ABSTRACT
We present here a case of gouty synovitis of the knee in a patient with partial hypoxanthine-guanine phosphoribosyl transferase deficiency (Kelley-Seegmiller syndrome), which is an inherited purine metabolic disorder. Magnetic resonance images and computed tomography showed a diffuse mass with stippled calcification around the posterior cruciate ligament (PCL) in the posterior intercondylar notch. Arthroscopic examination revealed that the articular surfaces and menisci in the affected knee were almost completely covered with white chalky monosodium urate (MSU) crystals. The diffuse mass around the PCL was composed of proliferative synovial villi covered with MSU crystals that looked like "snow covered trees". Arthroscopic total synovectomy was performed. The posterior trans-septal portal was especially useful for removal of the proliferative villi around the PCL. To our knowledge, this is the first report of arthroscopic examination in a patient with Kelley-Seegmiller syndrome.
Subject(s)
Knee , Poster , Transferases , Synovitis , SyndromeABSTRACT
Objective: The purpose of the present study is to clarify the efficacy of etidronate and vitamin K2 in sustaining bone mineral density (BMD) in patient with hip fracture by monitoring metabolic bone markers and BMD during the 36-week period after fracture.Materials and Methods: Forty-seven hip fracture patients from 51 to 93 years old (77.2±9.6) were randomly divided into three groups: 14 patients in the intermittent cyclical etidronate-treated group (group E), 16 patients in the vitamin K2-treated group (group K), and 17 patients in the control (group C). Drugs were administered to patients in groups E and K six weeks after their operations. Blood and urine samples were obtained just before the start of drug administration and at 12, 24, and 36 weeks thereafter. Urinary type I collagen C-terminal telopeptide (uCTx), pyridinoline (PYR), deoxypyridinoline (DPD), serum CTx (sCTx), osteocalcin (OCN-mid), and undercarboxylated osteocalcin (ucOC) were measured. The contra-lateral proximal femur and lumbar spine BMDs were measured at baseline and at 36 weeks.Results: Deoxypyridinoline at 12 weeks and OCN-mid at 36 weeks after treatment were lower in group E than those in group C. N-mid osteocalcin and ucOC at 24 and 36 weeks were lower in group K than those in group C. Although femoral neck BMD in groups C and E decreased compared to the baseline values at 36 weeks, femoral neck BMD in group K tended to increase. Specifically, in group K the BMD of Ward's triangle increased significantly after treatment. Bone mineral density of the lumbar spine in each group did not change significantly during the 42 weeks following hip fracture.Conclusion: Vitamin K2 prevented further bone loss in the contralateral proximal femur. The administration of vitamin K2 to patients with hip fractures in the early period after fracture is potentially useful in preventing a second hip fracture on the contralateral side.
Subject(s)
Hip FracturesABSTRACT
Objective: The aim of the present study was to clarify whether patients with Graves' disease who have lost bone mass can restore bone mass to age-matched control levels by antithyroid drug therapy.Patient/Materials and Methods: One male and 16 female patients (aged 21-71 years, mean±SE 39.9±16.5) with untreated Graves' disease were included in the study. Methimazole or propylthiouracil was given to all of the patients. Biochemical markers (serum N-mid osteocalcin (OCN-mid), alkaline phosphatase (ALP), type I collagen C-terminal telopeptide (sCTx), urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) and type I collagen C-terminal telopeptide (uCTx) and bone mineral density at the distal one third of the radius were assessed prior to treatment, and in the first, third, sixth and twelfth months of treatment.Results: All biochemical markers had increased significantly 12 months after treatment compared with the baseline values (OCN-mid, p<0.05; ALP, p<0.01; sCTx, p<0.05; Pyr, Dpyr, uCTx, p<0.01). Among the biochemical markers, urinary Pyr and Dpyr had decreased the most prominently 12 months after treatment. However, BMD at the distal one third of the radius did not improve after 12 months of treatment.Conclusion: Based on assessments of BMD at the distal one third of the radius, one year is not enough to restore bone mass using antithyroid drug therapy in patients with Graves' disease.