Arthroscopic treatment of ankle impingement syndrome / 中华创伤杂志(英文版)

Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.

Progressive pseudorheumatoid dysplasia misdiagnosed as ankylosing spondylitis: a case report / 北京大学学报(医学版)

In this study, we reported a case of progressive pseudorheumatoid dysplasia in Peking University Third Hospital. A 56-year-old male patient presented with hip joint pain for more than 40 years and multiple joints pain with limitation of movements of these joints for 28 years. This patient suffered from joint pain and impaired range of motion of the hip, knee, elbow and shoulder gradually, associated with difficulty in walking and inability to take care of himself. He was diagnosed with "femoral head necrosis" or "ankylosing spondylitis" in local hospitals, but the treatment of nonsteroidal antiinflammatory drugs (NSAIDs) and sulfasalazine was not effective. Up to the age of 14, the patient displayed normal physical development, with the highest height was about 158 cm, according to the patient recall. However, his height was 153 cm at present. There was no history of similar illness in any family member. Physical examinations descried limitation of movement of almost all joints. Enlargement and flexion deformity of the proximal interphalangeal (PIP) joints of the hands resulted in the claw hand appearance. Limited abduction and internal and external rotation of the shoulder and hip could be find. He had normal laboratory findings for blood routine test, biochemical indexes and acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Furthermore, HLA-B27 and autoimmune antibodies such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody and antinuclear antibody (ANA) were all negative. X-ray of the hip showed loss of the joint space and irregularities of the femoral head, both femoral head were flattened, it could be see hyperplasia, osteophytes, bilateral femoral neck thicken, neck dry angle turned smaller. The radiological findings of the spinal vertebra indicated kyphosis deformity, narrowing of the intervertebral discs, vertebral syndesmophytes and flattening of the vertebra. However, there was no clues of bone marrow edema in the lumbar MRI. At last, genetic testing for the Wnt1-inducible signaling pathway protein 3 (WISP3) gene was done and indicated compound heterozygous mutations: 756C>G and c.866dupA. These two mutations were derived from the patient's mother and father (the patient's parents each had a heterozygous mutation). Two exons of the WISP3 gene had nucleotide changes leading to amino acid mutations. According to the patient's history, symptoms, physical examinations, radiological findings and genetic testing, the final definitive diagnosis was progressive pseudorheumatic dysplasia.

Osteochondroma Arising from Anterior Inferior Iliac Spine as a Cause of Snapping Hip

Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.

Tumor fibroso solitario de la pleura asociado a síndromes paraneoplásicos / Solitary fibrous tumor of pleura associated with paraneoplastic syndromes

Introduction: solitary fibrous tumors of pleura (SFTP) are occasionally associated with paraneoplastic syndromes such as hypoglycemia and diffuse skeletal hyperostosis. Clinical case: we report a 60 years old male presenting with episodes of disorientation and inappropriate behavior, along with cough and weight loss. On physical examination there was digital clubbing. A chest X ray showed a big tumor in the right hemithorax. Fasting blood glucose was 24 mg/dl and erythrocyte sedimentation rate was elevated. Large bone X rays showed hyperostosis. A needle biopsy of the tumor showed a SFTP. The tumor was excised and the final pathological diagnosis was a benign SFTP. Hypoglycemia subsided after surgery. After four months of follow up, finger clubbing was disappearing.

Introducción: los tumores fibrosos solitarios de la pleura (TFSP) son neoplasias infrecuentes, consideradas lesiones benignas en general, con potencial maligno dependiendo de su histología. Se asocian en raras ocasiones a síndromes paraneoplásicos como la hipoglicemia (Síndrome de Doege-Potter) e hiperostosis ósea difusa (osteoartropatía hipertrófica pulmonar). Caso clínico: consulta un varón de 60 años en el Hospital Clínico de la Pontificia Universidad Católica de Chile por episodios de desorientación y conductas inapropiadas, junto con tos y baja de peso. Además refiere dolor en extremidades y aumento de volumen de falanges distales de manos. Al examen destaca disminución del murmullo pulmonar a derecha e hipocratismo digital. Se estudia con radiografía y tomografía de tórax revelando un gran tumor en hemitórax derecho de 20 por 18 cm con efecto de masa. Exámenes destacan hipoglicemia de 24 mg/dl y VHS elevada. Estudio endocrinológico y neurológico normal, radiografías de huesos largos y manos revelan hiperostosis ósea. Se estudia con biopsia de aguja gruesa, compatible con TFSP. Se realiza resección completa por toracotomía. Biopsia definitiva confirma diagnóstico de TFSP benigno. Paciente evoluciona satisfactoriamente, resolviéndose hipoglicemia y alteraciones conductuales. Se va de alta al octavo día postoperatorio. Seguimiento a los 4 meses sin nuevos episodios de hipoglicemia y resolución progresiva del hipocratismo digital. Radiografías de tórax sin recidiva. Conclusiones: Los TFSP son inhabituales, se pueden presentar con algunos síndromes paraneoplásicos que deben llevar a la sospecha diagnóstica. Su tratamiento consiste en la resección completa del tumor, logrando escasa recidiva y mejoría sintomática.

