Limited knee joint range of motion due to invisible gouty tophi.

OBJECTIVES: Tophi deposits are a well-known cause of joint destruction, gouty nephropathy and spinal cord compression. This study reports another major complication of gout, namely tophi deposition causing limited knee joint excursion. METHODS: Seven gout patients with limited knee joint excursion owing to tophi deposition were studied to reveal clinical features and magnetic resonance imaging (MRI) findings. None of the patients were able to assume a full squatting posture. RESULTS: No patients had visible subcutaneous tophi over the knee joints, except for one case in which a pea-sized subcutaneous tophus was noted. Additionally, two patients even lacked visible tophi elsewhere. All knee problems in the study group were initially regarded as being due to degenerative or other internal derangements, but MRI unexpectedly revealed multiple tophaceous depositions within and around the joint. CONCLUSIONS: Intra-articular and periarticular tophi limiting knee joint range of motion are a rare but important cause of walking disability in gout patients. Although most patients do not display visible subcutaneous tophi over the knee on physical examination, the differential diagnosis should consider intra-articular tophi and MRI is valuable in this clinical setting.

Combined computed tomographic pulmonary angiography and venography for evaluation of pulmonary embolism and lower extremity deep venous thrombosis: report of two cases.

Pulmonary embolism (PE) and deep venous thrombosis (DVT) are major causes of morbidity and mortality, which can be reduced with accurate diagnosis and proper treatment. More than 90% of PEs originate in lower-extremity DVT. Currently, evaluation of PEs and lower-extremity DVT requires 2 separate tests (ventilation-perfusion scan, computed tomographic pulmonary angiography (CTPA), or pulmonary angiography for PE and sonography, computed tomographic venography (CTV), conventional venography, or magnetic resonance venography for DVT). Combined computed tomographic pulmonary angiography and venography (CTPAV) is a new diagnostic technique that combines CTPA and CTV into a single study for the screening of PE and subdiaphragmatic DVT. CTPAV is a modified CTPA study that evaluates the subdiaphragmatic deep vein system at the time of CTPA, without additional venipuncture or contrast medium. It is easy to perform, fairly easy to interpret, readily available, and requires no invasive procedure. We present 2 cases of multiple PE and lower-extremity DVT in which CTPAV was used.

Accuracy of the orthopantomogram in assessment of tooth length in orthodontic patients.

The orthopantomogram (OPG) provides as assessment of root length and characteristics before orthodontic tooth movement. This study determined the accuracy of the OPG in assessing tooth length. Investigators compared the radiographic and actual tooth lengths in permanent first premolars indicated for orthodontic extractions. Results showed that the mean lengths measured from OPG were consistently higher than the actual lengths by 22% (p < 0.001) for maxillary teeth and by 1% for mandibular teeth. This study found that there is elongation of root images in OPG.

Laparoscopy in the diagnosis and management of ovarian cancer.

Ninety-two laparoscopies were performed for diagnosis and follow-up on 83 patients with clinical diagnoses of ovarian cancer from May 1979 to May 1981. With laparoscopy about 10% of the cases were disproven; of suspicious cases only 53% were confirmed. Laparoscopy was very helpful in clarifying the clinical diagnosis of ovarian carcinoma. Laparoscopy for follow-up evaluation of treatment was done on 44 patients. Very early recurrence, which is very difficult to detect on clinical examination, was found with second-look laparoscopy. If few adhesions are present, laparoscopy can replace second-look exploration in the majority of cases of complete remission.