1/37. Whipple endocarditis without overt gastrointestinal disease: report of four cases.BACKGROUND: Cardiac manifestations of whipple disease are rarely diagnosed before death. OBJECTIVE: To describe four patients with endocarditis caused by tropheryma whippelii who did not have overt gastrointestinal disease. DESIGN: Case series. SETTING: Five hospitals in eastern switzerland. patients: Three men and one woman undergoing replacement of insufficient heart valves. MEASUREMENTS: Histologic characteristics of heart valves and intestinal biopsy; broad-range and specific polymerase chain reaction for T. whippelii. RESULTS: tropheryma whippelii was found in the heart valves (three aortic valves and one mitral valve) of four patients with culture-negative endocarditis necessitating valve replacement. All patients had arthralgia for different lengths of time. Only one patient had mild gastrointestinal symptoms. Histologic characteristics of intestinal mucosa were normal in all patients, and polymerase chain reaction on intestinal biopsy was positive for T. whippelii in only one patient, who did not have diarrhea. In all patients, arthralgia resolved promptly after institution of antibiotic therapy. Disease did not recur in any patient after prolonged antibiotic therapy with cotrimoxazole. CONCLUSION: In patients with culture-negative endocarditis, the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease did not rule out T. whippelii.- - - - - - - - - - ranking = 1keywords = hip (Clic here for more details about this article) |
2/37. An uncommon presentation of a common disease: the importance of the history in medicine.A 32-year-old recent Russian immigrant, mother of a 20-month-old son, presented with right hip pain. She had a history of peptic ulcer disease and a positive helicobacter pylori serology. Her pain was not relieved by analgesics. spine and pelvic films were unremarkable. A bone scan was consistent with metastatic disease. She underwent several diagnostic tests including computed tomography of the chest and abdomen, magnetic resonance imaging of the spine, mammogram, and breast ultrasound. A bone marrow biopsy revealed adenocarcinoma, primary site unknown. An upper endoscopy performed eight weeks after her initial presentation showed an ulcerating gastric carcinoma. She was treated with chemotherapy but died two months after diagnosis. Our patient had an uncommon presentation of a common disease. Recognizing her country of origin, and other risk factors, may have facilitated an earlier diagnosis.- - - - - - - - - - ranking = 0.1keywords = hip (Clic here for more details about this article) |
3/37. ovulation induction and early pregnancy loss in a woman susceptible to autoimmune diseases: a possible interrelationship.We report a 34-year-old woman with sequentially occurring autoimmune diseases that are possibly triggered by numerous ovulation inductions. At the ages of 26-32 years, she experienced 27 uncontrolled ovulation induction cycles using clomiphene citrate (CC) or CC plus human menopausal gonadotropin plus human chorionic gonadotropin. She became pregnant at the ages of 27, 30 and 31 with subsequent pregnancy loss in the 28th, 8th and 10th week of gestation, respectively. insulin-dependent diabetes mellitus (IDDM) developed at the age of 28. During the second year of ovulation induction, at the age of 27, she developed arthralgia that worsened and became migratory from the age of 31. thrombocytopenia appeared at the age of 33. The diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) was established at the age of 34. To the best of our knowledge, this is the first case of concurrent IDDM, SLE and APS in a patient associated with ovulation inductions. Excessive levels of estradiol achieved during the ovulation inductions could play a role in the expression of multiple autoimmune diseases in the susceptible woman.- - - - - - - - - - ranking = 0.4keywords = hip (Clic here for more details about this article) |
4/37. familial mediterranean fever.familial mediterranean fever (FMF) is an inherited multisystem disease manifested by painful, febrile attacks affecting the chest, abdomen, joints, and skin. No simple studies confirm the presence of FMF, contributing to the difficulty in diagnosis. A 10-year-old boy initially presented with a diffuse rash and complaints of bilateral joint pain of the hips, knees, and ankles and pain of the right shoulder. The child responded to daily naproxen. One year later, he continued to complain of hip, knee, ankle, and bilateral wrist pain. He also reported mild to moderate recurrent abdominal discomfort. omeprazole provided intermittent relief. The patient continued to experience episodes of joint and abdominal pain. Two and a half years after he first presented, FMF was considered. In the second case, a 51-year-old man presented to the emergency department with complaints of fever, cough, and abdominal and joint pain. Fever, joint pain, and swelling decreased during the next few days. The patient was maintained on colchicine, with complete resolution of joint pain complaints during the next few days. colchicine, 1 to 2 mg per day taken continuously during flare and quiescent periods, is the treatment of choice for FMF. colchicine reduced the severity and frequency of attacks and may also delay or prevent secondary amyloidosis.- - - - - - - - - - ranking = 0.2keywords = hip (Clic here for more details about this article) |
5/37. Transient bilateral osteoporosis of the hip in pregnancy. A case report and review of the literature.osteoporosis of the hip is a rare complication of pregnancy, the diagnosis of which can only be determined by radiologic means. Differentiation between osteonecrosis and osteoporosis remains problematic in some cases. magnetic resonance imaging was reported as useful for the diagnosis of osteoporosis. Treatment of osteoporosis of the hip in pregnancy should be conservative including physical therapy, restricted weight bearing and analgetic therapy. We report an unusual case of bilateral transient osteoporosis of the hip in pregnancy.- - - - - - - - - - ranking = 0.7keywords = hip (Clic here for more details about this article) |