Treatment of pathological synovial plicae of the knee

OBJECTIVE: To analyze the incidence, clinical significance, and clinical manifestations of pathological synovial plicae of the knee. MATERIAL AND METHODS: Between 2002 and 2006, 63 patients with pathological synovial plicae of the knee were studied. Of those 63 patients, 21 had the diagnosis confirmed by previously performed magnetic resonance imaging. All of the patients initially underwent conservative treatment for 90 days that involved strengthening and improving the flexibility of the muscles surrounding the knee as well as modification of their sports activities. RESULTS: A total of 55 patients improved after conservative treatment. Six of these patients eventually experienced a recurrence of symptoms, but the symptoms were not incapacitating in any of these patients. The other eight patients underwent arthroscopic removal of the synovial plica. Of these eight patients, six returned to their pretreatment physical activities, and two had persistent symptoms during physical activity. CONCLUSION: The presence of a synovial plica of the knee should be considered as a potential diagnosis in patients with knee pain, especially those who practice sports inappropriately. Conservative treatment is effective in most cases, and surgical treatment should be reserved for exceptional cases that do not improve with conservative treatment.

A five year review of clinical profile in HSP.

To study the clinical profile of Henoch Schönlein Purpura [HSP] in children. A retrospective case series of 30 consecutive children with a diagnosis of HSP, with special focus on clinical manifestations. Two cases with unusual features are described in detail. Data of 19 boys and 11 girls with a mean age of 10.55 years was reviewed. Overall skin was involved in 100%, joints in 86.7%, GIT in 80% and renal system in 30% Two-thirds had palpable purpura at presentation. The mean duration of appearance of skin lesions after preceding joint and gastrointestinal symptoms was 8.6 days and 6.6 days respectively. Abdominal pain was the most common gastrointestinal symptom. Knee and ankle involvement occurred in more than 3/4th of the patients with arthritis. Vesciculobullous lesions were seen in two patients while one patient had rheumatic fever. Most children with HSP will have classical manifestation of the disease but diagnostic confusion can occur in those with atypical or absent cutaneous features at the onset.

Síndrome de Sharp o conectivitis mixta / Sharp syndrome or mixed connectivitis

El Síndrome de Sharp es una conectivitis en cuyo cuadro clínico se combinan manifestaciones de varias de las mesenquimopatias más frecuentes. Entre sus principales síntomas destacan el Síndrome de Raynaud; las poliartralgias de manos y las mialgias. El Síndrome de Sharp, generalmente no compromete la piel ni las vísceras y entre ellas especialmente el riñón. En el aspecto inmunológico, es característica la presencia, en el suero, y a título elevados de anticuerpos anti RNP. El pronóstico del Síndrome de Sharp es habitualmente benigno y se describe incluso evoluciones regresivas.

Tumoral calcinosis with hyperphosphatemia.

Tumoral calcinosis is a rare disorder of mineral metabolism among adolescents and young adults characterized by deposition of calcific masses around large joints. It is less commonly reported in pediatric population and commonly mistaken for bone tumors. Typical lab parameters include hyperphosphatemia with normal levels of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase. A ten-year-old boy with typical features of tumoral calcinosis is presented.

