1/12. Stress-related primary intracerebral hemorrhage: autopsy clues to underlying mechanism.BACKGROUND: research into the causes of small-vessel stroke has been hindered by technical constraints. Cases of intracerebral hemorrhage occurring in unusual clinical contexts suggest a causal role for sudden increases in blood pressure and/or cerebral blood flow. CASE DESCRIPTION: We describe a fatal primary thalamic/brain stem hemorrhage occurring in the context of sudden emotional upset. At autopsy, the brain harbored several perforating artery fibrinoid lesions adjacent to and remote from the hematoma as well as old lacunar infarcts and healed destructive small-vessel lesions. CONCLUSIONS: We postulate that the emotional upset caused a sudden rise in blood pressure/cerebral blood flow, mediating small-vessel fibrinoid necrosis and rupture. This or a related mechanism may underlie many small-vessel strokes.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/12. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/12. Mitral stenosis due to fibrous tissue overgrowth after mitral valve repair.We report an extremely rare case of fibrous tissue overgrowth 3 years after mitral valve repair using a mitral annuloplasty ring in a 53-year-old woman who underwent mitral valve replacement for mitral stenosis. Whitish fibrous tissue had overgrown from the ring on the atrial side of the annulus, and had severely reduced the valvular area. However, the motion of the mitral leaflets was not restricted. Considering the presence of concomitant aortitis syndrome, it is strongly suggested that the overgrowth of fibrous tissue was promoted as a reaction to chronic inflammation.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/12. Dorsal Dupuytren's disease causing a swan-neck deformity.A previously undescribed lesion of Dupuytren's disease is presented. An oblique cord coursed parallel to the oblique retinacular ligament of Landsmeer, but inserted proximal to the proximal interphalangeal joint, tethering the central slip and radial lateral band across the intervening transverse retinacular ligament. Contraction of this cord caused a rigid swan-neck deformity. Excision of the cord resulted in complete resolution of the deformity and a full range of motion in the affected digit.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/12. Description of 12 cases of nephrogenic fibrosing dermopathy and review of the literature.OBJECTIVES: To review the clinical and laboratory features of 12 cases of nephrogenic fibrosing dermopathy (NFD) studied at our institution and of 70 previously described cases in the literature. methods: Clinical evaluation and laboratory studies of 12 patients with NFD associated with chronic hemodialysis or peritoneal dialysis for end-stage renal disease and a review of 23 previous publications describing 70 patients with this disease. RESULTS: Eleven patients undergoing chronic hemodialysis and 1 patient undergoing chronic peritoneal dialysis for end-stage renal failure developed a severe and progressive cutaneous fibrotic process with woody induration of legs, thighs, hands, and forearms, and severe loss of motion and flexion contractures in multiple joints. Several patients displayed systemic involvement including fibrosis of muscles, myocardium, and lungs and marked elevations of the erythrocyte sedimentation rate and/or c-reactive protein. Three patients died within 2 years of symptom onset. A review of previously published reports of this disorder confirmed the presence of systemic involvement and a poor prognosis with a high mortality rate. CONCLUSIONS: NFD is a severe and usually progressive systemic fibrotic disease affecting the dermis, subcutaneous fascia, and striated muscles. It also appears that the disease can cause fibrosis of lungs, myocardium, and other organs.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
6/12. Arthroscopic release of first metatarsophalangeal arthrofibrosis.Various degrees of first metatarsophalangeal joint arthrofibrosis frequently occur in patients with bunion surgery or big toe trauma. In those patients with functional limitation who fail to respond to conservative treatment, surgery is indicated. We describe here an arthroscopic approach to first metatarsophalangeal release that is designed to improve functional results. Dorsomedial and dorsolateral portals are established at the medial and lateral sides of the extensor hallucis longus tendon. Through these 2 portals, the dorsal capsule is released and the medial and lateral joint gutters can be cleared up. The metatarsosesamoid compartment is approached through the straight medial portal and the working portal, the latter of which is located 4 cm proximal to the joint line between the abductor hallucis tendon and the medial head of the flexor hallucis brevis. Under visualization through the medial portal, adhesions around the sesamoid apparatus can be debrided with a shaver through the working portal. This completes the release of joint circumference and improves the motion range of the joint.