1/7. Reconstruction of upper chest wall defects with a function-preserving pectoralis major muscle flap: case report.The pectoralis major muscle or myocutaneous flap has a nearly 100% success rate in reconstructing chest wall defects. Major adverse sequelae resulting from the use of the pectoralis major muscle or myocutaneous flap are rarely reported in the literature. However, the loss of pectoralis major muscle function caused by the detachment of the muscle from its insertion on the humeral bone is of more and more concern. This is a significant loss for manual laborers when the patient tries to handle tools or control heavy machinery. A case of upper sternal osteomyelitis is reported. After wide debridement with partial excision of the sternum, the second and third ribs, the right pleura, and the lung were exposed. A right unilateral pectoralis major muscle flap was transposed to restore the defect. In addition, to preserve the lateral portion of the muscle and its insertion on the humerus, the origin of the lower sternocostal part of the pectoralis major muscle was transposed to the medial clavicle and residual upper sternum. In this way, not only was the chest wall defect reconstructed but the function of the residual pectoralis major muscle was also preserved. Postoperative follow-up at one year demonstrated no arm weakness, no limitation in shoulder range of motion, and no evidence of atrophy of the transposed pectoralis major muscle. Our experience with this function-preserving pectoralis major muscle flap was encouraging and we suggest it be employed in the reconstruction of the upper anterior chest wall.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. tuberculosis of the hip as the presenting sign of hiv and simulating pigmented villonodular synovitis.A 36-year old man, with no prior known exposure to human immunodeficiency virus (hiv) or tuberculosis, presented with monoarticular pain and a decreased range of motion in his left hip. radiography and magnetic resonance imaging revealed bony erosive lesions, juxta-articular cysts, a large effusion, and juxta-articular edema. The initial clinical and radiographic diagnosis was pigmented villonodular synovitis (PVNS) of the left hip. However, what was initially felt to be a chronic proliferative inflammatory process was later determined to be tuberculous arthritis. This case emphasizes the importance of including tuberculous arthritis in the differential diagnosis of patients with monoarticular destructive joint disease radiologically suggestive of PVNS.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/7. Isolated tuberculosis of talus without ankle and subtalar joint involvement.This case has been reported because of its rarity and atypical clinical presentation. An 8-year-old boy presented with a gradually increasing swelling localised on the antero-medial aspect of the foot haemogram, erythrocyte sedimentation rate (ESR), Mantoux and X-ray chest were normal. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting was sent for histopathological examination which confirmed the diagnosis of tuberculosis. Post operatively a below knee cast was given for 12 weeks and anti tubercular treatment was given for 20 months. At the end of the treatment patient had full and painless motion at the ankle and subtalar joint. The lytic lesion had healed on X-ray.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. Skeletal tuberculosis mimicking seronegative spondyloarthropathy.Skeletal tuberculosis (TB) is still a common problem in developing countries. It is a postprimary manifestation of TB and appears usually with fever, pain, tenderness, and limitation of motion at the involved site. We present a patient with a clinical course very suggestive of seronegative spondyloarthropathy and who had partially responded to sulphasalazine (SSZ) and nonsteroidal anti-inflammatory drugs (NSAID) but proved later to be a TB case.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/7. Tuberculous dactylitis: a rare entity.Tuberculous dactylitis is rare musculoskeletal infection, but as emigration from developing countries increases it is likely to be seen more frequently. The author reports the case of a 23-year-old man with this condition. The radiologic features of tuberculous dactylitis include soft tissue swelling, periostitis with bone expansion and cortical destruction, diffuse uniform infiltration and localized osteitis. The major role of surgery is to provide tissue for diagnosis and to allow for the removal of caseous avascular tissue to promote distribution of drugs into surrounding tissues. An important aspect in the rehabilitation of these patients is early motion to prevent joint contracture and subsequent ankylosis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. Arthroscopic synovectomy of synovial tuberculosis of the knee joint.Synovial tuberculosis is a rare, but important differential diagnosis of synovial diseases. Three cases of arthroscopic synovectomy of tubercular monarthritis affecting the knee joint are reported. The Lysholm scoring scale modified by Klein and Kloos was excellent in two cases, but poor in one. In all three cases there was an excellent improvement in the range of motion compared to the preoperative period and no deterioration of the Larsen score in the follow-up period (25-56 months postoperatively). Considering these results arthroscopic synovectomy can be recommended as an alternative to the open procedure of synovectomy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/7. tuberculosis of the ankle in childhood: clinical, roentgenographic and computed tomography findings.We report on three Italian children who presented with unilateral ankle tuberculosis (TB) consecutively during a short time period and in the same geographical area. A 6-year-old-girl with a family history of TB had limited mobility of the right leg at age 9 months; Mantoux test and radiographs at that age yielded normal findings. When severe right tibiotarsal swelling, reddening, pain and restriction of motion became apparent at age 4.6 years, the typical lesions of TB were evident on radiographs and computed tomographic (CT) scans. Mantoux test and synovial biopsy confirmed TB. A three-drug regimen of treatment proved useless: articular cartilage destruction and diffuse osteosclerosis ensued. Only a four-drug prolonged regimen of treatment proved to be somewhat effective. A 5-year-old girl had a 6-month history of painless swelling and limited mobility of the ankle; radiographs and CT showed osteopenia with marginal erosion of cartilages. A 14-month-old boy presented with a 2-week history of painless swelling ankle. Radiographs showed decreased bone density of talocalcanear bones. Mantoux test and synovial biopsy confirmed TB in both patients; treatment with a three-drug regimen greatly reduced symptoms. A careful suspicion of the diagnosis of tuberculosis is paramount in children with chronic or subacute monoarticular arthritis, even in absence of a positive tuberculin test or abnormalities on chest radiograph. When negative early on, the tuberculin test should be repeated after 6 weeks of arthritis, and a needle biopsy of the synovium is required in those children with monoarticular arthritis and a positive tuberculin test. Careful therapy is necessary to avoid sequelae that may lead to severe osteoarticular damage.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |