1/9. The role of arthroscopy in the diagnosis and management of cartilaginous lesions of the wrist.Articular cartilage lesions in the wrist are common. Diagnosis of these lesions is difficult, and the decision to operate may not be clear. A meticulous history and physical examination allows an accurate diagnosis. Appropriate surgical intervention can be useful in alleviating symptoms and returning the patient to normal activities. The origin, diagnosis, and treatment of cartilaginous lesions of the wrist are discussed in this article.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/9. Cartilaginous hamartoma of the chest wall with secondary aneurysmal cyst-like areas in an infant: a case report.A case of a four-month-old infant diagnosed as cartilaginous hamartoma of the rib is presented. This rare tumor usually presents at birth. The patient had respiratory distress syndrome. Swelling of the ribs was palpable on physical examination and the infant underwent surgery for excision of the ribs. Histopathologically, the tumor showed benign focal overgrowth of normal skeletal elements with cartilaginous, vascular and primitive-appearing mesenchymal elements. Additionally, secondary aneurysmal cyst formation coexisted with the tumor. The diagnosis was infantile cartilaginous hamartoma of the rib. In this entity, primitive-appearing mesenchymal stroma may be mistaken for a malignant condition. Usually a benign clinical course is expected and treatment is by block excision.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/9. Chondroid chordoma of the nasal septum.Chondroid chordoma is an uncommon malignant tumor of bone that occurs mostly in patients of early middle age. To our knowledge, this tumor has not been previously described in the nasal septum as a primary lesion. We describe a 39-year-old woman who presented with a 1-year history of nasal obstruction. Results of her physical examination and imaging studies demonstrated a nasoseptal mass. We also discuss the histologic and radiographic characteristics of the chondroid chordoma and compare it with other tumors that arise in the nasoseptal area to highlight the different prognoses and approaches to management.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/9. Sinonasal osteocartilaginous necrosis in cocaine abusers: experience in 25 patients.BACKGROUND: cocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases. methods: From January 1991 to September 2001 25 patients with cocaine-induced midline destructive lesions were observed at the Department of Otorhinolaryngology of the University of Brescia. The diagnosis was based on physical and endoscopic evaluation, routine blood and urine analysis, radiological findings, and repeated biopsies of the nasal mucosa. serum was analyzed by the antineutrophilic cytoplasmic antibody (ANCA) test using indirect immunofluorescence and by enzyme-linked immunosorbent assay for antibodies against proteinase 3 and myeloperoxidase. RESULTS: Septal perforation was present in all 25 patients, 16 of which (68%) also had partial destruction of the inferior turbinate. Hard palate reabsorption was observed in only six patients (24%); in two of these patients, the lesion also extended to the soft palate. Fourteen patients (56%) were positive by the immunofluorescence test (nine patients had a P-ANCA and five patients a C-ANCA pattern). Four patients (16%) with the P-ANCA pattern and all patients with the C-ANCA pattern also tested positive for anti-proteinase 3 antibodies. CONCLUSION: Any sinonasal inflammation involving the midline that persists or remains refractory to treatment may be the first manifestation of potentially lethal drug addiction. cocaine abuse should be considered in the differential diagnosis of destructive lesions of the nasal cavity even in the presence of a positive ANCA test.- - - - - - - - - - ranking = 0.093909675114291keywords = physical (Clic here for more details about this article) |
5/9. Idiopathic chondrolysis of the ankle.A 21-year-old West Point cadet presented to our institution with a history of chronic left lateral ankle instability. The initial injury occurred 5 years earlier. physical examination results and stress radiographs were consistent with lateral instability. The patient underwent an ankle arthroscopy and lateral ankle ligament reconstruction. Arthroscopic findings included moderate synovitis, grade II anterolateral chondrosis, and an anterior talar osteophyte. The patient had an uneventful postoperative course and returned to activity. Eleven months after surgery he presented with increased left ankle pain. On physical examination he had a stable ankle, but radiographs revealed marked loss of ankle joint space. Significant diffuse fraying and thinning of the articular cartilage noted on repeat arthroscopy were