1/17. Unilateral osseous bridging between the arches of atlas and axis after trauma.STUDY DESIGN: This is a case report. OBJECTIVE: To present a case of osseous bridging between C1 and C2 of posttraumatic origin and with an associated closed head injury and to discuss its pathogenesis and clinical outcome after surgical resection. SUMMARY OF BACKGROUND DATA: Heterotopic ossifications of posttraumatic origin in the spine are rare. To the authors' knowledge, no cases have been reported of spontaneous bony bridging between C1 and C2 with a posttraumatic origin. methods: Heterotopic ossifications were detected when pain and limited axial rotation (left/right 10 degrees/0 degree/20 degrees) were persistent, despite intensive physical therapy. Because heterotopic ossifications were ankylosing C1 and C2, the decision was to resect the osseous bridge in combination with a careful mobilization of the cervical spine. Functional computed tomography was performed for analysis of the postoperative results. RESULTS: Four months after surgery, clinical examination showed asymptomatic increased axial rotation. Functional computed tomography indicated that left C1-C2 axial rotation was reduced, possibly related to impingement caused by residual bony spurs. Pathologic changes in the surrounding soft tissue may be another important factor in the persistent limitation of rotation. CONCLUSIONS: Osseous bridging between C1 and C2 may be considered when persistent pain and limited axial rotation are observed after trauma. Operative resection, together with careful intraoperative and postoperative mobilization, may be the treatment of choice.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/17. iliac vein thrombosis complicating SAPHO syndrome: MRI and histologic features of soft tissue lesions.Subclavian and superior vena cava obstruction complicating SAPHO (synovitis, Acne, Pustulosis, hyperostosis, osteitis) syndrome has been described. We report the first case to our knowledge of iliac vein thrombosis complicating lumbar vertebral osteitis due to SAPHO syndrome. Lumbar MRI demonstrated a large tissue mass anterior to the involved vertebras and surrounding the right iliac vein. histology of the mass showed aseptic inflammation.- - - - - - - - - - ranking = 4keywords = soft (Clic here for more details about this article) |
3/17. Destructive diskovertebral lesions in ankylosing spondylitis: appearance on magnetic resonance imaging.We report magnetic resonance imaging findings of diskovertebral lesions in a case of ankylosing spondylitis mimicking metastatic and/or infectious disease. Multiple hypointense areas were seen on T1-weighted images corresponding to hyperintense areas on T2-weighted images in dorsal, lumbar, and sacral vertebral bodies and the manubriosternal joint, with accompanying soft tissue masses. diagnosis was achieved through biopsy, regression of the paravertebral soft tissue masses, later detection of bilateral sacroiliitis on computed tomography, and presence of histocompatibility antigen HLA-B27.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
4/17. Co-occurrence of spondyloarthropathy and connective tissue disease: development of sjogren's syndrome and mixed connective tissue disease (MCTD) in a patient with ankylosing spondylitis.spondylarthropathies (SpA) and connective tissue diseases (CTD) are clinically distinct entities which, at first glance, seem to have little in common. However, a link between SpA and CTD has recently been suggested by a study in which a higher prevalence of sjogren's syndrome (SS) and sicca symptoms was reported in patients with ankylosing spondylitis (AS) and undifferentiated SpA (1). Another link between SpA and CTD is a possible side effect of a DMARD widely used to treat SpA: sulfasalazine (SAS). SAS was reported to induce antinuclear antibodies (ANA) and systemic lupus erythematosus (SLE)-like syndromes such as drug-induced lupus. This report describes a 54-year-old white male, HLA B27-positive AS patient with some syndesmophytes who, after 15 years of disease, developed SS with salivary gland involvement, Raynaud's syndrome and anti-Ro antibodies. Then, 20 years after the onset of AS, he became acutely ill, suffering severe myositis and myocarditis along with swollen hands and highly elevated autoantibody titers recognizing UIRNP; his condition was interpreted as mixed connective tissue disease (MCTD). The patient had been treated with SAS and azathioprine (AZA) alone several times during the last years because he had not tolerated other DMARDs. A combination of both drugs had been prescribed 3 weeks before a severe flair because of progredient high disease activity with painful peripheral arthritis of the MCP and PIP joints which, however, had not shown radiographic erosions. We describe the rare development of MCTD in an AS patient and report, for the first time, the onset of MCTD potentially triggered by sulfasalazine.- - - - - - - - - - ranking = 677.58891966759keywords = connective (Clic here for more details about this article) |
5/17. Juvenile ankylosing spondylitis with uveitis.A 17-year-old boy had suffered from right ankle arthralgia when he was 13 years old. He also had bilaterally congested conjunctivas and were erythematous around his right ankle joint. A soft tissue echo showed swelling of the right ankle joint. A Ga 67 scan revealed a focal elevated uptake in the right ankle, but a bone scan was negative. Reactive arthritis was suspected due to conjunctivitis, arthritis and a previous episode of watery diarrhea. An ophthalmologic examination showed no evidence of uveitis. Laboratory data were negative for rheumatoid factor, antinuclear antibody and anti-ds dna. Erythrocyte sedimentation rate (ESR) was 40 mm/hr and a histocompatibility test was positive for antigen B27. Based on the diagnosis of cellulitis and reactive arthritis, oxacillin and naproxen were given for 14 days. During follow-up at the OPD, bilateral arthralgia of the ankle joints was noted and a sonography showed bilateral edematous ankle joints. Juvenile ankylosing spondylitis (JAS) was suspected. Two years later, he had lower back pain and arthralgia of the knee joints with uveitis of the right eye. He was treated with naproxen and prednisolone. Because few JAS cases initially present as axial arthropathy or enthesopathy and uveitis is uncommon in children, we presented the case with a review of literature and conclusion that the possibility of JAS should be considered in young adolescent boys with arthritis of the lower limbs, enthesitis, a family history of related diseases and positive HLA-B27, as well as negative rheumatoid factor (RF) and anti-nuclear antibody (ANA) results.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/17. Abdominal aortic aneurysm with arteritis in ankylosing spondylitis.Abdominal aortic aneurysm with arteritis in ankylosing spondylitis is described. An abdominal aortic aneurysm, 48-mm in diameter, in a 68-year-old woman with HLA-B27-associated ankylosing spondylitis was successfully replaced with a tube graft. The suture lines of the aortic wall were reinforced with Teflon felt strips. Pathologic examination of the aneurysmal wall revealed hyalinization of the connective tissue, with numerous lymphocytic infiltrates, remarkable calcification, and no elastic fibers. The original structure of the arterial wall was not recognized. These findings are compatible with aortitis reported in ankylosing spondylitis.- - - - - - - - - - ranking = 67.758891966759keywords = connective (Clic here for more details about this article) |
