The performance of the convolutional neural network exceeded that of orthopedic surgeons in detecting intertrochanteric hip fractures from proximal femoral radiographs under limited conditions. The convolutional neural network has a significant potential to be a useful tool for screening for fractures on plain radiographs, especially in the emergency room, where orthopedic surgeons are not readily available.

Object The authors assessed the role of 3D anisotropy contrast (3DAC) in evaluating specific ascending tract degeneration in patients with cervical spondylotic myelopathy (CSM). Methods The authors studied 10 patients (2 women, 8 men; mean age 59.8 ± 14.6 years) with CSM and spinal cord compression below the C2–3 disc level, as well as 10 healthy control individuals (3 women, 7 men; mean age 42.0 ± 24.1 years). Images of the cervical cord at the C2–3 level were obtained using a 3.0-T MR imaging system. Results Three-dimensional anisotropy contrast imaging clearly made possible tract-by-tract analysis of the fasciculus cuneatus, fasciculus gracilis, and spinocerebellar tract. Tract degeneration identified using 3DAC showed good correlation with a decline in fractional anisotropy. Degeneration of the fasciculus gracilis detected by “vector contrast” demonstrated a good correlation with Nurick grades. Conclusions The study unambiguously demonstrated that 3DAC imaging is capable of assessing ascending tract degeneration in patients with CSM. Degeneration of an individual tract can be easily identified as a vector contrast change on the 3DAC image, a reflection of quantitative changes in anisotropism, similar to fractional anisotropy. Excellent correlation between Nurick grades and fasciculus gracilis degeneration suggests potential application of 3DAC imaging for tract-by-tract clinical correlation.

Corynebacterium ulcerans is attracting attention as an emerging zoonosis that causes lymphadenitis, dermatitis and respiratory infections. We report here what appears to be the first case of subcutaneous abscess formation in the upper extremity due to toxigenic C. ulcerans in Japan. Awareness of the fact that C. ulcerans can cause a subcutaneous, elastic-hard, lessmobile mass with heat, redness and pain in the extremities is important for differential diagnosis. IntroductionCorynebacterium ulcerans is known as an emerging zoonosis that causes cutaneous infection, sinusitis, tonsillitis, pharyngitis, pneumonia and peritonitis (Dias et al., 2011). However, to the best of our knowledge, C. ulcerans has not been reported to cause subcutaneous abscess in the extremities. Therefore, clinicians encountering a subcutaneous mass in the extremities are unlikely to consider subcutaneous abscesses due to C. ulcerans as a differential diagnosis. This could lead to a delay in diagnosis and treatment, and in the worst scenario, it may result in a fatal diphtheria-like disease (Mattos-Guaraldi et al., 2008;Putong et al., 2011).Here, we report the diagnosis and treatment of a patient with a subcutaneous abscess in the upper extremity due to C. ulcerans and discuss the clinical characteristics useful for differential diagnosis. Case reportIn December 2011, a 37-year-old Japanese woman was referred to Tsuruoka Municipal Shonai Hospital, in Tsuruoka, Japan, with a painful mass in her right elbow. The patient had no cardiac symptoms. Her past medical history was unremarkable. Three days before the current hospital visit, she experienced swelling and itching on the medial side of her right elbow. Within a few days, a hot, red, painful mass rapidly formed subcutaneously.Physical examination revealed redness and local heat on the surface of the skin over the mass. The mass was approximately 4 cm in size, elastic hard and less mobile, and caused pain and tenderness. No radiating pain was produced on tapping on the mass (Tinel's sign). Laboratory tests revealed an increase in C-reactive protein levels (2.3 mg dl 21) and a white blood cell count in the normal range (7500 mm 23 ). Radiography did not reveal calcification within the lesion. On magnetic resonance imaging, a subcutaneous soft tissue mass (27622626 mm in size) was observed on the medial side of her elbow; it exhibited iso-signal intensity on T1-weighted images (Fig. 1a) and inhomogeneous high-signal intensity on T2-weighted images (Fig. 1b). Following intravenous administration of gadopentetate dimeglumine, ring enhancement was seen on T1-weighted images (Fig. 1c).Fine-needle aspiration biopsy was performed. No pus was aspirated, but small fragments of tissue were obtained. The tissue fragments were sent for pathological analysis and microbiological diagnosis. Histopathological examination showed no malignancy, but neutrophils and histiocytes were present in the specimen. Bacterial cultures were negative under aerobic conditions. In January 2012, the patient underwent surgery...

It has been reported that 25-60% of anaplastic large cell lymphomas (ALCL) carry the t(2;5)(p23;q35) translocation that results in the production of a novel chimeric protein anaplastic lymphoma kinase (ALK). Because ALK-positive ALCL has a more favorable prognosis than ALK-negative ALCL, recent investigations have suggested subclassification of ALCL according to ALK expression [1]. The sarcomatoid variant of ALCL is an extremely rare condition, which is easily misdiagnosed as high-grade sarcoma [2]. The ALK expression of sarcomatoid lymphoma has seldom been assessed. We report a case of sarcomatoid ALCL presented as malignant fibrous histiocytoma with evaluation of ALK expression.A 51-year-old man presented at another hospital with a 2-month history of an enlarging superficial mass in his left groin. The diagnosis based on biopsy results was high-grade sarcoma, probably a myxoid malignant fibrous histiocytoma. The patient was referred to our hospital. Physical examination revealed a soft, ulcerated, infected, immobile tumor which bled easily measuring 2323 cm in the left groin (Fig. 1). Bacterial cultures of the tumor demonstrated more than ten types of Gram-positive and Gram-negative bacteria. Magnetic resonance imaging A. Ogose ( ) ) · T. Urakawa · T. Hotta Fig. 1 Photograph showing a large, soft, easily bleeding tumor of the left groinFig. 2 T2-weighted magnetic resonance image showing a huge extruded tumoral mass invading the surrounding femoral vessels

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