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1.
Article in Chinese | WPRIM | ID: wpr-878669

ABSTRACT

Objective To explore the clinical characteristics of relapsing polychondritis(RP)patients presented with arthropathy. Methods We retrospectively analyzed the clinical data of 201 RP patients who were hospitalized in our center between December 2005 and February 2019.After 16 patients with co-existing other autoimmune diseases and malignancies were ruled out,185 RP patients entered the final analysis,among whom 16 RP patients were presented with arthropathy and 169 without arthropathy.The demographic data,clinical manifestations,laboratory findings,and prognosis were compared between these two groups. Results Five of the 16 RP patients with arthropathy at presentation were misdiagnosed as rheumatoid arthritis.Compared with RP patients without arthropathy at presentation,RP patients with arthropathy at presentation had a longer disease course[(37.50±66.50)months


Subject(s)
Arthritis, Rheumatoid , Delayed Diagnosis , Diagnostic Errors , Humans , Joint Diseases/diagnosis , Polychondritis, Relapsing/diagnosis , Prognosis , Retrospective Studies
2.
Rev. AMRIGS ; 60(4): 374-376, out.-dez. 2016. ilus
Article in Portuguese | LILACS | ID: biblio-847864

ABSTRACT

A Alcaptonúria é uma doença autossômica recessiva rara caracterizada pelo acúmulo de ácido homogentísico. Denomina-se também ocronose e manifesta-se por pigmentação azulada de tecidos orgânicos e urina enegrecida, além de artropatia. A seguir, será relatado o caso de irmãos portadores de artropatia ocronótica e a conduta ortopédica (AU)


Alkaptonuria is a rare autosomal recessive disease characterized by the accumulation of homogentisic acid. It is also called ochronosis and is manifested by bluish pigmentation of organic tissues and blackened urine, besides arthropathy. Here the authors report the case of siblings with ochronotic arthropathy and the orthopedic management (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Alkaptonuria/diagnosis , Alkaptonuria/genetics , Ochronosis/diagnosis , Ochronosis/genetics , Siblings , Joint Diseases/diagnosis , Joint Diseases/therapy
5.
Rev. Asoc. Argent. Ortop. Traumatol ; 78(1): 5-12, mar. 2013.
Article in Spanish | LILACS | ID: lil-689072

ABSTRACT

Introducción: Actualizar el cuadro de ligamento cruzado anterior mucoide y describir nuestra experiencia en el diagnóstico y el tratamiento quirúrgico. Materiales y métodos: Se analizan los aspectos clínicos y fisiopatológicos, los hallazgos por imágenes y el tratamiento quirúrgico, según las series publicadas. Además, se presenta un estudio retrospectivo con 27 pacientes (promedio de edad, 55 años ; rango 34-68 años), llevado a cabo entre 2004 y 2011. Para la evaluación de los pacientesse consideró el dolor, el rango de movilidad y la estabilidad. Se emplearon maniobras clínicas y el artrómetro KT-1000 para evaluar la estabilidad posoperatoria. Se realizaron radiografías y resonancia magnética preoperatorias y posoperatorias. Los resultados funcionales posoperatorios fueron evaluados con las escalas de Lysholm, IKDC, y la evaluación subjetiva del dolor. Se tomaron muestras para biopsia. Resultados: La escala de evaluación analógica del dolor mejoró un promedio de 6 puntos y el rango de movilidad, un promedio de 26°. La estabilidad de la rodilla no estaba comprometida. Las escalas de evaluación funcional arrojaron un IKDC de A en el 50 por ciento de los pacientes, de B en el 33 por ciento y de C en el 17 por ciento. El puntaje de Lysholm fue de 95. El resultado en la escala de evaluación subjetiva osciló entre muy bueno y excelente en la mayoría de los casos. No hubo complicaciones posoperatorias. Conclusiones: La resonancia magnética es el estudio por imágenes para el diagnóstico preoperatorio; los hallazgos son característicos y no deben confundirse con desgarros del ligamento cruzado anterior. El diagnóstico definitivo es histológico. Creemos que el tratamiento artroscópico es eficaz, reproducible y tiene una baja tasa de complicaciones.


