1/18. Periarticular calcification in systemic lupus erythematosus.OBJECTIVE: To describe the radiologic manifestations of periarticular calcification in patients with systemic lupus erythematosus (SLE) and to investigate clinical variables associated with its occurrence. methods: hand radiographs and clinical records of 52 patients who had 4 or more features of the 1982 revised criteria for classifying SLE and who had no other collagen vascular diseases were analyzed retrospectively. RESULTS: Periarticular calcifications were found in 7 patients (13.5%) near the distal and proximal interphalangeal (DIP and PIP) joints and metacarpophalangeal (MCP) joints. No significant association with calcification was noted for the following variables: age at disease onset, duration of the disease, sex, the maximum value of the serum calcium, organic phosphate, and uric acid, Raynaud's phenomenon, lupus nephritis, femoral avascular necrosis, central nervous system lupus, proteinuria, or the use of drugs such as corticosteroids, synthetic vitamin d, and nonsteroidal antiinflammatory drugs. However, a significant association was noted with the use of furosemide (p < 0.01 by chi-square). In 5 patients periarticular calcification was observed during or just after hyperuricemia had developed while taking diuretics. CONCLUSION: Periarticular calcification in patients with SLE was seen in the DIP, PIP, and MCP joints, and appeared to be associated with the use of diuretics. If patients with SLE are prescribed a diuretic regimen, crystal associated arthritis should be considered as a possibility when diagnosing oligoarthritis.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/18. reflex extension loss after anterior cruciate ligament reconstruction due to femoral "high noon" graft placement.We describe a rare case of a painful reflex extension loss due to femoral malplacement of an anterior cruciate ligament (ACL) graft in a female high-level athlete. The graft was placed on the femoral site in the "high noon" position combined with a slight medial tibial tunnel placement. The resulting anterior-posterior cruciate ligament impingement near extension caused a persistent functional extension deficit of 20 degrees. Under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a proprioceptive reflex leading to a functional extension loss while the patient is awake. After sacrifice of the graft and subsequent replacement of the ACL, full range of motion was achieved within 2 months. After a 3-year postinjury history of 3 arthroscopies and 2 ACL reconstructions, the athlete reached her preinjury activity level again. This rare cause of a reflex extension loss due to femoral high noon graft placement has not been described previously and should be included as a differential diagnosis when evaluating patients with an extension deficit after ACL reconstruction.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/18. Linear scleroderma with severe leg deformity.Linear scleroderma is an unusual form of localised scleroderma, mainly affecting the legs and occurring primarily in children. Sometimes the linear lesions may extend to involve the underlying muscles and bones, with severe disturbances in growth and possibly flexion deformities of the legs. In this study, two cases suffering from linear scleroderma of the legs are presented.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
4/18. polyethylene wear and acetabular component orientation.BACKGROUND: polyethylene wear contributes substantially to both periprosthetic osteolysis and aseptic loosening after total hip arthroplasty. Acetabular component orientation has been shown to affect the range of motion of the hip as well as contact stresses. A series of studies was designed to test the hypothesis that acetabular component orientation can affect the magnitude and direction of polyethylene wear. methods: A finite-element model was used to compute contact stresses during a normal gait cycle. Wear at the end of each gait cycle was calculated with use of the sliding-distance-coupled finite-element formulation. The wear that was calculated with use of finite-element analysis was validated by comparison with the findings of hip wear simulator studies with the acetabular liner oriented to simulate 45 degrees and 55 degrees of abduction. In a clinical study, fifty-six patients who underwent sixty hip arthroplasties with use of a single prosthetic design were followed for as long as five years. Radiographs were analyzed to measure the abduction angle of the acetabular component and polyethylene wear. RESULTS: The finite-element analysis predicted increased peak contact stresses with an increased abduction angle and reduced peak contact stresses with an increased anteversion angle. Linear wear rates ranging from 0.036 to 0.045 mm/million cycles were also predicted, and increased acetabular abduction angles were predicted to be associated with higher linear wear rates. In the hip wear simulator studies, significantly different wear rates were found between the cups with acetabular abduction angles of 45 degrees and 55 degrees (mean, 17.2 compared with 21.7 mg/million cycles; p < 0.01). In the clinical study, radiographic analysis revealed significant correlation between the acetabular abduction angle and the linear polyethylene wear rate. A 40% increase in mean linear polyethylene wear was seen in cups with an abduction angle of >or=45 degrees. The direction of wear was more medial (by 9.4 degrees ) in cups with an abduction angle of <45 degrees. CONCLUSION: All three studies presented here underlined the importance of optimizing the position of the acetabular component. Careful attention to acetabular position may help to minimize wear.- - - - - - - - - - ranking = 4keywords = near (Clic here for more details about this article) |
