Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “instability”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources
PubMed1997

Limited usefulness of traction-compression films in the radiographic diagnosis of lumbar spinal instability. Comparison with flexion-extension films.

STUDY DESIGN: A prospective, within-patient comparison of two methods for functional radiography of lumbar spine with consecutive patients. OBJECTIVE: To evaluate the usefulness of traction-compression radiography compared with conventional flexion-extension radiography in diagnosis of lumbar spinal instability. SUMMARY OF BACKGROUND DATA: Flexion-extension radiography generally is used and widely recognized as an effective method for diagnosis of segmental lumbar spinal instability, but the usefulness and findings of traction-compression films are less well known. METHODS: Flexion-extension and traction-compression radiography were performed on 306 consecutive patients (mean age, 43 years; range, 14-68 years) with clinically suspected lumbar spinal instability. Radiography was performed of each patient in an upright position. Axial traction was accomplished by letting the patient hang by his or her hands from a horizontal bar. Compression views were taken when the patient had sandbags of approximately 30% of the his or her weight on the shoulders. Main interest was translational forward and backward displacement of one vertebra on another. RESULTS: Signs of translational instability were present on the functional radiographs of 27% (84 of 306) of the patients. In diagnosis of instability, the overall agreement of flexion-extension and traction-compression films was only 0.786, and also statistic Kappa remained poor (0.05). Flexion-extension films more frequently revealed signs of instability than traction-compression films: 81 versus seven patients. CONCLUSIONS: Traction-compression films seem to be of questionable value in diagnosis of lumbar spinal instability.

Adolescent↗
PubMed2005

[Microsatellite instability predicts better outcome in colorectal cancer patients].

BACKGROUND AND OBJECTIVE: Two different pathways for the development of tumor have been described in colorectal carcinoma: the chromosomic instability, raised by suppressor genes and proto-oncogene alterations, and the microsatellite instability (MSI), caused by alterations in DNA repairing genes. PATIENTS AND METHOD: The frequency and the clinical meaning of the microsatellites instability pathway were determined in a consecutive prospective cohort of 106 patients who underwent surgical resection of colorectal carcinoma by a single surgeon. Microsatellite instability determination was established according to the criteria proposed by the National Cancer Institute in 1998. RESULTS: 9.4% of patients had a high instability and it was low in 11.3%; both groups displayed different clinico-pathological characteristics (age, sex, tumor site and histologic type). In the multivariant analysis of overall survival and disease free survival, high instability exhibited prognostic value independent of the rest of variables evaluated (p < 0.0001). CONCLUSIONS: The genetic alterations giving rise to microsatellite instability lead to a better prognosis in patients with colorectal cancer.

Adenocarcinoma↗
PubMed2004

Reflexive muscle activation alterations in shoulders with anterior glenohumeral instability.

BACKGROUND: Patients with glenohumeral instability have proprioceptive deficits that are suggested to contribute to muscle activation alterations. HYPOTHESIS: Muscle activation alterations will be present in shoulders with anterior glenohumeral instability. STUDY DESIGN: Posttest-only control group design. METHODS: Eleven patients diagnosed with anterior glenohumeral instability were matched with 11 control subjects. Each subject received an external humeral rotation apprehension perturbation while reflexive muscle activation characteristics were measured with indwelling electromyography and surface electromyography. RESULTS: Patients with instability demonstrated suppressed pectoralis major and biceps brachii mean activation; increased peak activation of the subscapularis, supraspinatus, and infraspinatus; and a significantly slower biceps brachii reflex latency. Supraspinatus-subscapularis coactivation was significantly suppressed in the patients with instability as well. CONCLUSIONS AND CLINICAL RELEVANCE: In addition to the capsuloligamentous deficiency and proprioceptive deficits present in anterior glenohumeral instability, muscle activation alterations are also present. The suppressed rotator cuff coactivation, slower biceps brachii activation, and decreased pectoralis major and biceps brachii mean activation may contribute to the recurrent instability episodes seen in this patient group. Clinicians can implement therapeutic exercises that address the suppressed muscles in patients opting for conservative management or rehabilitation before and after capsulorraphy procedures.

Adult↗
PubMed2005

Operative stabilization of posterior shoulder instability.

