Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: a case report.

This is a case report of an extremely rare condition of atlanto-axial subluxation secondary to gouty arthritis, which mimicked rheumatoid arthritis at presentation. Gouty arthritis involving the spine is a rare condition. We highlight a case of gouty arthritis involving the atlanto-axial joint resulting in joint instability, subluxation, and neurological deficit. A 66-year-old obese woman who had a polyarticular disease for the previous 3 years presented with neck pain and progressive neurology. A 2-stage procedure was performed: posterior decompression and occipitocervical fusion followed by further anterior trans-oral decompression. However, after an initial neurological improvement, she succumbed to aspirational pneumonia and septicaemia. Atlanto-axial subluxation caused by gouty arthritis can present in the same way as rheumatoid arthritis. Therefore, the possibility of this as a differential diagnosis should be kept in mind.

Objective triceps muscle strength measurement using computerized adaptation.

In our centre the non-availability computerized exercise machines limits the objective monitoring of strength rehabilitation. We undertook this research programme to objectively measure triceps muscle strength by interfacing NORSK-Gym machine with accelerometer and positional transducers to a computer. This data was tabulated and processed using Microsoft Excel. The positional transducer was first calibrated and it showed an excellent Pearson Correlation Coefficients against a standard metric reading (r = 0.9999). Peak Force was used as a test parameter for isotonic triceps muscle strength measurements. The criterion-referenced validity was established as the peak forces measured using the accelerometer and positional transducer demonstrated identical Peak Forces (r = 0.94). Analysis of our mean Peak Force measurements using non-biological force as well as the intra-individual reproducibility demonstrated excellent Pearson Correlation Coefficients (r) = 0.982-0.998 and 0.929-0.972 respectively. This computerized adaptation of the NORSK-Gym machine produced an objective, valid and reproducible triceps muscle strength measurement.

A rare case of chondrosarcoma of the clavicle.

Although all types of tumour and tumour-like conditions have been described to occur in the clavicle, they only contribute to less then 0.5% of all skeletal tumours. The incidence of primary chondrosarcoma of the clavicle is extremely rare. To our knowledge it has not been reported in Malaysia. We would like to highlight the possibility of chondrosarcoma as a differential diagnosis for a clavicular lesion.

Outcome of meniscus surgery at University Malaya Medical Centre.

Between January 1994 to December 1998, 133 patients had a meniscal surgery at University Malaya Medical Centre. Fifty-four patients were assessed and scored with the Lysholm and Tegner scoring system. Twenty-nine patients had partial meniscectomies and 25 had meniscus repair. The outcome was successful in 80% with meniscal repair and 51.7% with partial meniscectomy. The outcome of meniscal repair in this study is comparable to other reported series. However, the failure rate for partial meniscectomy was high.