5/18. Early MRI findings of the acetabulum and femoral head in a dysplastic hip resulting in a rapid destruction of the hip joint.We documented a case of rapidly destructive arthrosis of the hip joint (RDA), in whom abnormal findings were observed not only in the femoral head but also in the acetabulum on magnetic resonance images (MRI) in the early stage. Radiographs made 1 month after the onset of pain showed a slight narrowing of the joint space. MRI obtained 2 months after the onset detected small foci of low signal intensity in the subchondral area of the femoral head on the T1-weighted images, and a linear pattern of high signal intensity in the lateral side of the acetabulum on the T2-weighted images. During the 17-month follow-up period, this case eventually underwent massive destruction of the femoral head as well as the acetabulum.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/18. Linear IgA dermatosis with severe arthralgia.Linear IgA dermatosis with severe arthralgia is a rare clinical syndrome. Streptococcal infection may be important in its pathogenesis. The rash and arthralgia respond to dapsone although additional treatment with non-steroidal anti-inflammatory drugs and/or corticosteroids may be necessary. A case is presented which illustrates these features.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
7/18. Farber's disease (disseminated lipogranulomatosis)--a pathological, histochemical and ultrastructural study--.The first case of Farber's disease in japan was reported, which was confirmed clinically, biochemically and pathologically. Soon after birth, the patient started developing hoarseness, stridor, fever, muscle hypotonous with retarded psychomotor functions including incapability of sitting alone and head control, joint swelling, subcutaneous nodules, albuminocytologic dissociation in cerebrospinal fluid, nodular corneal opacity, and abnormal findings in electroencephalogram. Lipid analysis on the material obtained from a subcutaneous nodule confirmed the presence of ceramide. Pathologically, the subcutanoues nodules were made up of granulomatous lesions displaying varied histological pictures, i.e., from cellular to fibrous areas depending on the disease progress. In the beginning, cells were mostly spindle-shaped, and as these cells were getting more round and larger, cells manifested the morphology of foam cells. Spindle-shaped cells were positive for periodic acid-Schiff and acid mucopolysaccharide stainings. This particular substance disappeared almost entirely in typical foam cells. Electron microscopically, the cytoplasm of foam cells was filled with membrane-bound storage inclusions which consisted of so-called curvilinear tubular structures. morphogenesis of the granulomatous lesions and histochemical and ultrastructural correlation of storage cells in this disorder were discussed.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/18. Ichthyosiform and morpheaform sarcoidosis.Specific (usually papules and nodules showing a granulomatous histology) and non-specific (e.g. erythema nodosum) cutaneous lesions presenting manifestations of sarcoidosis have been well described. Two patients with unique presentations are here described; one with ichthyosiform cutaneous lesions and one with not previously described cutaneous lesions which mimicked linear morphea (localized scleroderma). The association of articular manifestations without pulmonary involvement was also unusual.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/18. Linear IgA dermatosis with severe arthralgia.Two patients aged 8 and 34 years, with linear IgA dermatosis and systemic symptoms are described. Both presented with fever and sore throat 5 to 10 days before the onset of their rash and both developed severe arthralgia accompanying the skin eruption. The joint pains resolved when the skin eruption was treated.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
10/18. Transient osteoporosis.Six hips in four patients with hip pain, limited range of motion, no antecedent trauma, and normal laboratory studies demonstrated roentgenographic evidence of periarticular osteoporosis. The subchondral cortex was attenuated. There was little or no cartilage loss. The preliminary diagnosis was transient osteoporosis (migratory osteolysis, regional osteoporosis). This problem is most frequently seen in the hip joint in two population groups: men near 40 and women in the third trimester of pregnancy. Other joints may be involved and the process may regress in one joint but recur in another. diagnosis is based on typical clinical and roentgenographic observations including an aspiration of sterile joint fluid. Radioisotope scanning may be helpful. Bone or synovial biopsy sampling is not necessary. Proper management requires accurate diagnosis and conservative treatment of a cooperative patient. pain may persist for six months or longer. Treatment consists of analgesics, protection against stress fractures, and physical therapy for prevention of contractures.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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