BACKGROUND: Symptomatic, traumatic posterior shoulder instability is often the result of a posteriorly directed blow to an adducted, internally rotated, and forward-flexed upper extremity. Operative repair has been shown to provide favorable results. Current arthroscopic techniques with suture anchors and the ability to plicate the capsule using a nonabsorbable suture may provide favorable outcomes with reduced morbidity. PURPOSE: To evaluate the results of operative shoulder stabilization in patients with traumatic posterior shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of patients who underwent arthroscopic or open posterior stabilization for traumatic posterior shoulder instability were evaluated using subjective assessments, physical examinations, the Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and the Western Ontario Shoulder Instability Index. RESULTS: Between May 1996 and February 2002, 31 shoulders (30 patients) underwent posterior stabilization (19 arthroscopically, 12 open). There were 29 men and 1 woman (mean age, 23 years). Preoperatively, all patients had a distinct traumatic cause for the instability. On physical examination, all patients had posterior apprehension and increased (2+, 3+) posterior load-shift testing. Preoperative radiographs and/or magnetic resonance imaging revealed posterior rim calcification or reverse Bankart lesions in 29 cases (94%). At arthroscopy, posterior labral injuries, reverse Bankart lesions, or humeral head defects were identified. Follow-up averaged 40 months, and the mean duration between injury and surgery was 21 months. The mean Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and Western Ontario Shoulder Instability Index scores, respectively, for the entire group were 89, 87, 11, and 346; for the open group, they were 81, 80, 10.5, and 594; for the arthroscopic group, they were 92, 92, 11.4, and 190. The Western Ontario Shoulder Instability Index (P < .03) and Rowe score (P < .04) outcomes scores for the arthroscopic group were statistically better than those of the open group. Twenty-nine of 31 shoulders were rated as excellent or good. CONCLUSION: In the case of traumatic posterior shoulder subluxation, posterior lesions of the labrum ("reverse Bankart"), articular edge, and capsule are observed. Surgical treatment addressing these lesions led to satisfactory results for both the open and arthroscopic treated groups. In this study, an arthroscopic technique utilizing suture anchor repair with capsular placation provided the most favorable outcomes.

Adolescent↗
PubMed2005

Arthroscopic treatment of posterior shoulder instability: results in 33 patients.

BACKGROUND: Posterior shoulder instability is a relatively rare condition and a surgical challenge. Arthroscopic techniques have allowed for a potential improvement as well as diagnosis and management of this condition. PURPOSE: To evaluate the outcomes of arthroscopic posterior shoulder stabilization and to evaluate preoperative and intraoperative variables as predictors of success. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-three consecutive patients with a mean age of 25 years (range, 19-34 years) who underwent posterior arthroscopic shoulder stabilization with suture anchors (mean, 3 anchors) or suture capsulolabral plication (mean, 5.3 stitches) or both were reviewed at a mean follow-up of 39.1 months (range, 22-60 months). Shoulder outcomes rating scores were determined using the American Shoulder and Elbow Surgeons Rating Scale, the Western Ontario Shoulder Instability Index, the Subjective Patient Shoulder Evaluation, and the Single Assessment Numeric Evaluation. RESULTS: There were 7 failures: 4 for recurrent instability and 3 for symptoms of pain. Overall, outcomes scores demonstrated mean values of the American Shoulder and Elbow Surgeons Rating Scale of 94.6, Subjective Patient Shoulder Evaluation of 20.0, Western Ontario Shoulder Instability Index of 389.4 (81.5% of normal), and Single Assessment Numeric Evaluation of 87.5. Patients with voluntary instability demonstrated worse outcomes (P = .025), and those with prior surgery of the shoulder also did worse (P = .02). CONCLUSION: Arthroscopic treatment of posterior shoulder instability is an effective means to improve symptoms associated with recurrent posterior subluxation of the shoulder. It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery.

Adult↗
PubMed2006

Thermal capsulorrhaphy for the treatment of shoulder instability.

