1/923. magnetic resonance imaging diagnosis, sonographically directed percutaneous aspiration, and arthroscopic treatment of a painful shoulder ganglion cyst associated with a SLAP lesion. A 30-year-old, right-handed man presented with the insidious onset of right shoulder pain associated with overhead activities. magnetic resonance imaging revealed a perilabral ganglion cyst associated with a SLAP lesion (lesion of the superior labrum, both anterior and posterior). After unsuccessful treatment with sonographically directed percutaneous aspiration of the cyst, arthroscopic techniques were employed to intra-articularly decompress the cyst and stabilize the labral tear. ( info) |
2/923. Juvenile hyaline fibromatosis: clinical heterogeneity in three patients. BACKGROUND: Systemic hyalinoses are genetic generalized fibromatoses characterized by an accumulation of hyalin in the dermis. Two distinctive syndromes are recognized in the literature: infantile systemic hyalinosis (ISH) and juvenile hyaline fibromatosis (JHF). ISH and JHF are sometimes difficult to separate since they show significant overlap. OBSERVATIONS: We report on 3 children from two unrelated families suffering from JHF. The first child is severely handicapped by joint contracture, massive hyperplasia of the gingivae, diffuse skin papules and subcutaneous nodules occupying the scalp, face, perianal area, palms, soles and chest. At the same age, the second child only shows pearly skin papules on the face, groin and perianal area and gingival hyperplasia without joint stiffness or any other subjective complaint. The third patient, a brother of the second child, developed mild skin abnormalities by the end of the first year. The occurrence in siblings and consanguinity in the second family suggests autosomal recessive inheritance. Histological skin examination in the 3 cases showed hyaline deposition in the dermis and abnormal ultrastructure of fibroblasts. Biochemical findings showed mucopolysaccharide abnormalities in both families. CONCLUSION: Our patients do not only illustrate the different expressions of JHF but also show some overlap with ISH, suggesting a common cause for both disorders. Genetic studies will finally answer this question. ( info) |
3/923. Systemic hyalinosis of delayed onset. We report a 46-year-old Japanese male with systemic hyalinosis. The condition had not been present during youth but was clearly evident in the patient's forties. The present case is remarkable because of a delayed onset. ( info) |
4/923. The management of a person with haemophilia who has a fixed flexed hip and intractable pain. The clinical picture of a fixed flexed hip associated with pain in a person with haemophilia is suggestive of a haemorrhage in that area. Sonography facilitates differentiation between a haemarthrosis, intraperitoneal haemorrhage, subperiosteal bleed, a bleed into the soft tissue around the hip joint or a psoas haematoma. All these aforementioned causes may result in the same clinical presentation. Two cases are described in which coxhaemarthrosis resulted in a flexion contracture of the joint associated with severe intractable pain. Narcotic drugs failed to alleviate the severe pain. Joint aspiration produced dramatic pain relief and early joint rehabilitation. ( info) |
5/923. Clonal chromosomal changes in juxta-articular myxoma. cytogenetic analysis of a juxta-articular myxoma revealed two distinct cytogenetically abnormal cell populations: inv(2)(p15q36) and 7, t(8;22)(q11-12; q12-13). These clonal chromosomal changes, the first to be reported in this tumour type, suggest that at least some juxta-articular myxomas are neoplastic rather than reactive in nature. ( info) |
6/923. 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. ( info) |
7/923. Childhood lipoma arborescens presenting as bilateral suprapatellar masses. Synovial lipomatous proliferations are uncommon idiopathic lesions. Suprapatellar synovial plicae commonly are diagnosed with mechanical knee problems. However, it is not widely known that these plicae can isolate the suprapatellar pouch from the rest of the knee joint. We describe a case of complete bilateral compartmentalization of the suprapatellar pouch (plica synovialis suprapatellaris) in which a 10-year-old boy developed articular tumors isolated in this area. Arthroscopic synovectomy specimens revealed the lesions to represent lipoma arborescens. Rheumatologists should be aware of these two findings when examining a child with swollen knee. ( info) |
| We describe a twenty-six year old patient who presented us with a dorsally retracted 'hidden' penis, which was entrapped in scar tissue and prevesical fat, 20y after a pelvic fracture with symphysiolysis. Penile 'lengthening' was performed by V-Y plasty, removal of fatty tissue, dissection of the entrapped corpora cavernosa followed by ventral fixation. ( info) |
9/923. Calcified bodies in popliteal cysts: a characteristic radiographic appearance. Calcified bodies in popliteal cysts have a characteristic radiographic appearance which can be confirmed by arthrography. Calcified bodies may arise in the true joint due to trauma, arthropathy resulting in joint destruction, or synovial osteochondromatosis. These calcified loose bodies may pass into a popliteal cyst through posterior joint-bursal communications or can arise in a popliteal cyst by chondrometaplasia. Correct radiographic interpretation will exclude soft tissue tumors and vascular lesions as differential considerations. Management of these patients will be determined by the clinical circumstances since neither popliteal cysts nor synovial osteochondromatosis are necessarily symptomatic. ( info) |
10/923. The locked patella. An unusual complication of haemophilia. Mechanical derangements of the knee are an uncommon complication of chronic haemophiliac arthropathy. Two patients with locking of the patella were treated by manipulation. The mechanism of the injury was forced flexion of the knee joint beyond the limit of its restricted range. The injury is a serious one and may take six months to recover. ( info) |