Cureus最新文献

{"title":"A Literature Review on Whether Immobilization of the Shoulder in External Rotation Improves Healing and Prevents the Recurrence of Acute Shoulder Dislocations.","authors":"Yasmin H Kazim","doi":"10.7759/cureus.80713","DOIUrl":"https://doi.org/10.7759/cureus.80713","url":null,"abstract":"<p><p>Shoulder dislocations are one of the most frequent joint dislocations, with recurrent dislocations being a common complication. Common practice is to immobilize the shoulder in internal rotation for two to three weeks following closed reduction. However, recent literature suggests immobilization in external rotation can be an alternative management strategy. External rotation braces have been manufactured over the years to support and maintain this position. This literature review aims to gather current evidence on the conservative management of primary traumatic anterior shoulder dislocations and compare the immobilization of the shoulder joint in internal and external rotation. A literature search and review was performed using PubMed and Google Scholar. Key phrases and words that were used in the search engines included \"shoulder immobilization\" AND \"external rotation\", \"anterior shoulder dislocation immobilization\" AND \"external rotation\", \"reduced recurrence rate of shoulder dislocation\" AND \"external rotation\", \"external rotation immobilization\" AND \"Bankart lesion\" and \"internal versus external rotation\" AND \"shoulder dislocation\". The reviewed articles included were dated from 2014 to 2024 but additional valuable studies dating earlier than 2014 were also included to provide a foundation of understanding to this review. Included were nine clinical studies and randomized controlled trials, three cadaveric studies, eight studies focusing on magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) or arthroscopy, and seven systematic reviews and meta-analyses. Research revealed improved coaptation of the labrum on the glenoid rim in external rotation not only in cadavers but also in patients with the aid of various imaging techniques. However, these findings were not consistently observed when translated into clinical trials. Based on the available data presented in this literature review, there remains a deficiency in evidence to exclusively support the use of external rotation immobilization over conventional internal rotation immobilization after primary traumatic anterior shoulder dislocations. External rotation immobilization may benefit a specific population, particularly those that fall in the 20-40-year-old age group, with a specific injury pattern, such as Bankart lesions and greater tuberosity fractures; therefore, further studies are required to determine who will benefit the most from such interventions.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80713"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Dangers: The Growing Vulnerability of Older Adults in Fatal Road Traffic Accidents.","authors":"Stefania Ungureanu, Camelia-Oana Muresan, Veronica Ciocan, Raluca Dumache, Emanuela Stan, Georgiana-Denisa Gavrilita, Alexandra Enache","doi":"10.7759/cureus.80712","DOIUrl":"https://doi.org/10.7759/cureus.80712","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults represent a growing and vulnerable road user group. Our aim was to develop targeted interventions and preventive measures for decreasing road deaths in older adults by establishing the circumstances and the characteristics leading to such fatalities with regard to each type of road user.</p><p><strong>Materials and methods: </strong>Medico-legal autopsy records of victims of road traffic accidents from Timișoara Institute of Legal Medicine (TILM), Romania, in a five-year period (2017-2021) were analyzed. Data was retrieved and grouped according to the victims' demographics (age and gender), date of the accident, type of road user (driver, passenger, pedestrian, cyclist), and traumatic injuries. Moreover, data from the traffic police reports regarding additional circumstances of the crash were retrieved.</p><p><strong>Results: </strong>A total of 51 medico-legal autopsies involving older adults (aged above 70 years) were performed at TILM in 2017-2021. Regarding the type of road user, pedestrians were the most affected group among older adults (n=17), followed by cyclists (n=13), passengers (n=11), and drivers (n=10). Most cases (n=9) occurred when the victims were hit by a car behind them. The second most seen circumstance that led to fatally injured older victims was represented by being hit by a moving vehicle while crossing the street outside of a marked crosswalk (n=7).