ABSTRACT
OBJECTIVES: Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS: The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS: The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0-0.83 and ultrasound had a likelihood of 0-0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION: Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Synovitis/diagnostic imaging , Tenosynovitis/diagnostic imaging , Magnetic Resonance Imaging/methods , Ultrasonography/methods , Wrist JointABSTRACT
Aneurysmal fibrous histiocytoma is rare clinicopathological variant of Cutaneous Fibrous Histiocytoma. The clinical manifestation of Aneurysmal Fibrous Histiocytoma is often confusing to distinguish from other skin lesions. Most of the cases showed rapid increase in size or a history of recurrence, however histologically all are almost similar. Rarity of aneurysmal fibrous histiocytoma and high numbers of recurrence rate poses a big diagnostic challenge. Late treatment will result in a decrease until loss of function of the affected region. In this article, author reported the case of aneurysmal fibrous histiocytoma of the hand in 7 years old girl with restricted at 2nd-3rd metacarpophalangeal joints. The patient had undergone a series of investigations until finally a wide excision was carried out. Excision tissue was performed CD 68 and CD 34 immunocytochemical smear to establish the diagnosis. It was not simple to make diagnosis aneurysmal fibrous histiocytoma. While it is benign, the lesion can appear malignant, and one should consider an excisional biopsy to rule out malignant conditions. The diagnosis had to be confirmed by histopathological and performed immunocytochemical smear. It was often necessary to take aggressive actions with wide excision and reconstruction.
ABSTRACT
El presente documento es una propuesta teórica, que tiene como finalidad presentar un protocolo de elaboración de una férula dinámica tipo tenodesis a partir de un material termoplástico de alta temperatura, de fácil consecución en el mercado llamado policloruro de vinilo; Este tipo de férula se clasifica dentro de las denominadas férulas dinámicas y su objetivo final es la promoción de agarre de pinza trípode en personas que por lesiones a nivel de C5-C6, presentan ausencia de movilidad en los dedos de la mano pero conservan movimientos de muñeca. Cuando el usuario extiende la muñeca, la férula activa una serie de mecanismos que producen flexión pasiva de articulaciones metacarpofalangicas de los dedos II y III y simultáneamente hay una abducción y una relativa oposición del pulgar; estos movimientos formarán una pinza que proveerá al usuario la posibilidad de realizar actividades básicas con sus manos.
This document is a methodological contribution, which is to present a protocol for developing a tenodesis type dynamic splint from a high temperature thermoplastic material, easy to achieve on the market called polyvinyl chloride, this type of splint is classified within the so-called dynamic splints and its purpose is to promote tripod pincer grip in people with injuries at C5-C6, present lack of mobility in the fingers but retain wrist movements. When the user extends the wrist, splint activates a series of mechanisms that produce passive flexion of metacarpophalangeal joints of fingers II and III and simultaneously there is a relative abduction and thumb opposition, these movements form a clamp that will provide the user the ability to perform basic activities with their hands.