6/37. Pigmented villonodular synovitis: keys to early diagnosis.Pigmented villonodular synovitis is a synovial proliferative disorder that remains a diagnostic difficulty. Many clues in the history, physical examination, and radiographic studies can aid in the diagnosis. A patient in the third or fourth decade of life often will present with vague monoarticular complaints. Symptoms include intermittent, extreme deep pain localized to the hip, occasionally relieved by position. Decreased active and passive range of motion may be found. Small erosions in the head of the femur and acetabulum may occur early in the course of the disease. magnetic resonance imaging is the imaging modality of choice and will show the characteristic findings of a joint effusion, synovial proliferation, and bulging of the hip. The synovial lining has a low signal on T1- and T2-weighted images, secondary to hemosiderin deposition. Pigmented villonodular synovitis should be included in the differential diagnosis of young patients with unexplained hip pain.- - - - - - - - - - ranking = 0.3keywords = hip (Clic here for more details about this article) |
7/37. Bilateral posterior shoulder dislocation: the importance of the axillary radiographic view.Whilst posterior shoulder dislocation is rare, it remains a frequently missed diagnosis. In all patients with a history of seizure, electrocution or similar trauma, where external rotation of the shoulder is limited, we recommend that an axillary or modified axillary view be added to the standard two radiographic shoulder views as routine protocol, to avoid missing a posterior dislocation.- - - - - - - - - - ranking = 0.044765531614952keywords = dislocation (Clic here for more details about this article) |
8/37. Hip arthroscopy in the adolescent and pediatric athlete.The current literature offers only sparse reports of the use of hip arthroscopy in the pediatric patient injured during athletics. In contrast, the role of this technique in the diagnosis and treatment of multiple childhood hip conditions including pyarthrosis, legg-calve-perthes disease, slipped capital femoral epiphysis, coxa vara, juvenile chronic arthritis, chondrolysis, and avascular necrosis is well described. The application of this relatively uncommon technique to the young athlete has only recently become more attractive. The ability to examine and treat traumatic intra-articular pathology with minimal morbidity and prompt recovery is mandated by the young age of these patients and their demanding activity levels. Hip arthroscopists are now beginning to correlate preoperative physical exam findings and history with diagnosis and expectations for outcome. As our combined experience with this technique grows, the specific indications for its use in the young athlete become increasingly better defined. In pediatric and adolescent patients, the new onset of hip pain should warrant a high level of suspicion for the more common causes of pain such as infection, legg-calve-perthes disease, slipped capital femoral epiphysis, or developmental dysplasia. When these have been evaluated, further differential diagnosis should include labral tears, loose bodies, synovitis, and chondral lesions. As this review begins to elucidate, these conditions are amenable to arthroscopic evaluation and treatment. At this time, the presence of reproducible mechanical symptoms after a twisting or axial loading injury during athletics should prompt the orthopaedic surgeon to consider arthroscopic examination of the hip if conservative therapy fails. Satisfying and reproducible results have been achieved when using hip arthroscopy within these parameters.- - - - - - - - - - ranking = 0.50032284926982keywords = hip, dysplasia (Clic here for more details about this article) |
9/37. Acetabular labral tears in the athlete.Pathologic involvement of the acetabular labrum is an increasingly recognized phenomenon. athletes involved in sports that require repetitive twisting or who suffer trauma to the hip are at risk of injury to the acetabular labrum. Injury mechanisms that include hyperextension, hyperflexion, or extremes of abduction place the labrum at particular risk. Symptoms may be acute in onset or, more commonly, insidious onset with persistence or escalation of symptoms. The orthopaedic surgeon evaluating patients with sports-related hip injuries needs to remain cognizant of intraarticular injuries within the hip and, in particular, injuries to the acetabular labrum. Further investigation is needed to fully define the functional importance of the acetabular labrum. Arthroscopic management has been successful in evaluation and management of acetabular labral tears.- - - - - - - - - - ranking = 0.3keywords = hip (Clic here for more details about this article) |
10/37. Retroperitoneal endometriosis causing unilateral hip pain.BACKGROUND: The usual symptoms of endometriosis are secondary dysmenorrhea, dyspareunia, and infertility, but when located in the retroperitoneal space, it might have atypical symptoms that delay diagnosis and postpone therapy. CASE: A young nulligravida presented with secondary dysmenorrhea and concurrent cyclic hip pain. Recent laparoscopy was reportedly normal. Computed tomography (CT)-directed percutaneous needle biopsy of a retroperitoneal mass showed endometriosis. laparotomy with retroperitoneal dissection removed the endometriosis, and operative arthroscopy released strictured hip tendons improving her hip pain and limp. CONCLUSION: Retroperitoneal endometriosis presenting as hip pain was diagnosed by CT-guided percutaneous needle biopsy permitting removal by a multidisciplinary surgical approach.- - - - - - - - - - ranking = 0.8keywords = hip (Clic here for more details about this article) |
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