</p><p><strong>Conclusion: </strong>Our findings illustrate the need to focus on road fatalities among older adults, as these tragic events affect this vulnerable group. Unfortunately, less attention has been given to the severity and significance of these incidents. Preventive campaigns focusing on road user education, safe driving, safe walking and the implementation of facile public transport or improved pedestrian crossings should be the key points.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80712"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Genetic Counseling Before and After the Birth of Children With Joubert Syndrome and Beckwith-Wiedemann Syndrome.","authors":"Yuri Hasegawa, Shoko Miura, Masayo Kagami, Sumito Dateki, Kiyonori Miura","doi":"10.7759/cureus.80677","DOIUrl":"https://doi.org/10.7759/cureus.80677","url":null,"abstract":"<p><p>The patient was a second child prenatally diagnosed with Joubert syndrome (JS) by ultrasound examination and family history of a first child with JS. After birth, the patient was also diagnosed with Beckwith-Wiedemann syndrome. Here, we report this case as a lesson on the importance of focusing on diagnosing the first hereditary disease and also considering the possibility of the development of a second genetic disease when providing treatment. We were able to confirm the diagnosis of both syndromes by detailed genetic testing after birth, allowing genetic counseling for future treatment and the next pregnancy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80677"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hindu Spiritual Music for Perioperative Anxiolysis and Stress Modulation: An Open-Label, Randomized Comparative Trial in Lower Limb Surgery Patients.","authors":"Anshul Jain, Brijendra Verma, Pankaj Saunakiya, Saurabh Agarwal, Pushpendra Agarwal, Paras Gupta, Charu Thakur","doi":"10.7759/cureus.80642","DOIUrl":"https://doi.org/10.7759/cureus.80642","url":null,"abstract":"<p><p>Background Perioperative anxiety is a common concern in patients undergoing regional anesthesia, as they remain conscious during surgery. Various non-pharmacological interventions, including music therapy, have been explored to reduce anxiety and stress response. Spiritual interventions, particularly religious music, have been shown to provide emotional stability and enhance coping mechanisms during stressful situations. Objective This study aimed to evaluate the impact of Hindu religious music compared to patient-selected instrumental music on intraoperative anxiety, stress response, and patient satisfaction in individuals undergoing lower limb surgery under regional anesthesia. Methods This prospective, open-label, randomized controlled trial was conducted at Maharani Laxmi Bai Medical College, a tertiary care teaching hospital in Jhansi, India, after obtaining approval from the Institutional Ethics Committee (Certificate No. 5208/IEC/I/2022-2023) and registration with the Clinical Trials Registry of India (CTRI/2024/01/062006, registered on January 30, 2024). The trial included 150 ASA class 1 or 2 patients undergoing elective lower limb surgery under regional anesthesia. Participants were randomly assigned to two groups: Group A (Hindu spiritual music) and Group B (patient-preferred instrumental music). Music was played intraoperatively via noise-canceling headphones. The primary outcomes were intraoperative anxiety (measured using the Visual Analog Scale for Anxiety (VAS-A)) and serum cortisol levels as a biochemical marker of stress. Secondary outcomes included hemodynamic parameters, additional analgesic requirements, incidence of nausea and vomiting, and patient satisfaction. Results Group A had significantly lower intraoperative VAS-A scores compared to Group B (2.13 ± 0.91 vs. 3.41 ± 1.12; p = 0.01). Serum cortisol levels were also significantly lower in Group A at the end of surgery (28.54 ± 6.11 vs. 32.50 ± 8.82 µg/dL; p = 0.001) and remained lower on the first postoperative day (p = 0.001). The incidence of postoperative nausea and vomiting was significantly lower in Group A (6.8% vs. 17.5%; p = 0.028). Patient satisfaction was also higher in the Hindu spiritual music group (p = 0.03). Conclusion Hindu spiritual music reduced perioperative anxiety, attenuated the stress response, and decreased postoperative nausea and vomiting compared to non-spiritual instrumental music. It should be considered a non-pharmacological intervention in the perioperative period to alleviate anxiety and improve patient comfort. However, the study's findings may have limited generalizability to non-Hindu patients. Future research should explore whether similar benefits are observed in religious individuals listening to music of their own faith and cultural background.