Confusing cytological findings in myositis ossificans.

BACKGROUND: Myositis ossificans (MO) is a rare non-neoplastic heterotopic ossification of soft tissue. Histological examination is the gold standard method for diagnosis, but fine needle aspiration (FNA) cytology may aid in presumptive diagnosis of this lesion. CASES: Nine patients with chief complaint of soft tissue mass with clinically suspected MO were selected. FNA of the mass showed low to hypercellular smears, composed of some amorphous pink to bluish material on Wright-Giemsa stain. The predominant cells were oval to spindle-shaped, resembling fibroblasts. Some cells had a high nucleo-cytoplasmic ratio with hyperchromatic nuclei, an irregular nuclear border and prominent nucleoli. Bland-looking osteoblasts and uni- and binucleated chondrocytes were also noted. FNA diagnosis of 4 patients was suggestive of osteosarcoma and of 2 patients suggestive of chondrosarcoma, 2 patients were diagnosed with a benign process and 1 was deferred due to hypocellularity of the smears. Histological examination of the corresponding surgical specimen confirmed the diagnosis of MO. CONCLUSION: MO cannot be diagnosed on FNA smears without analyzing the clinical and radiological findings. Experience shows that otherwise MO is mostly misdiagnosed as a malignant lesion.

Closed reduction of bilateral posterior shoulder dislocation with medium impression defect of the humeral head: a case report and review of its treatment.

Bilateral dislocation of the shoulder is a rare injury. The main causes are electrical shock, extreme trauma, and epilepsy. A 25-year-old athletic-body man had sustained bilateral shoulder pain and restricted external rotation following electrical shock for five days. Although articular surface damage was about 50% in the right side and 30% in the left, it could be managed successfully by close reduction without pinning. During one-year follow-up, no recurrent dislocation or limitation of motion was seen. Closed management of medium size defect of the humeral head after posterior dislocation can be performed in cooperative and especially muscular patients.

Synoviorthesis induced by rifampicin in hemophilic arthropathy: a report of 24 treated joints.

Intra-articular hemorrhage is the clinical hallmark of hemophilia. Synoviorthesis, the intra-articular injection of chemical or radioactive substances in order to produce fibrosis of the hypertrophied synovium, has proved effective in the treatment of chronic hemophilic synovitis. Between December 2006 and July 2007, we treated 21 patients with hemophilic arthropathy by synoviorthesis with rifampicin once a week. The procedures were performed on 14 knees, five elbows, four ankles, and one shoulder (24 joints and 113 injections). The mean age was 16.7 years (range, 7-49 years). According to the Fernandez-Palazzi classification, synoviorthesis was considered satisfactory (excellent or good) in 21 (87.5%) joints and unsatisfactory (fair or poor) in three (12.5%). A mean reduction of 6.3 bleeding episodes per month was obtained (P < 0.0001). The mean pain score was reduced from 2.62 (range, 2-3; SD, 0.49) before treatment to 0.79 (range, 0-2; SD, 0.65) after treatment. The mean World Federation of Hemophilia (WFH) score was 5.45 (range, 2-8) before synoviorthesis and 3.5 (range, 1-7) after treatment. This method effectively reduced hemarthrosis and pain and also improved the range of motion in patients with hemophilic arthropathy. Chemical synoviorthesis with rifampicin appears to be efficient, inexpensive, and simple and also especially practical in developing countries where radioactive agents are not easily available.

Pain relief after arthroscopic knee surgery--intraarticular sufentanil vs morphine.

BACKGROUND: Prevention of postoperative pain by injecting opioid into the knee joint is believed to support the hypothesis of peripheral opioid receptor activation in inflammation. Main outcomes were reduction of pain intensity and need for supplementary analgesics. The aim of the present study was to evaluate the analgesic effects of intraarticular sufentanil in comparison with morphine, following arthroscopic procedures of knee joint. METHODS: In this prospective, double-blind study, 45 patients were randomized in three equal number groups to receive either sufentanil 5 ug (group S), morphine 3 mg (group M) or normal saline 20 cc as placebo, (group P) intra-articularly at the end of arthroscopic knee surgery, under general anesthesia. Pain levels at rest and at intervals of 1,2,4,8,12,14 hours and during movement of knee at discharge time, were measured by a Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) postoperatively and the day after surgery. RESULTS: Significant difference between the groups (p < 0.001) were found. Pain scores were statistically lower in the sufentanil (S) and morphine (M) groups in comparison with the normal saline placebo (P) group. Inta-articular sufentanil was however more effective than morphine. CONCLUSION: The Intra-articular injection of morphine and sufentanil, reduce both the post arthroscopic knee procedures pain, and the need for supplementary analgesics. However, sufentanil, 5 microg is more effective than morphine.