Subject(s)
Adult , Knee Joint/surgery , Knee Joint/pathology , Joint Diseases/diagnosis , Joint Diseases/pathology , Arthroscopy/methods , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament/pathology , Anterior Cruciate Ligament , Magnetic Resonance Imaging , Mucus , Pain Measurement , Range of Motion, Articular , Retrospective Studies
6.
Article in English | WPRIM | ID: wpr-101284

ABSTRACT

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.


Subject(s)
Anterior Cruciate Ligament/pathology , Arthralgia/etiology , Humans , Joint Diseases/diagnosis , Knee Joint/pathology , Male , Middle Aged , Posterior Cruciate Ligament/pathology
7.
Article in English | WPRIM | ID: wpr-206708

ABSTRACT

BACKGROUND: Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. METHODS: Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. RESULTS: Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. CONCLUSIONS: Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.


Subject(s)
Ankle Joint/pathology , Arthroscopy/methods , Chronic Disease , Female , Humans , Joint Diseases/diagnosis , Joint Instability/diagnosis , Lateral Ligament, Ankle/pathology , Magnetic Resonance Imaging/methods , Male , Observer Variation , Pain Measurement , Retrospective Studies , Severity of Illness Index , Synovitis/pathology
8.
Rev. bras. reumatol ; 51(3): 286-288, maio-jun. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-588182

ABSTRACT

O tornozelo é sítio frequente de sintomas dolorosos em atletas e não atletas. A dor localizada na região posterior pode ser o resultado final de diversas patologias, sendo um desafio diagnóstico para o reumatologista. A síndrome do impacto (pinçamento) posterior do tornozelo, também denominada síndrome os trigonum e síndrome compressiva tibiotalar posterior, é um distúrbio clínico caracterizado por dor aguda ou crônica na região posterior do tornozelo, desencadeada pela flexão plantar forçada, que promove microtrauma crônico repetitivo. A patologia do processo os trigonum-talar é a causa mais comum dessa síndrome, mas existem outras causas, como tenossinovite do flexor longo do hálux, osteocondrite de tornozelo, doença da articulação subtalar e fratura. O diagnóstico baseia-se na história clínica e exame físico, e complementado por achados na radiografia simples (RX), ultrassom (US), cintilografia, tomografia computadorizada (TC) e ressonância magnética (RM). Destacamos o RX por seu baixo custo e boa sensibilidade, o US pela possibilidade de guiar infiltrações terapêuticas e a RM pela possibilidade de avaliar partes moles adjacentes.


The ankle is a common site of painful symptoms in athletes and nonathletes. Posterior ankle pain can be the end result of several pathologies, and a diagnostic challenge for rheumatologists. The posterior ankle impingement syndrome, also known as os trigonum syndrome and posterior tibiotalar compression syndrome, is a clinical disorder characterized by acute or chronic posterior ankle pain triggered by forced plantar flexion, which causes chronic repetitive microtrauma. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but there are other causes, such as tenosynovitis of the flexor hallucis longus, ankle osteochondritis, subtalar joint disease, and fracture. Diagnosis is based on clinical history and physical examination, and complemented by findings on plain radiography (RX), ultrasound (US), scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). It is worth noting that RX has low cost and good sensitivity, US can provide guidance to therapeutic infiltrations, and MRI allows the assessment of surrounding soft tissues.


Subject(s)
Female , Humans , Male , Middle Aged , Ankle Joint , Joint Diseases/diagnosis , Rheumatology
9.
Rev. Méd. Clín. Condes ; 20(3): 354-361, mayo 2009. ilus, tab
Article in Spanish | LILACS | ID: lil-525321

ABSTRACT

La artrosis de cadera es una patología de múltiples etiologías. Los principios biomecánicos implicados en el desarrollo de la artrosis se basan en la transmisión de fuerzas a través de la superficie articular, iniciándose la degeneración cartilaginosa por sobrecarga. Existe un grupo de pacientes jóvenes que presentan artrosis cuya causa ha sido históricamente catalogada como idiopática o primaria. El advenimiento de nuevos conocimientos de la anatomía normal y patológica de la cadera ha permitido detectar alteraciones más sutiles. El pellizcamiento fémoroacetabular (PFA) aparece entonces como una nueva causa mecánica de dolor de cadera (1). Esto, en el tiempo llevaría a una lesión del labrum acetabular y/o el cartílago adyacente (2, 3, 22) y finalmente, a una artrosis precoz. Esta patología es de consulta frecuente en pacientes jóvenes con coxalgia no diagnosticada. Puede comprometer a diversas especialidades de la medicina durante su consulta primaria con distintas formas de presentación, hallazgos semiológicos e imaginológicos.