7/17. myositis ossificans progressiva mimicking ankylosing spondylitis: a case report.myositis ossificans progressiva is a rare disorder of young adults characterized by ossification of the connective tissue of the voluntary muscles and ligaments. Although it is trauma-related, up to 40-60% of these patients have no history of previous injury. A young female with marked kyphosis and ankylosis of the spine presented with a recent onset of a rapidly growing painful mass over the anterior aspect of her left shoulder. She received an excisional biopsy but recurrent ossification developed soon after. It then spread to the biceps muscle with subsequent contracture deformities of the shoulder and elbow joints. A plain radiogram of her spine revealed similar characteristics of ankylosing spondylitis. However, the final diagnosis was made by the pathognomonic ectopic ossification of muscles and para-articular soft tissue. Despite poor response of the established constracture, the painful mass did respond well to prednisolone treatment within 2 months, in terms of size and consistency.- - - - - - - - - - ranking = 68.758891966759keywords = connective, soft (Clic here for more details about this article) |
8/17. Multiple and simultaneous spine fractures in ankylosing spondylitis: case report.STUDY DESIGN: A case report. OBJECTIVE: To report the unique occurrence and treatment of multiple and simultaneous spine fractures in a patient with progressed ankylosing spondylitis and preexisting multilevel spine instrumentation. SUMMARY OF BACKGROUND DATA: Ankylosing spondylitis is a complex inflammatory arthritic condition that renders the spine more susceptible to fracture than individuals who do not have ankylosing spondylitis. To our knowledge, in the patient with ankylosing spondylitis, the occurrence of nonregion-specific multiple and simultaneous spine fractures, and the role of internal instrumentation in subsequent fracture development have not been addressed in the literature. methods: An 81-year-old white male with ankylosing spondylitis had 2 low-energy falls, resulting in 3 spine fractures. During the first fall, he had a displaced fracture at the T11-T12 level without a spinal cord injury. Fracture treatment entailed posterior instrumentation with fusion at T8-L2 and immobilization after surgery with a thoracolumbosacral orthosis brace, which led to successful healing of the injury. Approximately 2 years later, the patient had a second fall, and presented with simultaneous displaced fractures at the C6-C7 and L2-L3 levels, and an American Spinal Injury association-A spinal cord injury. The cervical and lumbar fractures were both treated operatively via a 2-staged approach with posterior segmental instrumentation and fusion at C3-T3 and at L2-L5, respectively. A soft cervical collar and a thoracolumbosacral orthosis brace were worn after surgery. There were no intraoperative complications. RESULTS: Although anatomic reduction and stable fixation of the spinal injuries were achieved, the patient's neurologic status following the second injury remained unchanged. His postoperative course was complicated by pulmonary failure that ultimately resulted in death by the 3-month postoperative time. CONCLUSIONS: patients with ankylosing spondylitis have a strong susceptibility to spine fracture from minor trauma, which can have devastating outcomes. Nonregion-specific multiple and simultaneous spine fractures can occur, and require thorough radiographic evaluation with imaging of the entire spinal axis, appropriate operative planning, and meticulous perioperative treatment. Preexisting internal spine instrumentation may predispose the ankylosing spondylitis spine to multiple fractures, even following a minor traumatic event. As such, the clinician should be cognizant of the possible existence of multiple and simultaneous fractures in patients with ankylosing spondylitis with preexisting internal spine instrumentation.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/17. Late complications after a yersinia enterocolitica epidemic: a follow up study.Ninety four Finnish conscripts were affected by a yersinia enterocolitica epidemic in 1973. Thirteen years later 75 men completed a questionnaire about their present health. One half had no health problems, and the most common complaints in the other subjects were musculoskeletal disorders. Sixteen men wanted to be re-examined. In three cases a chronic connective tissue disease was diagnosed. Two men had ankylosing spondylitis. The most notable results of this study were (a) the fairly low number of late complications, (b) the close correlation between complications and the hla-b27 antigen, and (c) the correlation between raised yersinia antibody titres and the late complications. The nature of the primary causative agent may affect the development of late complications.- - - - - - - - - - ranking = 67.758891966759keywords = connective (Clic here for more details about this article) |
10/17. hemothorax--an unusual presentation of spinal fracture in ankylosing spondylitis.patients with ankylosing spondylitis are susceptible to spinal fractures. In many cases there is no history of associated trauma or only minor trauma. The instability of such fractures and complicating neurologic sequelae are well documented. We describe an unusual complication of ankylosing spondylitis, hemothorax secondary to spinal fracture, that to our knowledge has not been previously reported. Further, we reemphasize that the instability of such fractures may lead to significant paravertebral soft tissue and vascular injuries.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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