Thermal capsulorrhaphy has been used to treat many different types of shoulder instability, including multidirectional instability, unidirectional instability, and microinstability in overhead-throwing athletes. A device that delivers laser energy or radiofrequency energy to the capsule tissue causes the collagen to denature and the capsule to shrink. The optimal temperature to achieve the most shrinkage without causing necrosis of the tissue is between 65 degrees and 75 degrees centigrade. This treatment causes a significant decrease in mechanical stiffness for the first 2 weeks, and then, after the tissue undergoes active cellular repair from the surrounding uninjured tissue, the mechanical properties return to near normal by 12 weeks. If the thermal energy is applied in a grid pattern, then the tissue heals with more stiffness by 6 weeks. Clinical studies on thermal capsulorrhaphy for the treatment of multidirectional instability have shown a high rate of recurrent instability (12%-64%). The clinical studies on unidirectional instability showed much better recurrence rates (4%-25%), but because most of the patients also underwent concomitant Bankart repairs and superior labral anterior posterior lesion repairs, the efficacy of the thermal treatment cannot be ascertained. A randomized controlled trial would be needed to assess whether instability with Bankart lesions requires augmentation with thermal capsulorrhaphy. For the patients with microinstability who are overhead-throwing athletes, thermal capsulorrhaphy has shown varying results from a 97% rate of return to sports to a 62% rate of return to sports. Complications of this technique include temporary nerve injuries that usually involve the sensory branch of the axillary nerve and thermal necrosis of the capsule, which is rare.

Animals↗
PubMed2006

Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial.

BACKGROUND: Arthroscopic stabilization for anterior shoulder instability has been reported to result in a higher rate of recurrent instability compared to traditional open techniques. PURPOSE: To test the null hypothesis that there is no difference in the clinical outcomes in patients with recurrent anterior shoulder instability treated with open or arthroscopic stabilization. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Magnetic resonance arthrogram studies were obtained preoperatively. These findings were compared to arthroscopic findings. Postoperative evaluations included range of motion, stability, and subjective assessments including Single Assessment Numeric Evaluation, Simple Shoulder Test, Western Ontario Instability Index, and University of California, Los Angeles evaluation. Failure was defined as a second dislocation, recurrent subluxation, or symptoms precluding return to previous work or unrestricted active military duty. RESULTS: Sixty-one patients, 29 who received open stabilization and 32 who received arthroscopic stabilization, were evaluated at a mean of 32 months postoperatively (range, 24-48 months). Patient demographics were equivalent. Preoperative magnetic resonance arthrogram findings were confirmed at arthroscopic examination. The mean operative time was significantly shorter for the arthroscopic repairs (59 vs 149 minutes; P < .001). There were 3 clinical failures (2 open stabilizations, 1 arthroscopic stabilization) by the established criteria. There was a statistically significant improvement from preoperative to postoperative Single Assessment Numeric Evaluation scores in both groups (P < .001). The mean loss of motion (compared to the contralateral shoulder) was greater in the open shoulders. Subjective evaluations were equal in both groups. CONCLUSION: Clinical outcomes after arthroscopic and open stabilization were comparable. Preoperative magnetic resonance arthrograms in shoulders with anterior instability allow an accurate diagnosis of intra-articular abnormality that correlates well with operative findings. Arthroscopic stabilization for recurrent anterior shoulder instability can be performed safely; the clinical outcomes are comparable to those after traditional open stabilization.

Adult↗
PubMedDate not supplied

Repair and reconstruction of rotatory instability of the knee.

We studied the results of treatment in 110 of 129 consecutive patients who had knee instability for which they underwent reconstruction of the knee ligaments at the Mayo Clinic. Thirty-one patients underwent different types of extraarticular reconstruction. Nine (29%) had recurrence of the knee giving way, and 11 (36%) had objective signs of instability on examination. Fifty-five patients underwent combined extraarticular and intraarticular reconstruction with either the Lam-Jones patellar tendon (PT) procedure (21 knees) or the Zarins-Rowe semitendinosus and iliotibial band (ST & ITB) procedure (34 knees). Only two knees (10%) with PT procedure and three knees (9%) with ST & ITB procedures continued to have giving way. Three patients in each group had recurrence of instability. Twenty-four knees with acute instability had either primary repair (17 knees) or primary reconstruction with ST & ITB procedures (7 knees). The results in these knees were superior to the results in the knees reconstructed for chronic instability. On the basis of our 2 year results, we believe that a combined intraarticular and extraarticular reconstruction is the procedure of choice in chronic knee instability and is a useful procedure in acute knee instability with irreparable tears of the anterior cruciate ligament.