Hip osteoarthritis is pathology with multiple etiologies. The biomechanical principles involved in the development of hip osteoarthritis are based on force transmission through the articular surface, initiating carthilage degeneration due to overload. There is a group of young patients who present hip osteoarthritis that have been historically classified as idiopathic or primary. The progress in knowledge of normal anatomy and pathologies of the hip has made it possible to detect more subtle alterations. The femoroacetabular impingement (FAI) appears as a new mechanical cause for hip osteoarthritis (1). This, in time, would lead to acetabular labral and/or carthilage lesions (2, 3, 22) and eventually, early onset osteoarthritis. This pathology is frequent in young patients with an undiagnosed hip pain. It can involve multiple medical specialties in its initial consult due to different forms of early presentation, findings during physical exam and image studies.


Subject(s)
Humans , Acetabulum/pathology , Joint Diseases/diagnosis , Osteoarthritis, Hip/diagnosis , Femur/pathology
10.
Arq. bras. med. vet. zootec ; 60(5): 1035-1044, out. 2008. ilus, tab
Article in Portuguese | LILACS | ID: lil-500067

ABSTRACT

Avaliaram-se e classificaram-se por meio da vídeo-artroscopia as alterações da articulação fêmoro-tíbio-patelar (FTP), 21 dias após secção experimental do ligamento cruzado cranial (LCCr) em cães, tendo como referência os parâmetros encontrados no exame artroscópico imediatamente anterior à secção. Ao exame artroscópico, foi possível visibilizar os cotos remanescentes do LCCr e as alterações articulares, como aumento da vascularização, aumento das vilosidades na membrana sinovial, bem como fibrilação e osteófitos, principalmente nas bordas trocleares do fêmur. Os resultados sugerem que a artroscopia é um método preciso de avaliação macroscópica dos tecidos articulares moles e duros.


By the use of videoarthroscopy, the changes of the stifle joint after experimental rupture of cranial cruciate ligament (CCL) in dogs were evaluated and classified, based on the parameters found at the arthroscopic examination right before the rupture. By the arthroscopic examination, it was possible to visualize the remainings of the CCL and joint changes such as increase of the vascularity and synovial proliferation increase in the synovial membranes, as well as fibrillation and irregularities on the joint surfaces and osteophyte formation, mainly on the trochlear ridges. The results suggest that arthroscopy is a precise method for macroscopic evaluation of the smooth and bone joint tissues.


Subject(s)
Animals , Joint Diseases/diagnosis , Arthroscopy/methods , Dogs , Ligaments, Articular/injuries
11.
Medicina (B.Aires) ; 68(4): 298-300, jul.-ago. 2008.
Article in Spanish | LILACS | ID: lil-633556

ABSTRACT

La meningococcemia crónica es una forma clínica infrecuente dentro del espectro de infecciones producido por Neisseria meningitidis. Clásicamente esta forma clínica se caracteriza por fiebre, lesiones cutáneas, compromiso articular, y desarrollo en hemocultivo de la bacteria responsable, habitualmente con ausencia de compromiso meníngeo. Generalmente afecta a adultos jóvenes previamente sanos. Se desconoce la razón por la cual estos pacientes, a diferencia de los que presentan meningitis aguda por Neisseria meningitidis y meningococcemia aguda, pueden sobrevivir sin complicaciones durante semanas en ausencia de tratamiento antibiótico útil. Se ha planteado que debido a la alta sensibilidad de esta bacteria a los antibióticos beta-lactámicos, muchos casos podrían ser tratados inadvertidamente. Describimos un caso de meningococcemia crónica en una mujer joven que presenta un cuadro clásico no reconocido inicialmente.


Chronic meningococcemia is an unfrequent clinical picture within the spectrum of infections produced by Neisseria meningitidis. It is classically characterized by fever, skin lesions and joint involvement, usually without meningeal involvement, and with blood culture growth of the responsible bacteria. It generally affects previously healthy young people. It is unknown why these patients, unlike patients with Neisseria meningitidis’s acute meningitis and with acute meningococcemia, can survive without complications during weeks, in abscence of an useful antibiotic treatment. It has been hypothesized that owing to high susceptibility to beta-lactam antibiotics of Neisseria meningitidis, many cases may be treated inadvertently. We describe a case of chronic meningococcemia in a young woman who presented a classical clinical picture, not recognized initially.