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80642"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive Uropathy Secondary to Accidental Ureteric Placement of an Indwelling Urinary Catheter at the Time of Caesarean Section: A Case Report.","authors":"Sara E Hariz, Priti Pradhan","doi":"10.7759/cureus.80674","DOIUrl":"https://doi.org/10.7759/cureus.80674","url":null,"abstract":"<p><p>This case describes a rare complication of Foley catheter insertion where accidental instrumentation of a ureter occurred at the time of caesarean section with the subsequent development of bladder obstruction and acute kidney injury. Rapid identification and management can minimise the associated long-term implications; this therefore necessitates greater awareness of this possible complication. The current understanding of this condition recognises neurogenic bladder and female sex as risk factors; however, physiological changes in pregnancy may also act as a significant risk factor for this complication.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80674"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Approach in Management of Acute Appendicitis Within a De Garengeot Hernia: A Case Report.","authors":"Suanne C MacConnell, Joel D Stein","doi":"10.7759/cureus.80669","DOIUrl":"https://doi.org/10.7759/cureus.80669","url":null,"abstract":"<p><p>De Garengeot hernias are rare surgical occurrences and even more so when the histopathology reveals acute appendicitis. Varying approaches are documented with regards to open versus laparoscopic and the use of mesh. This case demonstrates the successful use of an open high McEvedy approach with primary suture closure in an elderly female who presented with an acute history of a right groin lump, right iliac fossa pain, nausea and fever.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80669"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Old Gustilo-Anderson Type IIIB Open Tibial Fractures With Medial Gastrocnemius or Combined Medial Gastrocnemius-Hemisoleus Flaps.","authors":"Rajib Sarkar, Samriddhi Sarkar, Sayantika Sarkar, Atanu Pramanik, Ujjwal Singh, Sanjay Roy","doi":"10.7759/cureus.80687","DOIUrl":"https://doi.org/10.7759/cureus.80687","url":null,"abstract":"<p><p>Introduction  Old Gustilo-Anderson Type IIIB open tibial fractures presenting one to three months post-primary management with deep infection, superinfection, and inadequate soft tissue coverage pose significant treatment challenges. This study evaluates the outcomes of medial gastrocnemius or combined medial gastrocnemius-hemisoleus flaps in managing these old injuries, along with adjuvant orthopaedic (orthoplastic) procedures. Methods  A retrospective review was conducted on 15 cases involving fractures of the middle third of the tibia. These patients had initially undergone debridement and external fixation as primary management and presented one to three months post-injury. Management involved infection control through daily irrigation and debridement. In the definitive stage, revision of external fixation was performed along with decortication of the exposed tibia, bone grafting, and local muscle flap coverage.  Results  All fractures achieved union with complete infection eradication and durable soft tissue coverage, enabling full functional recovery with normal gait and strength. All patients returned to their pre-injury functional status and occupations.  Discussion Old Type IIIB fractures are underreported. This study highlights the role of staged infection control, decortication of the exposed tibia, bone grafting, revision of external fixation, and local muscle flap coverage in promoting bone healing, soft tissue restoration, and eradication of infection leading to satisfactory functional outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80687"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scapulothoracic Dissociation Following a Fall From Standing Height: A Rare and Atypical Presentation of Severe Shoulder Girdle Injury.","authors":"Dimitrios Giotis, Christos Konstantinidis, Christos Koukos, Dimitrios Vardakas, Sotiris Plakoutsis","doi":"10.7759/cureus.80652","DOIUrl":"https://doi.org/10.7759/cureus.80652","url":null,"abstract":"<p><p>Scapulothoracic dissociation (SD) is a rare and severe injury, typically associated with high-energy trauma. It is characterized by scapular