Cases reported "Arthritis, Rheumatoid"

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11/85. hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports.

    Rheumatoid arthritis (RA) involvement of the cervical spine is a well-known but perhaps underappreciated phenomenon. Neurologic complications of this involvement include pain, myelopathy, and cranial nerve (CN) palsies. However, hypoglossal nerve palsy (CN XII) is rarely diagnosed. Mechanical nerve injury, either from vertical odontoid subluxation or pannus formation, is the suspected mechanism. We present 2 cases of hypoglossal nerve palsy attributed to cervical spine involvement of RA and 1 case of postoperative tongue weakness after cervical fusion in a patient with long-standing RA. These cases show a potentially devastating complication of RA that may be underdiagnosed. Therapy involving the cervical spine must be prescribed with caution in this patient population.
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ranking = 1
keywords = operative
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12/85. Surgical treatment of aortic valvular disease in rheumatoid arthritis.

    Two patients with severe rheumatoid arthritis and aortic regurgitation, developed progressive symptoms of left ventricular failure. Symptoms were inadequately controlled by medical therapy. Surgical treatment was at first considered with great reluctance because of the theoretical risk of operative and postoperative complications in patients with a diffuse disease of connective tissue. The suspected complications did not materialize. Valvular replacement should be considered in patients with severe valvular disease associated with rheumatoid arthritis.
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ranking = 2
keywords = operative
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13/85. Case challenges in shoulder surgery: what would you do?

    The management of complex shoulder issues was discussed in an interactive case presentation session. Patient scenarios discussed included reoperation of a rotator cuff repair with a subscapularis tear; uncemented hemiarthroplasty presenting with pain and osteolysis; severe osteoarthritis with all nonoperative options exhausted; rheumatoid arthritis with pain and diminished function; and significant pain, limited motion, and weakness in an active patient.
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ranking = 1
keywords = operative
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14/85. posterior tibial tendon dysfunction and MR imaging in rheumatoid arthritis.

    We present the case of a patient with long-standing rheumatoid arthritis and an acute onset of total dysfunction of the posterior tibial tendon. On MRI, a rupture of the tendon was apparent. Intraoperatively, however, massive tenosynovitis with stricture of the tendon was identified as the cause of posterior tibial tendon dysfunction. This case illustrates a pitfall in MRI imaging with potential diagnostic and therapeutic consequences.
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ranking = 1
keywords = operative
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15/85. Cricoarytenoid arthritis: a cause of acute upper airway obstruction in rheumatoid arthritis.

    PURPOSE: To report acute upper airway obstruction due to cricoarytenoid arthritis, a well known but uncommon complication of rheumatoid arthritis. CLINICAL FEATURES: We report the case of a 70-yr-old female scheduled for a colostomy who had been suffering from rheumatoid arthritis for 17 years. Preoperative history and physical examination revealed no cardiopulmonary compromise. anesthesia was induced while an assistant immobilized the cervical spine and an atraumatic intubation was performed. Surgery was uneventful. Muscle paralysis was reversed, demonstrated by normalization of the train-of-four response, and the patient was extubated awake. Shortly postextubation, the patient developed inspiratory stridor, which disappeared after a second dose of neostigmine. The patient was transported to the postanesthesia care unit. Just prior to arrival the patient once again developed inspiratory stridor, became distressed, and oxygen saturation decreased. Direct laryngoscopy followed by a nasal fibreoptic examination of the larynx was performed. Cricoarytenoid arthritis secondary to rheumatoid arthritis with airway compromise was diagnosed. An uneventful awake tracheostomy was performed. The patient was discharged on day ten with a colostomy and a tracheostomy in place. One month postdischarge the patient's trachea was decannulated. On follow-up, a normal voice and mobile cords were observed. CONCLUSION: Cricoarytenoid arthritis is an infrequent complication of rheumatoid arthritis. A thorough history and physical examination are necessary to recognize signs and symptoms of cricoarytenoid arthritis. Prompt recognition of airway obstruction due to cricoarytenoid arthritis is essential for appropriate management.
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ranking = 1
keywords = operative
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16/85. Antiinflammatory effect of preoperative ketorolac in phacoemulsification.

