1/11. Subcutaneous phaeohyphomycosis of the finger caused by exophiala spinifera.A patient with severe rheumatoid arthritis treated with prednisone had a painless soft tissue nodule develop on the dorsal aspect of the ring finger. She denied any history of hand trauma, animal exposure, or systemic symptoms such as fever or malaise. Fungal cultures performed on an aseptically obtained aspirate of this lesion demonstrated dark, olive-black creamy colonies on Sabouraud's agar. Slide cultures made from mold colonies produced slender conidial forms with annellations and spine-like conidiophores, features characteristic of exophiala spinifera. The lesion was surgically excised, and the patient was successfully treated with a course of oral itraconazole. This nodular lesion has not recurred at the time of this writing. exophiala species are difficult to differentiate, and E. spinifera may be confused with exophiala jeanselmei. A literature review will consider exophiala species and clinical manifestations produced by these dematiaceous fungi.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/11. Rheumatoid granuloma of kidney.A seventy-year-old black man with long-standing rheumatoid arthritis who had been treated with corticoids presented with painless hematuria originating from the kidney. The clinical findings were suggestive of a renal cell carcinoma. The resected kidney was markedly enlarged, scarred, and disclosed a necrotic rheumatoid granuloma surrounded by chronic inflammatory reaction. The mechanism of hematuria and the clinical significance of the rheumatoid granulomatous involvement of the kidney are discussed.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/11. Fatal hepatic necrosis associated with parenteral gold therapy.Two young black male patients with seronegative rheumatoid arthritis and treated with nonsteroidal antiinflammatory agents developed fulminant hepatic necrosis following the institution of parenteral gold therapy. These cases, reported from different institutions, may represent a severe form of idiosyncratic gold hepatonecrosis. awareness of the possible association between gold therapy and severe hepatic injury may become increasingly important as oral gold preparations become widely available.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/11. Tophaceous gout in a nigerian with rheumatoid arthritis.A male Nigerian patient, with co-existing gouty arthritis and rheumatoid arthritis, is presented. These two conditions rarely co-exist in the same patient. There has been no previous report in black Africans.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
5/11. Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with "cranial settling".Lack of correlation between the severity of rheumatoid subluxation of the upper cervical vertebrae and supposed absence of neurological damage has led to the erroneous supposition that this finding is innocuous. Incomplete autopsy studies in rheumatoid arthritis have failed to recognize the cause of death, despite previously proven dramatic occipito-atlanto-axial dislocations. The most feared entity of rheumatoid basilar invagination, namely "cranial settling," is poorly understood. Between 1978 and 1984, the authors treated 45 rheumatoid arthritis patients who were symptomatic with "cranial settling." This consisted of vertical odontoid penetration through the foramen magnum (9 to 33 mm), occipito-atlanto-axial dislocation, lateral atlantal mass erosion, downward telescoping of the anterior arch of C-1 on the axis, and rostral rotation of the posterior arch of C-1 producing ventral and dorsal cervicomedullary junction compromise. Cervicomedullary junction dysfunction has mistakenly been called "entrapment neuropathy," "progression of disease," or "vasculitis." Occipital pain occurred in all 45 patients, myelopathy in 36, blackout spells in 24, brain-stem signs in 17, and lower cranial nerve palsies in 10. Four patients had prior tracheostomies. Four previously asymptomatic patients with "cranial settling" presented acutely quadriplegic. The factors governing treatment were reducibility and direction of encroachment determined by skeletal traction and myelotomography. Transoral odontoidectomy was performed in seven patients with irreducible pathology. All patients underwent occipitocervical bone fusion (with C-1 decompression if needed) and acrylic fixation. Improvement occurred during traction, implying that compression might be the etiology for the neurological signs. There were no complications. Thus, "cranial settling" is a frequent complication of rheumatoid arthritis; although it is poorly recognized, it has serious implications and is treatable.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/11. sezary syndrome with arthropathy. Report of a case.A 65-year-old black female with sezary syndrome had generalized intractable pruritus, erythroderma, alopecia, onychogryphosis, lumphadenopathy and hepatomegaly. Abnormal lymphocytes with large, convoluted and grooved nuclei (Sezary cells) were identified in the skin and peripheral blood. A striking feature of her disease was severe, deforming arthropathy of the hands and knees, a clinical finding which has been described previously in only one patient with sezary syndrome. At necropsy no associated lymphoma was found.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
7/11. scleritis, pericarditis, and aortic insufficiency in a patient with rheumatoid arthritis.A 55-year-old black man developed anterior nodular scleritis in his left eye in November 1981. He had no symptoms of systemic disease, and initial laboratory tests revealed only a positive rheumatoid factor. Fourteen months later he presented with pericarditis and aortic insufficiency requiring aortic valve replacement. Examination of excised valvular and pericardial tissue showed changes compatible with rheumatoid disease. Shortly after the surgery he developed florid rheumatoid arthritis. The clinical course of this patient illustrates how scleritis can be the initial sign of severe systemic disease.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
8/11. jaw claudication. Its value as a diagnostic clue.jaw claudication accompanies relatively few disorders, but it may be an important presenting feature that heralds serious underlying disease. In temporal arteritis, for example, jaw claudication rather than the classic finding of unilateral lancinating headache may be the distinguishing symptom. In the case reported here, jaw claudication was a prominent symptom for five months in a black woman. temporomandibular joint disease can produce pain similar to that of jaw claudication, as can rheumatoid arthritis involving the temporomandibular joint in the elderly. myasthenia gravis closely mimics jaw claudication, and parotid tumors can produce similar pain. Atherosclerotic narrowing of the external carotid artery proximal to the origins of the facial and maxillary branches is a rare cause of jaw claudication. Recognition of the importance of jaw claudication can lead to early identification of the underlying disease and quick initiation of therapy to avoid serious complications.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
9/11. Rheumatoid scleritis.A 59-year-old black female with rheumatoid arthritis developed diffuse anterior scleritis with orbital and adnexal involvement. Computerized axial tomograhy (CAT) demonstrated the location and extent of the lesion. biopsy of subconjunctival tissue revealed a rheumatoid nodule, characterized by granulomatous inflammation and fibrinoid necrosis. The patient improved rapidly on large doses of systemic corticosteroids. The relationship of scleritis to rheumatoid arthritis is discussed. The histopathologic features of rheumatoid scleritis, its apppearance on the CAT scan, and the management of this disease are also presented.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
10/11. Cementless or hybrid total elbow arthroplasty with titanium-alloy implants. A study of interim clinical results and specific complications.Twenty-six patients (32 elbows) with rheumatoid arthritis had a total elbow arthroplasty with insertion of a cementless prosthesis. The humeral component was made of titanium alloy and it was fixed without cement in all elbows. The patients were followed for an average of 3 years 1 month (range, 2 years 2 months to 4 years 4 months). A good result was seen in 25 elbows, a fair result in 2, and a poor result in 5. The reason for the poor results was a breakage of the humeral component at the junctional portion of its stem. In all five of these elbows a marked resorption of bone mass within the condylar portion of the humeral component was observed on the lateral radiograph. The five elbows with a poor result had a revision operation, and in each of these black staining of the soft tissues within the joint was seen. This tissue metallosis due to wear debris of the titanium alloy was responsible for the osteolysis within the condylar portion. It became clear from this study that even in a non-weight-bearing joint, such as the elbow, titanium alloy may wear and result in tissue metallosis when used as a bearing surface of the implant. However, it was also found that in the majority of the elbows an establishment of the biologic fixation of the porous-coated stem could be achieved by use of this alloy.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
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