Subject(s)
Adult , Female , Humans , Joint Diseases/diagnosis , Meningococcal Infections/diagnosis , Neisseria meningitidis , Chronic Disease , Diagnosis, Differential , Joint Diseases/microbiology , Meningitis, Meningococcal/diagnosis
12.
Pediatr. día ; 24(2): 4-8, mayo-jun. 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-547418

ABSTRACT

El dolor de la cadera en niños es un motivo de consulta de relativa frecuencia en pediatría, pudiendo ser causado por patología propia de la cadera o referida. La acuciosidad semiológica y el conocimiento de las distintas etiologías permiten un adecuado análisis, evitando secuelas derivadas de un diagnóstico y tratamiento tardío.


Subject(s)
Humans , Child , Joint Diseases/complications , Hip/pathology , Pain/etiology , Joint Diseases/diagnosis , Diagnosis, Differential , Risk Factors
14.
Indian J Pathol Microbiol ; 2008 Apr-Jun; 51(2): 257-8
Article in English | IMSEAR | ID: sea-74912

ABSTRACT

We report an unusual case of a 10-year-old female with complaints of pain and swelling of the right knee for the last 4 years along with the limitation of movement for last 1 year. Repeated fine needle aspirations yielded blood and a provisional diagnosis of hemarthrosis was suggested. Coagulation profile subsequently carried out was found to be within normal limits. Arthroscopic biopsy was performed and tissue was sent for histopathological examination. A diagnosis of synovial hemangioma was made. Subtotal synovectomy was performed and the lesion was completely excised. The patient is completely asymptomatic and shows no signs of recurrence at 1 year.


Subject(s)
Child , Female , Hemangioma/diagnosis , Humans , Joint Diseases/diagnosis , Knee Joint/pathology , Soft Tissue Neoplasms/diagnosis , Synovial Membrane/pathology
15.
Bulletin of Alexandria Faculty of Medicine. 2008; 44 (1): 161-165
in English | IMEMR | ID: emr-86023

ABSTRACT

When clinical data are insufficient to diagnose infrction of bone or joints, nuclear scanning becomes crucial in making an accurate diagnosis. The efficiency of' technetium-99m antigranulocyte monoclonal antibody Fob fragment [leukoscan] was evaluated in 66 patients with suspected muscloskeletal infection and was compared with technetium- 99m methylene diphosphonate bone scan in 54 patients. The overall sensitivity of leukoscan and MDP bone scan was 94.4% and 86.5% respectively Specificity was 91.6% and 50% respectively, and accuracy was 94% and 85% respectively. Leukoscan is more accurate in detecting bone and joint infection with better sensitivity and specificity compared with MDP bone scan


Subject(s)
Humans , Male , Female , Joint Diseases/diagnosis , Technetium Tc 99m Medronate/blood , Sensitivity and Specificity , Antibodies, Monoclonal , Diagnosis , Gallium , Leukocytes
16.
Article in English | WPRIM | ID: wpr-43603

ABSTRACT

OBJECTIVE: To validate the use of contrast-enhanced (CE) fat-suppressed three-dimensional (3D) fast gradient-recalled acquisition in the steady state with radiofrequency spoiling (FSPGR) magnetic resonance imaging (MRI) for the diagnosis of anterolateral soft tissue impingement of the ankle, as compared to the use of routine ankle MRI. MATERIALS AND METHODS: Contrast-enhanced fat-suppressed 3D-FSPGR MRI and routine MRI scans were retrospectively reviewed for 45 patients with arthroscopically proven anterolateral impingement. In addition, scans were reviewed in 45 control subjects with diagnoses other than impingement. Two radiologists independently reviewed the two sets of images in random order. Using areas (Az) under the receiver operating characteristic curve (ROC), we compared the depiction of anterolateral soft tissue impingement in the two sets of images. RESULTS: The overall accuracy for lesion characterization was significantly higher (p < 0.05) using the CE fat-suppressed 3D-FSPGR MR images (Az = 0.892 and 0.881 for reader 1 and 2, respectively) than using the routine MR images (Az = 0.763 and 0.745). The use of CE fat-suppressed 3D-FSPGR MRI enhanced impingement depiction in most cases. However, in cases with a thickened non-enhancing scar or joint effusion, the routine images better depicted a soft tissue mass that intruded into anterolateral gutter than the CE images. CONCLUSION: The use of CE fat-suppressed 3D-FSPGR MRI of the ankle allows a more accurate assessment of anterolateral soft tissue impingement of the ankle, as compared to the use of routine MRI.