    We report the antiinflammatory effect and efficacy of preoperative treatment with ketorolac in a patient with rheumatoid arthritis having phacoemulsification. This 70-year-old woman was on a maintenance dose of systemic methylprednisolone at the time of uneventful phacoemulsification in the left eye. She developed a sterile hypopyon on the first postoperative day and was treated aggressively with topical and systemic therapy, resulting in a gradual resolution of the inflammatory response. The patient subsequently had phacoemulsification in the right eye. The only significant difference in the preoperative management this time was that the patient received topical ofloxacin and ketorolac 4 days before surgery. The postoperative inflammatory response was much more controlled. The patient was continued on ketorolac and prednisolone acetate, resulting in the usual postoperative inflammatory response.
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ranking = 9
keywords = operative
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17/85. Rheumatoid arthritis of the cricoarytenoid joints: an airway hazard.

    The anesthesiologist must maintain a high index of suspicion for the presence of cricoarytenoid arthritis and vocal-cord fixation in the rheumatoid arthritic. He must be prepared to intubate the trachea blindly, attempting to minimize trauma by using a smaller endotracheal tube. Indirect laryngoscopy, or direct laryngoscopy using a fiberoptic laryngoscope, may be indicated as part of the preanesthetic evaluation. In some instances, preanesthetic tracheostomy or an alternative regional anesthetic technic may be appropriate. Unusually close vigilance in the postoperative period may be required to detect signs of postextubation airway obstruction.
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ranking = 1
keywords = operative
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18/85. Salvage of major joint prostheses in aggressive non-specific panniculitis.

    panniculitis is a relatively rare condition, which is usually treated non-operatively. We present a case of panniculitis causing an acute septicaemic episode and threatening the integrity of underlying joint prostheses. The situation was salvaged by radical debridement of the affected areas, and reconstruction using split-skin grafts. Considerations in the management of patients with this condition are discussed.
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ranking = 1
keywords = operative
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19/85. spinal cord injury following osteoporotic vertebral fracture: case report.

    STUDY DESIGN: This report details the sudden catastrophic neurologic deterioration concerning a patient with an acute fracture of T5 associated with osteoporosis. OBJECTIVE: To describe a unique presentation of abrupt spinal cord injury in this condition. SUMMARY OF BACKGROUND DATA: Vertebral fractures occur frequently in osteoporosis, but associated spinal cord injury is a rare occurrence. When neurologic injury occurs it is generally of a very low incidence and with a gradual onset, and spontaneous recovery can be expected. Most reports in the literature are of delayed-onset paraplegia after vertebral collapse. We report a unique case of a sudden and catastrophic thoracic spinal cord injury occurring spontaneously. methods: An 88-year-old woman had a sudden thoracic vertebral fracture with complete spinal cord injury while attempting to get out of bed. She was treated with continuous oral corticosteroids for >40 years for both rheumatoid arthritis and restrictive lung disease. She was never investigated or treated for osteoporosis. RESULTS: Plain radiographs indicated multilevel osteoporotic fractures throughout the spine with diffuse, marked osteopenia. magnetic resonance imaging scans showed changes in keeping with severe vertebral osteoporosis and spinal cord injury. She was treated nonoperatively in view of the extremely osteoporotic spine and her overall poor medical condition. Despite an initial improvement in her respiratory condition with medical therapy, she died 72 hours following admission. CONCLUSION: With increasing awareness of the morbidity attached to the osteoporotic spine, investigation and pharmacologic treatment are warranted and may reduce the possibility of catastrophic neurologic impairment as occurred in this case.
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ranking = 1
keywords = operative
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20/85. Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report.

    Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.
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ranking = 3
keywords = operative
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