1/11. A 'made in one piece' skeleton in a 22-year-old man suffering from sickle cell anaemia.A 22-year-old African male with known sickle cell anaemia was referred by a Congolese medical centre with a request to improve his poor physical condition. He was unable to walk, stand or sit because his large joints and his spine were either ankylosed or very rigid. Radiographs showed joint fusion from the third to the fifth cervical vertebrae, of both hips, of the left knee, and a bilateral osteonecrosis of the humeral head. There was no scintigraphic evidence for an active osteomyelitis (99mTc-MDP (methyldiphosphonate) bone scan, Tc monoclonal antigranulocyte scan and 99mTc sulphur colloid scan). To improve his mobility the right femoral head was resected in June 1997; 14 days later the left femoral head was resected. Four months after the resection of the right hip, a right uncemented total hip prosthesis was implanted on this side. One month later the same type of hip arthroplasty was performed on the left side. During the postoperative rehabilitation period the patient regained autonomy. We have found no previous reports of such severe and multiple joint complications in a single patient suffering from sickle cell anaemia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. Subchondral microfracture of the knee without osteonecrosis after arthroscopic medial meniscectomy.We report a case of an osteonecrosis-like lesion of the knee that developed shortly after an arthroscopic medial meniscectomy. Clinical presentation, physical findings, and imaging of the knee including magnetic resonance imaging were similar to those of the cases that have been reported as osteonecrosis after meniscectomy. However, histologic analysis of the lesion revealed that there was no osteonecrosis but rather a subchondral microfracture with active callus formation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/11. Iliac bone graft for steroid-associated osteonecrosis of the femoral condyle.The use of steroid medication may predispose to osteonecrosis of the femoral condyle. However, there is a controversy regarding treatment of this disease, especially for lesions in advanced stages. Since 1987, the authors have treated such lesions by autologous osteoperiosteal graft obtained from the iliac bone. When limb alignment was affected by the disease, proximal tibial valgus or varus osteotomy was done concomitantly. The rationale for this method is to replace the necrotic bone and damaged cartilage by autogenous bone and periosteum, anticipating the chondrogenic potential of the latter. In this study, 10 knees in eight patients were reviewed to learn the outcome of this procedure with a mean followup of 79 months (range, 32-158 months). The grafts were incorporated successfully in nine joints, and satisfactory results were achieved in all patients. Therefore autologous iliac bone graft is a promising alternative for treatment of osteonecrosis, especially when patients are young and physically active.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/11. 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 = 1keywords = physical (Clic here for more details about this article) |
5/11. Implications of androgen-deprivation therapy in patients with prostate cancer: A case study.S.R., a 65-year-old male with a history of prostate cancer, went to a cancer center in 2003. He had developed symptoms of bladder outlet obstruction in 1999 and was seen by a urologist. His baseline prostate-specific antigen (PSA) was 44 ng/ml. On physical examination, his prostate was enlarged, and a biopsy in January 2000 revealed adenocarcinoma with a Gleason score of 8. A metastatic workup, including a bone scan and a computed tomography scan of the abdomen and pelvis (CT A/P), was negative for evidence of metastatic disease. S.R. received conformal external beam radiation, and the luteinizing hormone-releasing hormone agonist leuprolide acetate was initiated. Following treatment, his PSA nadired to 0.2 ng/ml, and he did well until 2002, when his PSA started to rise. A reevaluation CT A/P revealed enlarged retroperitoneal and pelvic lymph nodes, and a bone scan was positive for metastatic disease. He underwent a bilateral orchiectomy in November 2002.- - - - - - - - - - ranking = 7.0365326904535keywords = physical examination, physical (Clic here for more details about this article) |
6/11. Roentgen rounds #94. osteomyelitis of the left ilium--left iliacus muscle abscess.A left iliac osteomyelitis and left iliacus muscle abscess occurred in a patient who underwent bipolar hemiarthroplasty of the left hip six months prior for avascular necrosis of the left femoral head, secondary to sickle-cell disease. This illness followed an upper respiratory tract infection, and her physical examination was suggestive of a septic process involving the left hip. An aspirate of the hip was not confirmative for septic arthritis. The plain roentgenograms demonstrated that the prosthesis was in an acceptable position, but had limited value in the remainder of the differential diagnosis. In this case, the bone scan contributed significant information distinguishing osteomyelitis from osteonecrosis. The CT scan allowed rapid localization of an occult abscess and destructive changes in the left ilium secondary to osteomyelitis and guided surgical treatment.- - - - - - - - - - ranking = 7.0365326904535keywords = physical examination, physical (Clic here for more details about this article) |
7/11. Hass' disease.A case of posttraumatic avascular necrosis of the humeral head (Hass' disease) is presented along with serial radiographs taken over a period of 4 1/2 y. The favorable response to conservative physical therapies is described.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. Alveolar bone necrosis and tooth loss. a rare complication associated with herpes zoster infection of the fifth cranial nerve.Eleven case reports involving herpes zoster infection associated with alveolar bone necrosis and tooth loss were reviewed in order to develop a patient profile for this rare combination of physical findings. The clinical course of a 56-year-old white woman with herpes zoster infection of the fifth cranial nerve and related alveolar bone necrosis, tooth loss, and oroantral fistula development is reported. The etiology and management of herpes zoster infection associated with destructive oral sequelae are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. osteonecrosis and resorption of the patella after total knee replacement: a case report.A 54-year-old woman with a history of right total knee replacement had right knee pain and swelling for 6 months. Radiographs of the knee showed significant fragmentation and resorption of the patella consistent with osteonecrosis. Evidence of increased anteroposterior laxity was noted on physical examination. Revision surgery to a posterior stabilized prosthesis with excision of the patellar fragments resulted in a marked improvement in her symptoms and functional capabilities 2 years after surgery. The authors review the blood supply to the patella and how it may be disturbed by knee surgery and speculate that this patient's symptoms may have been worsened by the anteroposterior instability of her prosthesis.- - - - - - - - - - ranking = 7.0365326904535keywords = physical examination, physical (Clic here for more details about this article) |
10/11. A 26-year-old man with shoulder pain.This case report included roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. The medical history, physical findings, and results of roentgenographic examinations precede clinical and roentgenographic differential diagnoses.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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