Arthroscopic treatment for gouty tophi mimicking an intra-articular synovial tumor of the knee.

Tophi deposition is a well-recognized complication of chronic gout, but usually lacks obvious symptoms. Magnetic resonance imaging (MRI) findings may allow a relatively specific diagnosis to be rendered. In this study, we report an unusual case of gouty tophi presenting as an intra-articular synovial tumor of the knee, blocking the range of motion. We also describe its MRI appearance, which was compatible with the clinical suspicion. After arthroscopic excision of the "tumor," the patient was symptom free.

Primary synovial chondromatosis mimicking medial meniscal tear in a young man.

Magnetic resonance imaging has recently become a noninvasive and cost-effective diagnostic tool for meniscal pathology in the knee. We report an unusual case of primary synovial chondromatosis for which the clinical diagnosis was medial meniscal tear but magnetic resonance imaging also showed a displaced torn meniscus, causing a so-called "double meniscus sign." The patient was definitely diagnosed and successfully treated with arthroscopy. We discuss the clinical diagnostic and therapeutic challenges, and the possible pathogenesis.

Stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a spinner bowler: a case report and a review of the literature.

Stress fractures of the ulnar shaft are uncommon injuries, which have been documented in a variety of sports. The location of the fracture is influenced by the activity and mechanism of injury with which it is associated. The combined traditional approach of clinical history, physical examination, plain radiographs and nuclear scintigraphy for unusual stress fracture may be troublesome. This report is the first to describe a stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a bowler due to chronic torsional stress. We discuss the possible mechanism of injury and describe the diagnostic imaging. A review of the literature is also given and compared with the findings and data of this case.

Clinical significance of gelatinases in septic arthritis of native and replaced knees.

We hypothesized that more gelatinases appear in effusions of septic arthritis than aseptic arthritis. This study examined the laboratory variables of inflammation and the levels of gelatinase A and B (matrix metalloproteinases-2 and -9) in 75 effusions from the knees of 37 patients with inflammatory arthritis and compared them with effusions of septic and aseptic arthritis. Gelatin zymography revealed that the levels of the latent matrix metalloproteinase-9 were higher in 24 effusions of septic arthritis than in 51 effusions of aseptic arthritis. The latent matrix metalloproteinase-9 levels of septic arthritis also correlated with the neutrophil counts in effusions. Significantly more activated matrix metalloproteinases-2 and -9 appeared in effusions of septic arthritis in native and replaced knees than in effusions of aseptic arthritis. A high matrix metalloproteinase-9 level and the appearance of activated matrix metalloproteinases-2 and -9 may distinguish septic from aseptic arthritis, even in cases with a low neutrophil count in the replaced knee. Joint aspiration may not only reduce the bacteria counts, endotoxins, and proinflammatory cytokines, but also decrease the amount of matrix metalloproteinases in effusions that attack the extracellular matrix of native and artificial joints.

Spinal cord compression caused by extradural arachnoid cysts. Clinical examples and review.

Most spinal arachnoid cysts are asymptomatic and detected incidentally during magnetic resonance imaging or myelography. The etiology of intraspinal arachnoid cyst is not yet clear. We present two children with three spinal extradural arachnoid cysts and each cyst protruded from a separate dura defect. In both patients, plain radiographs demonstrated widening of the interpedicular distance, which suggested progressive widening of the spinal bony canal. Limited laminectomy was performed to remove the intraspinal cysts. Separate dura defects, the apparent predisposing factors, were also found and repaired. The patients completely recovered neurologically. Radical cyst removal and dura defect closure are the surgical intervention of choice in patients with symptomatic extradural arachnoid cyst.