Adolescent↗
PubMed1991

Chronic lateral ankle instability.

Chronic lateral ankle instability may be present in as many as 10% to 30% of people suffering from acute lateral ankle ligament injuries. Ankle instability has been referred to as either functional instability or mechanical instability. Management options consist of either nonoperative or operative treatment, with the majority of the literature emphasizing operative management for chronic instability. Long-term studies assessing the different types of available operative repairs have now been published. This review article discusses chronic lateral ankle ligament instability from a functional, anatomical point of view. The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. The major emphasis of this review is discussion and analysis of the many different surgical treatment options. Following this review, we presently recommend anatomical repair to the bone of both the anterior talofibular ligament and the calcaneofibular ligament, together with imbrication of the ligaments. In patients with hypermobility, long-standing instability, or arthritis, reconstruction using the Chrisman-Snook technique is recommended.

Ankle Joint↗
PubMed2000

Bipolar hip arthroplasty as a salvage treatment for instability of the hip.

BACKGROUND: Recurrent instability of the hip in the absence of an identifiable cause is a challenging problem. It has been proposed that bipolar hip arthroplasty may have a role in the treatment of these complex cases. The purpose of our study was to evaluate the results of bipolar hip arthroplasty for the treatment of recurrent instability of the hip in a series of patients at our institution. METHODS: We reviewed the records of twenty-seven patients who had undergone bipolar hip arthroplasty as a salvage procedure for the treatment of recurrent instability of the hip after total hip replacement. All patients had undergone at least two, and a mean of three, stabilizing operative procedures on the hip prior to the bipolar arthroplasty. The mean duration of follow-up was five years (range, two to twelve years), with no patient lost to follow-up. There were six deaths, of unrelated causes. RESULTS: Bipolar arthroplasty prevented redislocation in twenty-two hips (81 percent). At the time of final follow-up, twenty-five patients (93 percent) had a stable hip. Five patients (19 percent) had had episodes of subluxation or dislocation following the bipolar arthroplasty. Two of these patients had only a single episode of dislocation that was treated successfully by immobilization. Two of the remaining three patients required a reoperation because of the instability. The hip was stabilized with the use of a constrained cup prosthesis in one of these patients, and the other patient eventually required resection arthroplasty. The third patient had continuing instability but improved function and pain relief, and a reoperation was not performed. There were a total of seven reoperations; these included revision because of disassembly of the cup in one hip, revision bipolar arthroplasty because of continuing instability in two, resection arthroplasty because of deep infection in two, revision arthroplasty because of recalcitrant groin pain in one, and revision arthroplasty because of deep infection and superior migration of the implant in one. The Harris hip score improved significantly, from a mean of 24 points (range, 5 to 45 points) preoperatively to a mean of 55 points (range, 35 to 80 points) postoperatively (p < 0.05). CONCLUSIONS: We believe that, despite some potential problems, bipolar hip arthroplasty can have a role in the salvage management of recurrent instability of the hip in patients in whom other stabilization procedures have failed.

Adult↗
PubMed2006

Clinical assessment of three common tests for traumatic anterior shoulder instability.

BACKGROUND: Although traumatic anterior shoulder instability is common, the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently. We hypothesized that (1) such tests would be specific but not sensitive for this condition, (2) the usefulness of the anterior drawer test would be limited because of pain during the test, and (3) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms. METHODS: Between 2000 and 2004, 363 patients underwent a physical examination followed by shoulder arthroscopy. Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group, and the remaining patients served as controls. The clinical usefulness of three tests (anterior apprehension, relocation, and anterior drawer tests) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity, specificity, and likelihood ratios. RESULTS: If demonstration (or relief) of apprehension was used as the diagnostic criterion for a positive test, the sensitivity, specificity, and likelihood ratio were 72%, 96%, and 20.2, respectively, for the apprehension test and 81%, 92%, and 10.4, respectively, for the relocation test. If pain (or relief of pain) was used as the diagnostic criterion for a positive test, the values for the sensitivity, specificity, and likelihood ratio of both tests were lower. The anterior drawer test could be performed successfully in the physician's office for 87% of the patients. If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test, the sensitivity, specificity, and likelihood ratio values of that test were 53%, 85%, and 3.6, respectively. CONCLUSIONS: The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive. Apprehension is a better criterion than pain for a positive apprehension or relocation test. The anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

ENU administration causes genomic instability along with single nucleotide polymorphisms in p53 during gliomagenesis: T11TS administration demonstrated in vivo apoptosis of these genetically altered tumor cells.