Subject(s)
Adolescent , Adult , Aged , Ankle Joint/pathology , Contrast Media , Female , Gadolinium DTPA , Humans , Image Interpretation, Computer-Assisted , Imaging, Three-Dimensional , Joint Diseases/diagnosis , Magnetic Resonance Imaging/methods , Male , Middle Aged , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Statistics, Nonparametric
17.
Braz. j. infect. dis ; 11(4): 426-429, Aug. 2007. ilus, tab
Article in English | LILACS | ID: lil-460706

ABSTRACT

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.


Subject(s)
Humans , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Bone Diseases/chemically induced , Carpal Tunnel Syndrome/chemically induced , Joint Diseases/chemically induced , Anti-HIV Agents/therapeutic use , Bone Diseases/diagnosis , Bone Diseases/therapy , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/therapy , HIV Infections/drug therapy , Joint Diseases/diagnosis , Joint Diseases/therapy
18.
Article in English | WPRIM | ID: wpr-92064

ABSTRACT

There are currently no initial guides for the diagnosis of somatic referred pain of lumbar zygapophyseal joint (LZJ) or sacroiliac joint (SIJ). We developed a classification system of LZJ and SIJ pain, the "pain distribution pattern template (PDPT)" depending on the pain distribution patterns from a pool of 200 patients whose spinal pain source was confirmed. We prospectively applied the PDPT to determine its contribution to clinical decision-making for 419 patients whose pain was presumed to arise from the LZJs (259 patients) or SIJs (160 patients). Forty-nine percent (128/259) of LZJ and 46% (74/160) of SIJ arthopathies diagnosed by PDPT were confirmed by nerve blocks. Diagnostic reliabilities were significantly higher in Type A and C patterns in LZJ and Type C in SIJ arthropathies, 64%, 80%, and 68.4%, respectively. For both LZJ and SIJ arthropathies, favorable outcome after radiofrequency (RF) neurotomies was similar to the rate of positive responses to diagnostic blocks in Type A to Type D, whereas the outcome was unpredictable in those with undetermined type (Type E). Considering the paucity of currently available diagnostic methods for LZJ and SIJ arthropathies, PDPT is useful in clinical decision- making as well as in predicting the treatment outcome.


Subject(s)
Adult , Aged , Decision Making , Female , Humans , Joint Diseases/diagnosis , Low Back Pain/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Pain Measurement , Sacroiliac Joint , Treatment Outcome , Zygapophyseal Joint
20.
Iranian Journal of Veterinary Research. 2005; 6 (1): 17-20
in English | IMEMR | ID: emr-71174

ABSTRACT

Reports on the physical and biochemical parameters ofsynovial fluid in buffaloes are limited. This study was conducted to evaluate the normal parameters ofsynovial fluid on buffaloes that can be very helpful in diagnosis of arthropathy. Synovial fluid of carpal joints was collected by arthrocentesis of the right and left forelimbs in 21 water buffaloes immediately after slaughtering of animals in abattoir. The quality of mucin clot and viscosity were normal in 100% of animals. The synovial fluid was colorless in 50% of cases and the other 50% had a yellowish color. Only 77.5% of samples were transparent and 22.5% were semitransparent. The range of values for different measured parameters were: AST: [27.65 +/- 5.9] IU/L, ALT: [15.08 +/- 2.75] IU/L, LDH: [36.55 +/- 13.28] IU/L, glucose: [59.25 +/- 3.39] mg/dL, total protein: [0.89 +/- 0.055] g/dL, urea nitrogen: [7.96 +/- 1] mg/dL. There was no significant difference between groups according to age, sex and side [left and right forelimbs] for all parameters except ALT and LDH which differed according to sex, ALT and LDH were significantly [P<0.05] greater in females


Subject(s)
Male , Female , Animals , Synovial Fluid/chemistry , Carpal Joints , Buffaloes , Joint Diseases/diagnosis , Sex Factors
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