Cases reported "Arthralgia"

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1/46. Clinical and laboratory findings in immunocompetent patients with persistent parvovirus B19 dna in bone marrow.

    The clinical relevance of parvovirus B19 dna persistence in bone marrow was examined in 10 immunocompetent individuals undergoing examinations for unexplained fever, arthralgia or chronic leukopenia. Common causes of these symptoms had been ruled out and bone marrow aspiration was indicated at this stage of investigation. In addition to morphological analysis of the bone marrow, a test for B19 dna was performed with 2 nested PCRs. Five of these 10 selected patients had detectable B19 dna in their bone marrow, whereas no viraemia was observed. Additional bone marrow samples were collected at least 6 months after the first sample from the B19 dna-positive patients, of whom 3 were found to be still positive. Indeed, 2 of the patients have been positive for more than 5 y of follow-up. Sera from all patients with persistent B19 dna in bone marrow could neutralize the virus. One patient responded to treatment with immunoglobulin but later relapsed. No other cause of the symptoms was found, despite extensive investigations, and at least some of the prolonged disease manifestations may be due to parvovirus B19.
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2/46. Bilateral discoid medial menisci.

    SUMMARY: This article adds 2 more cases of bilateral discoid medial menisci to the previously reported 9 cases. The radiographs of the first case revealed bilateral cupping of the medial tibial plateaus and a small lytic lesion of the left distal medial femoral metaphysis. Beside the posteriorly unstable incomplete type discoid medial meniscus, the left knee had several associated arthroscopic findings: depression of the medial tibial plateau with exposed subchondral bone, anomalous insertion of the anterior horn of the discoid meniscus to the anterior cruciate ligament, a pathological medial plica, and longitudinal deep fissures in the trochlea. The second case was a complete type with peripheral horizontal cleavage tears. Following arthroscopic surgery, magnetic resonance imaging (MRI) scans of the contralateral knees were obtained in both cases to search for bilaterality. MRI revealed discoid medial menisci in the unoperated knees as well. The short-term results of arthroscopic meniscectomy may not be as satisfactory as those reported for normal menisci.
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3/46. 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.
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4/46. osteochondritis dissecans of the knee: a radiology case report.

    OBJECTIVE: To discuss the case of a patient with osteochondritis dissecans, a common disorder primarily affecting children and adolescent patients that involves the medial femoral condyle, and to examine its radiologic appearance. Clinical Features: A 25-year-old man with knee pain sought treatment at a chiropractic clinic. The patient had a 2-year history of left knee pain that was exacerbated by activity and relieved with rest. Plain film radiography of the knee revealed findings consistent with osteochondritis dessicans. Intervention and Outcome: The patient was promptly referred for a concurrent orthopedic consultation with subsequent management. A trial basis of conservative care was initiated with the possibility of future surgical intervention if necessary. CONCLUSIONS: osteochondritis dissecans is a common disorder of unknown and perhaps controversial cause. The disease is characterized by a fragment of articular cartilage and subchondral bone (osteochondral fragment) that becomes separated from the underlying bone. Treatment is aimed primarily at the preservation of articular surface congruity.
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5/46. Arthroscopic removal of os centrale carpi causing wrist pain.

    The os centrale carpi is a relatively rare accessory carpal bone of the wrist that infrequently has been reported to cause symptoms. This report describes 2 cases where an apparently mobile os centrale carpi caused painful clicking and crepitus and where the symptoms disappeared after arthroscopic removal of the ossicles.
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6/46. Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain.

    It has been reported that almost 50% of lunates have a separate medial facet on the distal surface for articulation with the hamate; about a quarter of these have erosion of the cartilage with exposed subchondral bone on the proximal pole of the hamate. We describe 4 cases of ulnar-sided wrist pain caused by hamato-lunate impingement that resulted in chondromalacia. The pain could be reproduced by a modification of the Lichtman test. The diagnosis was confirmed by arthroscopy. All 4 patients responded favorably to resection of the head of the hamate.
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7/46. Gross vertebral collapse associated with long-term disodium etidronate treatment for pelvic Paget's disease.

    Inhibition of skeletal mineralisation is a well-recognized complication of disodium etidronate therapy that was identified in the earliest studies of its use in osteoporosis and Paget's disease. The effect is seen at lower doses in Paget's disease than in osteoporosis. Several cases of spontaneous fractures occurring in unaffected bones of Paget's patients have been reported. However, we believe the case described here is the most severe example of etidronate-induced osteomalacia published in the literature, featuring widespread vertebral collapse occurring as a consequence of nearly 10 years of uninterrupted etidronate treatment for isolated hemipelvic Paget's disease.
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8/46. sarcoidosis presenting with large vessel vasculitis and osteosclerosis-related bone and joint pain.

    A 34-year-old African-American female diagnosed earlier with idiopathic thrombocytopenic purpura (ITP), lymphadenopathy, splenomegaly, uveitis, and pulmonary nodules, developed a subclavian artery aneurysm, and generalized annular osteosclerotic lesions with disabling arthralgias. Biopsies from bone and lymph node revealed non-caseating granulomas and no evidence of malignancy or infection, confirming the clinical impression of sarcoidosis.
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9/46. Realignment of tibial deformity in Paget's disease. A case report.

    Paget's disease of bone is a relatively common condition which usually is asymptomatic. Furthermore, there is limited experience in surgical procedures, especially in realignment of severe skeletal deformities. Likewise, there are often relapses in tibial deformities treated with plates. We report a case of a severe tibial deformity treated with multiple osteotomies and stabilized with an unreamed medullary nail.
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10/46. Avascular necrosis in the femoral head secondary to bone marrow infarction in a patient with graft-versus-host disease after unrelated bone marrow transplantation.

    We previously reported a case of bone marrow infarction attributable to acute graft-versus-host disease (GVHD) in a patient with acute lymphoblastic leukemia after unrelated bone marrow transplantation (BMT). Although the bone marrow infarction-induced arthralgia in this patient improved, severe arthralgia appeared again with exacerbation of chronic GVHD, and the arthralgia was strongly correlated with the clinical course of chronic GVHD, i.e., the course of symptoms such as dermal and hepatic GVHD and ocular dryness. Finally, the patient developed avascular necrosis (AVN) in the right femoral head. serum interleukin (IL)-6 and IL-10 levels were high at the onset of arthralgia but low during remission, and levels of interferon-gamma were undetectable throughout the period of arthralgia. Based on the clinical course and these data, chronic GVHD was thought to have been the major cause of the AVN. Since IL-10 antagonizes various other cytokines that induce GVHD, the increase in IL-10 might have inhibited the development of GVHD.
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