Pigmented villonodular synovitis: Four pediatric cases and brief review of literature.

Pigmented villonodular synovitis (PVNS) is a rare benign disorder of a joint which affects its synovium, tendon sheaths and bursas. While most cases of PVNS are adult patients aged between 20-50 years, few afflicted children have also been reported. Clinical signs of PVNS are insidious and non-specific. Pain, swelling and stiffness are the major symptoms. Magnetic Resonance Imaging (MRI) is the best radiological method for diagnosis of PVNS, as the initial X-ray is normal in early phase of disease in most cases. Therefore, diagnosis is often delayed or confused with mechanical disorders, haemophilic arthropathy, tuberculosis, juvenile idiopathic arthritis (JIA), and other disorders. Four paediatric PVNS cases are being reported in this case series with the aim to highlight that PVNS should be considered in the differential diagnoses of chronic monoarthritis. Two of our cases were initially misdiagnosed as JIA and the remaining two as Familial Mediterranean fever (FMF). They did not respond to conventional anti-inflammatory treatment and eventually only benefited from surgery. These four cases emphasize that the radiologist and clinician should collaborate carefully while managing any child with monoarthritis to ensure that the diagnosis of PVNS is not missed.

Methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized children: correlation of molecular analysis with clinical presentation and antibiotic susceptibility testing (ABST) results.

The molecular analysis of methicillin-resistant Staphylococcus aureus (MRSA) from 98 children admitted to the Children's Hospital of Michigan, Detroit, MI, with serious MRSA infections during 2006-2007 was correlated with risk factors, clinical features, and antibiotic susceptibility testing (ABST) results. Isolates were characterized by staphylococcal cassette chromosome (SCC) mec type, the presence of Panton-Valentine leukocidin (PVL) genes, repetitive sequence (rep) polymerase chain reaction (PCR) and pulsed-field gel electrophoresis (PFGE), requirement for surgical intervention, antibiograms, and response to therapy. rep-PCR was more rapid than PFGE typing and correlated well. SCCmec type IV-containing isolates caused 92.8% of all infections, but the demographics and diseases associated with subtypes IVa and IVd differed. Subtype IVa (all PFGE type USA300 and PVL-positive) was identified in 81/93 (87.1%) of patients with community-onset (CO) MRSA, including 21/35 of those with risk factors for health care-associated (HA) infection. All other clones were PVL-negative. Subtype IVd (10 isolates; 9 USA800 and 1 eMRSA15) caused mainly HA-MRSA and no skin and soft tissue infections (SSTI). Seven classic HA-MRSA strains (SCCmec types II [6; 3 USA100 and 3 USA600] and III [1; USA200]) caused HA and hospital-onset (HO) infections. Surgical intervention was required in 68/81 patients infected with USA300 and 8/17 of the others. Most USA300 were susceptible (S) to clindamycin (CD) and patients were treated with CD alone or in combination. The other isolates were generally treated with vancomycin (VA) alone or in combination.

Effect of heparin on tendon degeneration: an experimental study on rats.

This study investigated the local effects of heparin on locally administered corticosteroid-induced experimental Achilles tendinitis. After performing Achilles degeneration, 28 rats were divided into two groups; one was treated with local heparin and the other with saline injections at 3 and 6-day intervals. The tendons and paratenons were excised after 60 or 75 days and evaluated histopathologically and statistically. Heparin-injected tendons and paratenons demonstrated significantly higher scores for most compared groups, thus worsening the degeneration. At the second part of the research, eight healthy tendons were injected with heparin at 3-day intervals for 1 month, and seven of them showed various degrees of degeneration. Heparin itself thus has a degenerative effect on the tendon and should not be used in the treatment of Achilles tendon degeneration.

Deleterious effects of local corticosteroid injections on the Achilles tendon of rats.

The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.

Serum magnesium, copper, and zinc alterations following spinal fusion.

Changes in serum magnesium, copper and zinc values were evaluated in spinal fusion patients at four monitorings. For magnesium and copper individually, a significant difference was found between the mean values at each monitoring (p < 0.05), whereas the changes of zinc values between four monitorings were insignificant. There was no statistical difference between the changes of each trace element values and gender, age, operative time, intraoperative blood loss, blood replacement, number of the vertebral levels fused, and antibiotic type used. As a result, magnesium can be suggested to be more important than the other two elements in the postoperative period. Alterations of serum magnesium, copper, and zinc values do not have any correlation with the fusion of the spinal column, either with the width of the fused area or operative time and blood loss. This study cannot confirm the exact reason for this entity and the etiology remains speculative. There is no need for magnesium, copper, or zinc supplementation during the surgical period for the patients. It will be worthy to evaluate the patients who were sent to the intensive care unit after spinal surgery and compare their results with the other intensive care patients.

Forty-two year survival with bilateral Judet hip prostheses.

In this case report, a 70-year-old man is presented who had begun to suffer from ankylosing spondylitis when he was 12 years old and had been operated on because of bilateral hip ankylosis at the age of 21 years. The interesting aspect of this case is that both hips were replaced with Judet type prostheses, which survived for 42 years.

Effect of preoperative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis: retrospective analysis of 434 cases.

A retrospective analysis of 434 patients with vertebral tuberculosis who were treated surgically was performed with special reference to the preoperative duration of chemotherapy. Of these, 376 underwent 4 weeks of a chemotherapy regimen with isoniazid, rifampin and ethamburol, and in 2 re-activation of the disease was observed. The remaining 58 underwent operation for neurological impairment with 6-18 h of the same chemotherapy regimen, and in no case did re-activation occur. These results suggest a shorter duration of chemotherapy may be utilised in all patients undergoing surgical treatment for vertebral tuberculosis, providing a thorough debridement is performed, leaving no necrotic or infected tissue behind.

Primary intramuscular hydatidosis of supraspinatus muscle.

Hydatid disease of the muscle is very rare and represents approximately 3% of all patients with hydatidosis. Since the infection closely resembles a soft-tissue tumor on clinical examination, the preoperative radiologic diagnosis is very important to avoid biopsy. We report an unusual case of primary intramuscular hydatidosis with its magnetic resonance imaging appearance, clinical and pathological findings.

Predictors of febrile seizure: a matched case-control study.

In a prospective matched case-control study carried out to determine risk factors of febrile seizures among children in the United Arab Emirates, 84 patients with febrile seizure were identified and were matched with 84 control febrile patients without seizure in the same age range, who attended the same hospital during the same period of time. Logistic regression analysis showed that the age at first seizure, family history of febrile seizure, duration of fever, and height of temperature were the only significant predictors for febrile seizures.

Pigmented villonodular synovitis of the knee presenting as a popliteal cyst.

Pigmented villonodular synovitis is a locally aggressive tumor of the synovium of joints and tendon sheaths. It is commonly seen in the synovial lining of the flexor tendons of the hand and in the synovium of the knee and less commonly in other joints. A case of pigmented villonodular synovitis of the knee in a 60-year-old man, with an intra-articular origin extending extra-articularly, is presented. The interesting point is that the initial diagnosis was a Baker cyst.

Recurrence of the severe form of microgastria-limb reduction defect in a consanguineous family.

This report concerns two sibs from a consanguineous Sudanese family with microgastria-limb reduction defect associated with hydrocephalus and agenesis of corpus callosum. We suggest that these cases together with other previously reported cases of central nervous system (CNS) anomalies associated with microgastria-limb reduction defect could represent an autosomal recessive syndrome differing from the classical microgastria-limb reduction defect by its severity, presence of CNS anomalies and its pattern of inheritance.