Cases reported "Joint Diseases"

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1/63. Synovial actinomycosis of the hip: case report and review.

    A case of hematogenous spread of an actinomycotic granule to the left hip joint is presented. This occurred in a 62-year-old woman under immunosuppressive treatment for Wegener's disease. It was a chance finding on routine synovium biopsy during a total hip replacement. Treatment consisted of 1 g ampicillin I.M. a day for six weeks. The postoperative course was uneventful.
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keywords = synovium
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2/63. Giant-cell tumor of the synovial membrane: localized nodular synovitis in the knee joint.

    Giant-cell tumor of the synovia is a benign neoplasm characterized histologically by proliferating histiocytes bearing lipids and hemosiderin intermingled with a variable number of multinuclear giant cells. Areas of predilection are the hand, and in the case of synovial joints, the knee joint is particularly affected. Clinically, patients have signs of mechanical derangement and, with the knee joint, meniscal symptoms and locking are often present. Joint effusion without previous trauma is another typical finding. diagnosis is carried out by radiographic tools and has to be confirmed histologically. Giant-cell tumor of the synovia is treated by local excision either by arthroscopy or by arthrotomy. To our knowledge, the case we present is the largest giant-cell tumor of the synovia in the knee joint ever described in literature.
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ranking = 15.48823722712
keywords = synovial membrane, membrane
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3/63. Acral synovial chondrosarcoma.

    Acral chondrosarcoma is rare. Synovial chondrosarcoma is even rarer. Synovial chondrosarcoma arising without evidence of pre-existing or concurrent synovial chondromatosis is exceedingly rare. We present a case of acral synovial chondrosarcoma involving both sides of the metacarpophalangeal joint of the thumb in a 69-year-old man. Radiographically, the lesion mimicked gout. On MR imaging, the lobulated contours of the soft tissue mass suggested synovial chondromatosis. Histological examination revealed a chondrosarcoma, which on the basis of imaging findings we present as having arisen from the synovium. The tumor invaded a portion of the cartilage of the metacarpophalangeal joint and equally destroyed the bones of the distal metacarpal and base of the proximal phalanx of the thumb, while sparing the bony joint surfaces.
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keywords = synovium
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4/63. Synovial cysts of the proximal tibiofibular joint: three case reports.

    Synovial cysts are fluid-filled masses lined with synovium and located within or about joints. The main symptoms are pain and/or neurological deficits. They can be intraneural or extraneural or develop between or within muscles. Synovial cysts that arise at a distance from a joint raise diagnostic challenges. We report three cases of synovial cysts of the proximal tibiofibular joint, including an intramuscular cyst responsible for paralysis of the anterolateral leg muscles. Tibiofibular synovial cysts are less common than popliteal cysts, and their pathophysiology is poorly understood. pressure on the common peroneal nerve is the main complication and requires careful surgical excision of the cyst. Injection of a glucocorticoid into the cyst can be used as the first-line treatment in patients without common peroneal nerve symptoms.
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keywords = synovium
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5/63. Synovial hemangioma. Description of a case.

    Intra-articular angioma, or vascular hamartoma, is a tumor-like lesion essentially made up of anomalous blood vessels localized in the joint capsule, in the synovial membrane, or in both structures. There are two anatomical varieties: one circumscribed localized and one extended. There seems to be predilection for the female sex, and age of onset ranges from birth to 20-30 years of age; it occurs more frequently in the knee, less in the elbow, in the wrist and in the ankle. Symptoms, which often begin after local trauma, include joint swelling and pain, both characterized by discontinuity and long duration. Sometimes there is an increase in swelling, repeated episodes of hemarthrosis (or hydrarthrosis), forced position and functional limitation of the joint, increase in skin temperature. Final diagnosis can only be obtained with histological examination, although MRI may be useful and arteriography clearly reveals it, if the harmatoma is extended enough and communicating with the circulation. Histological examination carried out on fragments of tissue taken in loco reveals a labyrinthine agglomerate of fissures and lengthening cavities, with walls that are generally thick and of a venous-like anomalous type. The course of the disease is slow, with periods of remission of local symptoms of varying duration. Treatment is surgical and it consists in complete removal when possible of the angiomas. The results, particularly in the localized form, are satisfactory; recurrence is infrequent and it is generally due to incomplete excision of the neoformation.
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ranking = 3.87205930678
keywords = synovial membrane, membrane
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6/63. Cardiopulmonary complications in multicentric reticulohistiocytosis. Report of a case.

