received orthopaedic surgery during the study period, with 159 having hospital admission dates. The single orthopaedist at MRRH performed the majority of orthopaedic procedures (61.6% of cases). Significant task-shifting was seen, both to other physicians (33% of cases) and orthopedic clinical officers (5.4%). The orthopaedist performed most hardware implantation procedures (80.8%), while other practitioners performed the majority of trauma cases, particularly conservative fracture management (92.7%). Overall, the average time from admission to surgery was longer for orthopaedists (11.2 days) than for other providers (4.2 days, p<0.001). Conclusions: The current study demonstrates high utilization of orthopaedic task-shifting, and its associated decreased time-to-surgery, at MRRH. This reinforces the role of task-shifting in resource-limited settings. Furthermore, it highlights the importance of continued training of non-orthopaedic providers in foundational orthopaedic surgical principles.

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Perioperative services play a critical role in preparing specimens from the operating room for laboratory and surgical pathology evaluation. This preanalytical process must be handled appropriately as the quality of evaluation is often dependent upon the quality of material submitted. Furthermore certain specimens require special handling for evaluation. Despite these facts, there is usually limited interdepartmental training and communication between the pathology department and perioperative services regarding specimen handling. It is hypothesized that specific training from the pathology department will lead to improved specimen handling. To test this hypothesis a 1-hour presentation was given to the staff of perioperative services introducing the pathology department, outlining the tissue processing procedure and discussing specimen handling techniques. A short test covering proper specimen handling techniques was administered to each employee prior to and immediately following the presentation. Students rotating in perioperative services were not included for evaluation. In total 59 employees completed the pre-test with 45 of those completing the post-test. The mean test score prior to completing the presentation was 1.83 (46%) while the mean test score after completion of the presentation was 3.84 (96%). A t test was completed and there was a significant difference between the two scores t(102)= -11.62; P < .5. Perioperative services play an important role in the pre-analytical phase of specimen evaluation. However, practical training from pathology is not common for these professionals. This project found a significant difference in knowledge of specimen handling after a 1-hour presentation targeting these skills. This suggests that practical training modules for perioperative services staff have the potential to improve patient care through better understanding of the importance of specimen handling to the success of laboratory testing. Future projects could examine the effect of similar presentations to other clinical departments regarding topics such as blood utilization and laboratory testing.