Condromatosis sinovial: revisión de 25 casos monoarticulares / Synovial chondromatosis: review of 25 monoarticular cases

We report 25 patients (20 female) aged 34 to 74 years old, with monoarticular synovial chondromatosis. Affected joints were tha knee in 25 cases, the ankle in one case and the elbow in one case. Chronic articular pain was the main symptom, followed by swelling, limitation in motion range, free palpable bodies and symptomatic popliteal cysts. X ray examination showed free calcified osteochondroid bodies in 48 percent of patients and secondary osteoarthritis in 36 percent. Bone scintiscan showed an increased focal uptake. All pathological samples had chondroid or osteochondroid nodules; 64 percent had small blood vessels, thickened with concentric collagen laminae and 20 percent had isolated chondrocytes. Malignant degeneration was not observed. Surgical or artroscopic synevectomy was the procedure of choice in 20 knees. In the affected elbow and ankle, extraction of free bodies was the sole procedure. No recurrences were observed. It is concluded that synovial chondromatosis must be considered in the differential diagnosis of chronic articular pain and monoartritis

Sinovectomía radioactiva con yttrium 90 y rhenium 186, en artritis reumatoídea: seguimiento a largo plazo y efecto en la membrana sinovial / Radiation synovectomy with yttrium 90 and rhenium 186 in rheumatoid arthritis: long term follow up and effects on synovial membrane

Despite the progress in the treatment of rheumatoid arthritis (RA), many patients continue to suffer from persistent and painful synovitis. We assessed the clinical results of 64 intraarticular injections of Yttrium 90 in the knee and 56 injections of Rhenium 186 in the wrist in 71 patients with RA, older than 40 years, without relief of synovitis after six months of systemic or local treatment and with a radiological stage I or II of the joints. We obtained good results in 75 percent of knees and 100 of wrists during a follow up period of 8 to 60 months. A repeat histological examination of the synovial membrane of 14 joints in which good results were obtained disclosed a reduction in inflammation and transitory synovial cell hyperplasia that ended in a dense fibrosis. It is concluded that radiation synovectomy continues to be an effective therapy for selected patients with RA and synovitis. The observed histopathological changes may aid the interpretation of magnetic resonance imaging of the treated joints

Algunas reflexiones sobre la naturaleza de la enfermedad / Some reflections on the nature of disease

La medicina ha llegado a comprender la enfermedad sólo en su exterioridad; describe síntomas, explica alteraciones y atribuye causas, pero aún ignora la esencia íntima del enfermar. Por sobre cualquiera explicación científico natural y causal de la enfermedad, más allá de su comprensión psicosomática, se plantea algo más genérico y profundo que constituye la realidad subyacente y radical del enfermar y cuya naturaleza exacta aún no comprendemos. El cuerpo-mente es sólo la interfase entre aquéllo más interno y el mundo exterior. La misión del médico no puede limitarse a la rutina de tratar lo superficial, lo externo, lo aparente de la enfermedad. Tiene que intentar desentrañar el significado profundo del proceso morboso y entender que en la situación de enfermedad, el interjuego de lo primariamente vital con lo anímico-corporal y el entorno, actuando como un todo, en el hombre incompleto y necesitante, se manifiesta en forma de dolor, limitación y angustia existencial