Advancement of molecular analysis of neoplastic cells demonstrated that multiple genetic changes are associated with the development of tumors. Cancer cell must exhibit a mutator phenotype, which is likely to be responsible for the genomic instability found in cancer tissues. The mutator phenotype, such as defective mismatch repair, is known to cause microsatellite instability, which is associated with certain cases of sporadic cancer. Previously many studies have been carried out to determine the relationship between microsatellite instability and human brain tumors. However information on genomic instability in the animal model of brain tumor is still very limited. In the present course of investigations we genetically characterized our ENU induced brain tumor animal model by using PCR based randomly amplified polymorphic DNA (RAPD) analysis and restriction fragment length polymorphism (RFLP) with three microsatellite probes. ENU induced tumors demonstrated genetic instability, including some microsatellite instability. As single nucleotide polymorphisms of the tumor suppressor gene p53 were associated with diverse types of human cancer, we examined the p53 gene of the tumor cells isolated from ENU induced brain tumor animal model, by PCR based RFLP method in p53 exon-2, -3 and -4. In these studies we showed that the restriction site of p53 exon-3 and 4 were mutated in ENU induced brain tumor indicating a genetic defect associated with ENU induced tumorigenesis. In the therapeutic part, we confirmed the anti-tumor property of T11TS/S-LFA-3 in the ENU induced genetically altered cells. Histological evidences, cytotoxic study, PI-FACS cell-cycle analysis and TUNEL assay confirmed the apoptotic death of glioma cells by T11TS treatment in which p53 is mutated. From the present study we can conclude that ENU administration causes genomic instability along with mutations in p53 during the process of gliomagenesis. Whereas, T11TS/S-LFA3 demonstrated the potential to induce apoptosis of these tumor cells even when p53 is mutated and thus showed its immense potential to be an anti-neoplastic probe against p53 mutated diverse types of tumors.

Alkylating Agents↗
PubMed2006

Recurrent posterior shoulder instability.

Recurrent posterior shoulder instability is an uncommon condition. It is often unrecognized, leading to incorrect diagnoses, delays in diagnosis, and even missed diagnoses. Posterior instability encompasses a wide spectrum of pathology, ranging from unidirectional posterior subluxation to multidirectional instability to locked posterior dislocations. Nonsurgical treatment of posterior shoulder instability is successful in most cases; however, surgical intervention is indicated when conservative treatment fails. For optimal results, the surgeon must accurately define the pattern of instability and address all soft-tissue and bony injuries present at the time of surgery. Arthroscopic treatment of posterior shoulder instability has increased application, and a variety of techniques has been described to manage posterior glenohumeral instability related to posterior capsulolabral injury.

Biomechanical Phenomena↗
PubMed2001

The bone block procedure in recurrent posterior shoulder instability.

We analyzed the results of eleven shoulders in ten patients who had a bone block procedure for recurrent posterior shoulder instability after extensive conservative treatment had failed. Five patients had posterior instability with additional laxity in another direction (UPI+), and five patients had unidirectional posterior instability without additional laxity (UPI-). After a median follow-up of 72 (43-102) months there was no recurrent posterior instability in the UPI-group (100% success), but the recurrence rate in the UPI+ group was high (20% success). We concluded from these results that a bone block procedure is not sufficient to treat recurrent posterior shoulder instability in unidirectional posterior instability with additional laxity but it seems to be a good method to treat unidirectional posterior instability without additional laxity.

Adolescent↗
PubMed1992

Carpal instability associated with fracture of the distal radius. Incidence, influencing factors and pathomechanics.