consistent with chondrolysis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/9. A newly described hereditary cartilage debonding syndrome.OBJECTIVE: We describe a hereditary chondropathy characterized by extreme cartilage friability and cartilage-bone debonding, which has not previously been described in the literature. We also describe initial studies into the molecular basis of this disorder. methods: Affected family members had multiple shoulder, hip, and knee arthropathies, beginning in the pre-teen years and continuing into adulthood. Various diagnoses had been suggested, including spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, legg-calve-perthes disease, and Osgood-Schlatter disease. The affected proband father, his 3 affected children, and unaffected family members provided blood samples, which were examined for single-nucleotide polymorphisms (SNPs) in the chromosome 2 region that included the Frizzled-related protein gene, a soluble Wnt protein signaling antagonist that influences bone and cartilage development. RESULTS: All affected individuals showed clear similarities, including effusions, large loose bodies, and bubbling and delamination of the cartilage with exposure of subchondral bone. All affected individuals exhibited radiographic changes in the hip, showing femoral head flattening and secondary degenerative arthritis, accompanied by abnormalities in the physical properties of the cartilage that were evident upon arthroscopic examination. Two SNPs were identified in subjects with the hereditary cartilage debonding syndrome. Examination of the siblings and parents of the proband demonstrated, however, that both SNPs were present in the unaffected mother and in 2 of 4 unaffected siblings of the proband. CONCLUSION: The clinical findings reported here represent a newly defined clinical syndrome characterized by marked cartilage friability and osteochondral debonding. Because the SNPs are present in the general population, and because unaffected members of this family carry the SNPs, these polymorphisms alone are insufficient to result in the observed phenotype.- - - - - - - - - - ranking = 0.093909675114291keywords = physical (Clic here for more details about this article) |
7/9. Infective complications of brief nasotracheal intubation.Two cases are described where infective complications, namely nasal septal abscess and parapharyngeal abscess, occurred after short-term (less than one hour) nasotracheal intubation. These conditions are serious as they can be life-threatening and in one case led to permanent physical disfigurement.- - - - - - - - - - ranking = 0.093909675114291keywords = physical (Clic here for more details about this article) |
8/9. Discoid meniscus presenting as juvenile rheumatoid arthritis.Discoid meniscus is a mechanical lesion described as having little inflammatory reaction. We describe a child with lateral discoid meniscus misdiagnosed as juvenile rheumatoid arthritis (JRA). synovitis responded to aspirin, but function gradually deteriorated with increasing flexion deformity until arthrotomy and meniscectomy. histology showed intense inflammatory changes compatible with JRA. Clinical and laboratory clues to early diagnosis were the localized nature of the inflammation on physical examination, radiographs and bone scan.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/9. Hyperbaric oxygen for the management of radionecrosis of bone and cartilage.OBJECTIVES: To review the use of hyperbaric oxygen in the management of radionecrosis of the head and neck. STUDY DESIGN: A retrospective analysis of patients utilizing chart review and telephone interviews. All patients diagnosed with osteoradionecrosis and chondroradionecrosis of the head and neck and treated with hyperbaric oxygen at the University of virginia are included. methods: Demographics, pretreatment data, and precipitating events were recorded. Outcomes were evaluated using a grading scale of symptomatology and physical examination as determined by the patient and physician. RESULTS: Sixteen patients with osteoradionecrosis and five with chondroradionecrosis were reviewed. All patients showed clinical improvement with decreased pain following HBO therapy. None of the patients with chondroradionecrosis required laryngectomies, and two of the four who were tracheotomy dependent were successfully decannulated. The patient and physician grading scores demonstrated moderate to significant improvement in both groups following therapy. CONCLUSION: The successful use of hyperbaric oxygen for the management of radionecrosis of the head and neck is supported. The unusual prevalence of chondroradionecrosis may be an early reflection of changes in treatment protocols for patients with head and neck cancer.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |