calcified intraarticular mass in a man with severe shoulder osteoarthritis: what are the implications?

Rapidly progressive osteoarthritis in the shoulder in the elderly is often associated with chronic rotator cuff calcifications and damage and with apatite crystals identifiable in the joint fluid. The key roles of the crystals and rotator cuff lesions although suspected have been disputed. We describe a 57-year-old man with severe degenerative changes at the right shoulder and other joints. A calcified mass 2-cm in length was found on radiographs medially in relation to the proximal humeral diaphysis. At arthroscopy, the mass was confirmed to be in the joint and due to calcified synovium. Biopsy revealed synovium with apatite like crystal clumps in this mass. Calcium pyrophosphate crystals were also found but in the cartilage only. This case with the apatite crystals only in synovium and with destructive arthritis without a complete rotator cuff tear raise the possibility that synovium as a primary site for apatite deposition might be important in the destructive arthritis. Management of this patient like many with rotator cuff tear arthropathy has been difficult. Rapidly destructive osteoarthritis at the shoulder, much like that in the patient reported here, has been described under a variety of terms that suggest implications for pathogenesis. Neer et al used the term cuff tear arthropathy to describe glenohumeral degenerative arthritis and a rotator cuff tear in twenty-six patients who had required a total shoulder replacement.[1] McCarty et al described 4 elderly women with destructive arthropathy of the shoulder, large effusions, apatite crystals present in the joint effusions and massive tears of the rotator cuffs and coined the term Milwaukee shoulder syndrome.[2],[3],[4]. Dieppe et al suggested the terms apatite-associated destructive arthritis and idiopathic destructive arthritis.[5] Calcifications have been noted in the rotator cuff structures but have not been reported in the joint or synovium.[3] We describe a patient with a similar destructive arthropathy, who had a calcified mass about 2-cm in length in the right shoulder, well visible by X-ray and arthroscopy, that was localized to synovium at arthroscopy. Since this patient did not have prominent rotator cuff disease, our case suggests that intraarticular crystals can be associated with difficult to manage progressive shoulder osteoarthritis without a prominent primary rotator cuff cause

Incidence of ototoxicity in patients receiving cytotoxic medication

This study was done with the objective to evaluate the efficacy of otoacoustic emission in early detection of cochlear lesion due to ototoxic drugs. A total of thirty five patient twenty of them were receiving cisplatin and fifteen were receiving vincristine. They were receiving the therapy at the Oncology unit, Assiut university hospital. All study patients were submitted to complete audiological evaluation including pure tone audiometry, speech audiometry, Immittancemetry test and otoacoustic emissions [OAE] including, Transient evoked otoacoustic emissions. This evaluation was done before drug therapy and after each subsequent course of therapy. Comparisons were made between basic pre-therapy evaluation and the serial follow up for three mouths [by audiometry and otoacoustic emission test]. After therapy, significant evaluation of pure tone thresholds were demonstrated in high frequencies [4-8 KHZ] in 67% of patients receiving cisplatin and 13.3% in patients receiving vincristine therapy. There were a significant decrease in OAE amplitude specially at high frequency band; 3-4 KHZ in both groups even in patients with no changes in their audiometric thresholds. In conclusion vincristine and cisplatin therapy could produce Ototoxicity due to cochlear lesion and TEOAEs were more a sensitive than audiometric test in early detection of cochlear Ototoxicity and could be used for its monitoring