Enfrentamiento del paciente con dolor musculoesquelético / Confrontation of patient with musculoskeletal pain

Primary musculoskeletal pain consultation is high, and physicians are faced with a number of challenges. One of these is to differentiate between diseases that present similar symptoms, some potentially serious that leave sequelae and limitations, and other that are less severe but more frequent and affect patient's everyday life. Another challenge is early diagnosis in order to avoid greater damage. In order to deal with these problems, doctors must have adequate training and skills that allow them to differentiate the origin of the pain, i,e, if the pain is articular or not, or if is origin does not stem from the muscular and skeletal system. Diagnosis must also include if manifestations are localized or generalized, axial or peripheral, inflammatory or non inflammatory, acute or chronic; if the manifestation is a mono, oligo or polyarthropathy. Together with this, physicians must be aware of the extraskeletal manifestations of rheumatic diseases, such as general manifestations or involvement of diverse systems that are fundamental when diagnosing inflammatory rheumatisms. Moreover, clinical doctors must know how to used and correctly interpret the studies of articular fluid, general and correctly interpret the studies of articular fluid, general and immunological laboratory, and images, always oriented to the patient's clinical manifestation. Once these parameters have been defined, they must be syndromatically sorted in order to prepare a specific diagnosis and consequently offer the patient the most adequate pharmacological and non pharmacological treatment for each case.

Extraintestinal manifestations of idiopathic ulcerative colitis in northwestern India.

OBJECTIVE: To determine the frequency of extraintestinal manifestations in patients with idiopathic ulcerative colitis. METHODS: 46 patients underwent detailed clinical, biochemical and radiological evaluation. RESULTS: One patient (2%) had peripheral arthritis and two patients (4%) had ocular involvement in the form of anterior uveitis. No patient had mucocutaneous, vascular, or hepatobiliary manifestations, or sacroiliitis. CONCLUSIONS: The frequency of extraintestinal manifestations in patients with IUC in northwestern India is low.

The palm print as a sensitive predictor of difficult laryngoscopy in diabetics: a comparison with other airway evaluation indices.

AIMS: To evaluate the ink impression made by the palm of the dominant hand as a screening tool for difficult laryngoscopy in diabetic patients. SUBJECTS AND METHODS: In this prospective study, airway of 50 adult diabetic patients, undergoing elective surgery under general anaesthesia, was assessed preoperatively using the common clinical indices such as Modified Mallampati test, thyromental distance, degree of head extension and a specific index- the palm print test. Following induction of anaesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index were calculated. RESULTS: The incidence of difficult laryngoscopy was 16%. The palm print test had the highest sensitivity (75%) of all the indices. The thyromental distance less than six cm had the highest specificity (95.2%) but was least sensitive (25%). 87% of patients with difficult laryngoscopy had two or more indices abnormal. CONCLUSION: Though the palm print test was the most sensitive index of the four indices studied, a better prediction of difficult laryngoscopy can be achieved by evaluating all the four airway indices preoperatively.

Quinolone induced arthropathy in adolescents and adults

To ascertain the incidence, clinical pattern and outcome of arthropathy in adolescents and adults induced by different quinolones. Cases of enteric fever treated with different quinolones having no previous history of joint disorders who developed arthropathy and improved well with conservative treatment were labelled as quinolone induced arthropathy. In-patients of Rajshahi and Khulna Medical College Hospitals and private clinics of the authors. Four hundred and three cases of enteric fever were treated with various quinolones during the period January 1995 to June 1999. Main outcome measures: Clinical characteristics, incidence, relation with quinolones used and outcome of quinolone induced arthropathy. The age of the 403 [males 260 and females 143] patient ranged from 13-60 years. They were treated with either ciprofloxacin, pefloxacin or ofloxacin. Out of them 31 [7.7%] patients developed arthropathy. It was highest with pefloxacin [12.5%]. The arthropathy was maximum [11.8%] in the age group of 11-20 years. Patterns of arthropathy were oligoarthropathy [23], polyarthropathy [7] and monoarthropathy [1]. Although quinolones use is not advocated in children for development of arthropathy, it also occurs in adolescents and adults in considerable number of cases. It improves well with conservative treatment without residual effect

Artroplastia total de cadera tipo Charnley en menores de 65 años de edad: estudio de 10 y 25 años / Charnley arthroplasty of the hip in patients under 65 years: a 20 and 25 year study