displacement, often leading to neurovascular compromise. SD resulting from low-energy mechanisms, such as a fall from standing height, is exceptionally rare. We present the case of a 93-year-old male who sustained SD after a fall from standing height. He was hemodynamically unstable upon arrival, with progressive neurological deficits in the right upper limb. Computed tomography (CT) revealed an isolated right scapular glenoid fracture with lateral scapular displacement and a large hematoma, while CT angiography ruled out major vascular injury. Conservative management included hemodynamic stabilization and immobilization with a Velpeau-type splint. One month post-injury, neurological function in the affected upper extremity had significantly improved. By five months, the patient had regained nearly full, painless shoulder range of motion without neurological deficits. Although SD is classically associated with high-energy trauma, this case highlights its occurrence following minor trauma in elderly patients. Clinicians should maintain a high index of suspicion for SD in atypical presentations to facilitate early diagnosis and optimize treatment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80652"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epithelial-Stromal Polyp With Features of Perineurioma Lacking Covering Serrated Crypts Associated With a Sessile Serrated Lesion With High-Grade Dysplasia of the Colon: A Case Report.","authors":"Hideki Mori, Kenichirou Suzuki, Masako Kawamura, Takashi Yao","doi":"10.7759/cureus.80681","DOIUrl":"https://doi.org/10.7759/cureus.80681","url":null,"abstract":"<p><p>A 79-year-old woman received a colonoscopy, and 6 polyps were found in the proximal colon. Histologically, four polyps were conventional tubular adenomas. Interestingly, one protuberant polyp was a sessile serrated lesion (SSL) with high-grade dysplasia being regarded as a potent precursor lesion for colorectal cancers. The polyp was connected with a flat-type SSL. Furthermore, another polyp was a bland spindle cell lesion filling the lamina propria. The polyp lacked covering serrated epithelium. Although the mesenchymal neoplasm displayed architectural features of perineurioma, immunoexpression of epithelial membrane antigen (EMA) and GLUT1 was negative. Accordingly, the benign mesenchymal neoplasm was considered an unusual epithelial-stromal polyp with a perineurioma-like lesion. In cases of usual perineuriomas, stromal cell proliferation is suggested to be a concern for serrated crypts that often harbor BRAF mutation. However, the mechanical nature of the proliferation of stromal cells in the polyps without serrated crypts is unknown. For the present case, proliferation of the mesenchymal cells of the epithelial-stromal polyp was suspected to relate to the serrated lesion near the polyp. Moreover, it is also presumed that the occurrence of the six polyps, including the serrated lesion, mesenchymal neoplasm, and tubular adenomas in the proximal colon, took part in both the BRAF and WNT signal pathways.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80681"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of Periodontal Vaccines: Hope or Hype?","authors":"Pratiksha Patel, Bhavin Patel, Shruti D Vyas, Maitri S Patel, Tanvi Hirani, Mainul Haque, Santosh Kumar","doi":"10.7759/cureus.80636","DOIUrl":"https://doi.org/10.7759/cureus.80636","url":null,"abstract":"<p><p>Globally, periodontal diseases, mainly driven by polymicrobial biofilms, are a widespread concern of social medicine due to their considerable incidence and tie-up to systemic disorders like diabetes, cardiovascular diseases, and complications during pregnancy. Traditional treatments focus on mechanical debridement and antimicrobial therapies, but these approaches have limitations, including recurrence and antibiotic resistance. Periodontal vaccines offer a promising alternative by targeting the immunological mechanisms underlying periodontal disease. This review explores the current state of periodontal vaccine development, highlighting key antigens, vaccine delivery systems, and preclinical and clinical advancements. Special emphasis is placed on antigen selection, host variability, immune tolerance, and future directions to overcome these barriers. This article highlights the advancements and challenges in periodontal vaccine research, offering insights into the capability of immunoprophylaxis as a groundbreaking way to manage periodontal diseases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80636"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}