    Multicentric reticulohistiocytosis (MR) is a rare disease. Only recently was its systemic nature appreciated. It affects the skin, mucous membranes, joints, muscles, tendon sheaths, synovial membranes, bones, liver, kidney, lymph nodes, heart, and lungs. Our patient, a 50-year-old woman, had life-threatening cardiopulmonary complications of MR. The connection between the skin lesions, the arthritis, and the pathologic changes in the heart and lungs is still obscure.
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ranking = 3.872168454754
keywords = synovial membrane, membrane
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7/63. lipoma arborescens; successfully treated by yttrium-90 radiosynovectomy.

    Although radiosynovectomy (RS) applications have been carried out for many years, clinical indications of this non-invasive procedure is thought to be limited probably due to the lack of information of clinicians. Clinicians' preferential indication for RS is the treatment-resistant synovitis of individual joints, i.e. despite systemic pharmacotherapy and intra-articular steroid injections. We present here a case of "lipoma arborescens" treated by yttrium-90, which is a rare intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of subsynovial fat. The results of clinical, biochemical and hematological examinations, magnetic resonance (MR) imaging, arthroscopy and histological analysis have shown that the etiology was lipoma arborescens in a female patient, aged 36 having swelling and sometimes associating pain at her right knee for 4 years. We have applied to our patient's right knee RS with 185 MBq yttrium-90 colloid together with 40 mg of methylprednisolone acetate, although in our literature survey we have not met any similar case being treated with such indication. Even a year after the application, the patient has absolutely benefited from the treatment clinically, and this was also confirmed by comparative MR images (pre- and post-treatment). Consequently, we consider that Y-90 treatment might be applicable in suitable cases with lipoma arborescens.
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ranking = 3.87205930678
keywords = synovial membrane, membrane
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8/63. Needle biopsy of joints--its contribution to the diagnosis of ochronotic arthropathy (alcaptonuria).

    The authors present the case history of a 48-year-old man with ochronosis. They discuss the possibilities of articular needle biopsy in the diagnosis of this disease. The histology of the synovial membrane may help establish the diagnosis of ochronotic arthropathy.
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ranking = 3.87205930678
keywords = synovial membrane, membrane
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9/63. alkaptonuria, ochronosis, and ochronotic arthropathy.

    OBJECTIVES: To describe the clinical presentation and course of a relatively large group of Italian adult patients screened for mutation of the homogentisate dioxygenase gene causing alkaptonuria (AKU) and ochronosis, and to review typical and atypical facets of this condition. methods: We reviewed the medical records of 9 patients affected by ochronotic arthropathy who were observed in our institutions between 1979 and 2001. All patients were diagnosed as having AKU through a rapid urine test with alkali. mutation screening was performed by single-strand conformation analysis of all homogentisate dioxygenase exons, followed by sequencing of altered conformers. RESULTS: Our 9 cases had similar clinical features and they reflected those described in the literature: a progressive degenerative arthropathy mainly affecting axial and weight-bearing joints associated with extraarticular manifestation. Musculoskeletal symptoms began in most of our patients around the age of 30 years with back pain and stiffness: involvement of the large peripheral joints usually occurred several years after spinal changes. Ochronotic peripheral arthropathy generally was degenerative, but joint inflammation was observed in some cases; this could be attributed to an inflammatory reaction of the ochronotic shard in the synovial membrane. CONCLUSIONS: ochronosis is a model of arthropathy with known etiologic factors. Over time, AKU, the genetically determined metabolic defect, leads to the accumulation of pigment and the development of this crippling condition. Most of the clinical findings may be explained by inhibition of collagen crosslinks, but some require additional interpretation. For example, inflammatory features of the ochronotic joint only occur in a minority of cases, and may be attributable to ochronotic shards. Further studies are needed to establish the genotype-phenotype correlation to identify mutations that are predictive of severe disease. For this purpose, the Italian Study Group on alkaptonuria (www.dfc.unifi.it/aku) is enrolling affected patients in an on-line database to characterize the molecular defects and their relationship to clinical data.
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ranking = 3.87205930678
keywords = synovial membrane, membrane
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10/63. Case report 745: Synovial lipoma arborescens.

    A case is presented of lipoma arborescens of the knee with an atypical, sudden onset. arthrography and ultrasound confirmed a synovially based lesion in the suprapatellar pouch. CT enabled a preoperative diagnosis of lipoma arborescens to be made, which was confirmed by surgical excision of a fronded fatty mass. Histological studies showed hyperplastic villi with mature adipose cells in the subsynovial layer. Resection of the synovium is considered curative, with only one case of recurrence after synovectomy having been reported [4].
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ranking = 1
keywords = synovium
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