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/12. Partial hammock valve: surgical repair in adulthood.We describe a forme frustree of hammock valve involving only the posterior mitral leaflet. Three adult patients were referred to surgery with the diagnosis of severe mitral regurgitation due to fibrosis of the posterior mitral leaflet. The final diagnosis was done intraoperatively. In all of them the posterior leaflet was attached to some accessory papillary muscles arranged en palisade, with three to four fused muscle heads producing restrictive leaflet motion in systole. Repair consisted in division of the papillary muscles, patch augmentation, and ring annuloplasty. This previously unreported lesion is congenital but manifests itself in adulthood.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/12. wrist arthrofibrosis.wrist arthrofibrosis is a condition of decreased range of wrist motion due to intrinsic adhesions and extrinsic contracture. It is clinically characterized by restricted wrist range of motion, pain, swelling, and a plateau in improvement after at least 6 months of intensive physiotherapy. Other conditions must be excluded, such as articular incongruity, arthritis, spasticity, skin and subcutaneous scarring, and loose bodies. We have devised a classification system based on pathologic anatomic location, where Type I represents intrinsic adhesions, and Type II represents extrinsic contracture. The types are subdivided according to where the pathology is present. The operative approach should be wrist arthroscopy for Types IA (radiocarpal adhesions) and IB (midcarpal adhesions) where intraarticular adhesions are present. Types IC (distal radioulnar joint adhesions) and II C (distal radioulnar joint capsular contracture) are best approached in an open manner where dorsal and palmar capsulectomies of the distal radioulnar joint are performed. For Types IIA, B, and D (dorsal, palmar, and combination extrinsic contracture, respectively), both open and arthroscopic methods are described.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/12. Right ventricular dysplasia: a clinical and pathological study of two families with left ventricular involvement.BACKGROUND--Right ventricular dysplasia is a heart muscle disease of unknown cause that is often familial and is anatomically characterised by adipose or fibroadipose infiltration of the right ventricular myocardium. It is generally regarded as a selective disorder of the right ventricle. AIM--To investigate the prevalence and characteristics of left ventricular involvement in two families in which at least one member had right ventricular dysplasia confirmed at necropsy. methods AND RESULTS--Eight patients were found to be affected by right ventricular dysplasia. In three of them this was confirmed at necropsy. echocardiography or angiography or both showed left ventricular involvement in seven. This ranged from localised wall motion abnormalities to moderate or severe left ventricular dysfunction. The disease was progressive in four cases. At necropsy the left ventricular myocardium showed predominant fibrosis and degenerative changes of the myocardial cells. There were areas of myocardial thinning with fatty infiltration at the apex in two patients. CONCLUSIONS--Familial right ventricular dysplasia can be a progressive disorder that affects the left ventricle. Advanced disease may be clinically confused with dilated cardiomyopathy.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
10/12. Fibrous tissue overgrowth and prosthetic valve endocarditis: report of a case.Mechanical valve stenosis without restricted occluder motion and paravaluvular leakage developed in a patient who had undergone patch closure of partial atrioventricular septal defect and replacement of the left atrioventricular valve 13 years previously. Dense calcification of the supravalvular region was shown in a cineradiogram, whereas transthoracic and transesophageal echocardiography failed to reveal any obstructive mechanism. Elevated transprosthetic pressure gradient with unrestricted occluder motion suggested prosthetic valve stenosis resulting from fibrous tissue overgrowth, although this was not visualized by the modern diagnostic imaging tools. reoperation confirmed calcified fibrous tissue overgrowth obstructing the mechanical valve inflow. Examination of resected tissue revealed prosthetic valve endocarditis due to alpha-streptococcus. Paravalvular leakage accompanying fibrous tissue overgrowth may indicate the presence of prosthetic valve infection even if the clinical manifestations are scarce.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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