134 fractures of the distal radius in 132 patients are reviewed to determine the incidence and influencing factors of coexisting carpal in stability. By measurement and analysis of the changes in carpal angles and joint spaces, carpal instability was discovered in 41 fractures, an incidence of 30.6%. Six patterns of instability were observed, including dorsal intercalated segmental instability (DISI), scapholunate dissociation, dorsal and palmar translocations, volar intercalated segmental instability (VISI) and ulnar carpal translocation. Accompanying carpal instability was more often seen in elderly patients. To a certain extent, the patterns of instability were related to the type of fracture and palmar tilt angle (PTA) values. DISI was often seen in fractures with PTA smaller than -15 degrees, while scapholunate dissociation was seen in fractures with PTA between -5 degrees and -20 degrees. The possible pathomechanics of the accompanying carpal instability were deduced based on the kinematics and influencing factors indicated in this study.

Adolescent↗
PubMed1992

The inferior capsular-shift procedure for multidirectional instability of the shoulder.

Thirty-eight patients (forty-three shoulders) who had disabling multidirectional instability of the shoulder were managed with an inferior capsular-shift procedure through an anterior approach. All of the patients were followed for a minimum of two years. The postoperative range of motion of the shoulders was well maintained. The mean forward elevation was 172 degrees; external rotation, 77 degrees; and internal rotation, to the level of the eighth thoracic vertebra. Four patients (four shoulders) had recurrence of symptomatic and disabling multidirectional instability, but thirty-nine (91 per cent) of the shoulders continued to function well with no instability. Nine patients (24 per cent) continued to have episodes of apprehension, which correlated with the residual inferior and posterior translations found at the postoperative physical examination. Thirty-four patients (thirty-nine shoulders) stated that they were subjectively satisfied with the status of the shoulder, but four patients, in whom the instability had recurred, were not satisfied. Thirty-seven (86 per cent) of the shoulders were judged to have been improved by the procedure, the initial postoperative stability had been maintained, and the result had not deteriorated with time. Six shoulders, however, including the four with recurrent instability, were thought by the patient to have deteriorated with the increased duration of follow-up. It was our experience that if non-operative treatment of multidirectional instability of the shoulder failed, the inferior capsular-shift procedure provided satisfactory objective and subjective results. Failures and recurrences of symptomatic instability occurred early in the postoperative period. There appeared to be no deterioration of the results with follow-up to seventy-one months.

Adolescent↗
PubMedDate not supplied

Evaluation of BAT-26 as an indicator of microsatellite instability in gallbladder carcinomas.

BACKGROUND/AIMS: The genetic pathways of gallbladder cancer are not yet well defined, since the contribution of genetic abnormalities, clarified in other organs, remains questionable. Our aim was to evaluate the role of microsatellite instability in this organs carcinogenesis. METHODOLOGY: We investigated a group of 20 gallbladder carcinomas from Greek patients with regard to alterations in length of the BAT-26 mononucleotide marker--as an indicator of microsatellite instability. The findings were correlated with the presence of p53 and ras mutations, alterations of the bax and TGF-beta RII genes and tumors' clinicopathological features. Polymerase chain reaction and electrophoretic analysis in a non-denaturating 25% polyacrylamide gel was performed for the detection of BAT-26 size variations. RESULTS: None of our specimens showed microsatellite instability at the BAT-26 marker. CONCLUSIONS: BAT-26, an indicator of high-level microsatellite instability, may not be sufficient, when used alone, for determining the microsatellite instability status of gallbladder carcinomas, since these may be characterized by low-level instability. Bax and TGF-beta RII genes may not also be targets of instability in this type of tumors.

Adenocarcinoma↗
PubMed2004

Multidirectional instability: surgical decision making.

Although previous authors have described multidirectional instability of the shoulder, it was not until 1980 that Neer and associates solidified the current understanding and treatment of inferior and multidirectional instability. They emphasized the importance of differentiating this condition from the more common unidirectional instabilities and introduced the concept of an inferior capsular shift to globally tension the capsule anteriorly, inferiorly, and posteriorly, while thickening and reinforcing it on the side of greatest instability (i.e., anterior or posterior). Since the time of this initial description, the diagnosis and treatment of multidirectional instability has been fraught with difficulty and confusion. More recently, the advent of shoulder arthroscopy has blazed the trail for minimally invasive techniques to correct multidirectional instability, including arthroscopic thermal capsulorrhaphy and suture plication. However, despite strong opinions regarding these surgical techniques, when comparing open approaches to arthroscopic techniques for the treatment of multidirectional instability, long-term outcomes of arthroscopic techniques have yet to replicate those of open surgery.

Arthroscopy↗