Entre mayo de 1970 y mayo de 1975 se efectuaron 171 artroplastias de cadera. De éstas, 48 fueron en pacientes menores de 65 años. Diez enfermos murieron o fueron perdidos del seguimiento. Entre marzo y mayo de 1995, examinamos 30 pacientes con 42 artroplastias con un seguimiento mínimo de 20 años y máximo de 25 años (promedio de 21.5). Las edades fueron de 20 a 64 años (promedio 37.6 años). Veintiún procedimientos fueron en el lado derecho y 21 en el izquierdo. Diagnósticos: Dislocación congénita de cadera 13, osteoartritis 10, artritis reumatoides 10, espondilitis anquilosante 4, fracturas 3 y necrosis avascular 2. Resultados. Ausencia de dolor y movimientos normales en 28. Marcha normal en 26. Hodgkinson grado 0 en cuatro, grado I en 14, grado II en seis, grado III en dos y grado IV en 11. De acuerdo con Gruen, las zonas 1 y 7 fueron las más afectadas. Siguiendo a Pacheco: Aspecto normal en 17 casos, cavitación en nueve, demarcación en ocho, hundimiento en dos y fractura del cemento en uno. Los resultados fueron buenos reserva ósea. Los fracasos fueron más comunes en dislocaciones congénitas con múltiples procedimientos previos y errores técnicos

Niveles séricos de interleuquinas en pacientes con insuficiencia renal en hemnodiálisis crónica y su relación con las manifestaciones articulares / Interleukins serum levels in patients with renal insufficiency submitted to chronic hemodialysis and their relationship with articular manifestation

Treinta por ciento de los pacientes con insuficiencia renal en hemodiálisis crónica presentan artropatías. La etiopatogenia de estos cuadros es aún discutida. Con el objetivo de estudiar si las citoquinas inflamatorias tienen algún papel en su desarrollo se consideró un grupo de 119 dializados de uno u otro sexo, con antigüedad promedio, de ser dializados, de 48 meses. En esta población se realizó un estudio transversal, clínico y radiológico, estableciendo dos grupos; grupo A con manifestaciones clínicas (artralgias intra o posdiálisis, síndrome de túnel carpiano, signos radiológicos erosivos, etc.) y grupo B sin manifestaciones clínicas ni radiológicas articulares. En ambos grupos se midieron los niveles séricos de las interleuquinas ILI y TNF por ELISA y de la proteína C reactiva (PCR) por turbidimetría. Se obtuvieron diferencias significativas (p < 0.001) para ILI, TNF y PCR entre ambos grupos, con un índice de correlación de 0.95. El grupo con manifestaciones particulares mostró niveles superiores de interleuquinas y PCR (medias: ILI 34.3 y TNF 36.4 en pg/mL y PCR 14.7 mg/dL) respecto del grupo sin manifestaciones articulares (medias: ILI 13.1, TNF 17.3 en Pg/mL y PCR 4.7 mg/dl). Dado que la ILI tiene mayor actividades lesiva sobre cartílago y hueso se realizó el índice ILI/TNF de ambos grupos encontrando diferencias significativas (media de grupo A 0.94, media del grupo B 0.76). Es decir, se observó una mayor actividad relativa de ILI en el grupo con manifestaciones clínicas. Se plantea que una hiperactividad relativa de ILI, respecto de TNF, puede estar en la base patogénica de las manifestaciones articulares durante la hemodiálisis crónica. Se discuten los mecanismos de elevación absoluta y relativa de ILI respecto de TNF durante el periodo de hemodiálisis

Análisis de la pseudoartrosis de la clavícula / An assessment of pseudoartrhosis of the clavicle

Se revisa una serie no comparativa de 12 pacientes con diagnóstico de pseudoartrosis de la clavícula, con edades que variaron de 18 a 50 años, tratados de 1994 a 1997. El tratamiento incial había sido conservador en 11 casos y sólo uno con enclavamiento. De los 12 casos, en 2 se encontró solamente un callo óseo protuberante que se trató con remodelación quirúrgica. Los 10 restantes se trataron con plastía de la pseudoartrosis y clavo intramedular bloqueado e injerto óseo. En todos los pacientes operados apareció callo primario en promedio a las 6 semanas después de la plastía de la pseudoartrosis. A pesar del número de pseudoartrosis aquí reportado, se sigue enfatizando la importancia de la indicación de tratamiento quirúrgico de las fracturas primarias de la clavícula únicamente en las tipo III de la clasificación AO, modificada en México por Inárritu