Arthroscopic decompression and notchplasty for long-standing anterior cruciate ligament impingement in a patient with multiple epiphyseal dysplasia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Multiple epiphyseal dysplasia is a genetically and clinically heterogeneous osteochondroplasia with symmetrical involvement. It is characterized by joint pain in childhood and early adulthood with early onset of osteoarthritis, mainly affecting the hips.</p> <p>Case presentation</p> <p>We report the case of a 20-year-old man of Asian origin with multiple epiphyseal dysplasia presenting with bilateral knee pain, stiffness and instability found to be caused by bilateral anterior cruciate ligament impingement on abnormal medial femoral condyles. Bilateral staged arthroscopic notchplasty was performed successfully, resulting in subjective relief of pain, and improved range of movement and stability.</p> <p>Conclusion</p> <p>Care should be taken not to exclude a diagnosis of multiple epiphyseal dysplasia when few of the characteristic radiographic features are evident but clinical suspicion is high. This case highlights the scope for subjective symptomatic improvement following a minimum of surgical intervention. We recommend limiting early intervention to managing symptomatic features rather than radiographic abnormalities alone.</p

A comparison between the transpatellar tendon and the lateral approach to the knee joint during arthroscopy: A cadaver study

PubMed ID: 7361973The cental transpatellar tendon arthroscopic approach and the standard lateral approach were compared in 200 unselected cadaver knees. A 5-mm arthroscopic dummy was used in the investigation. In 198 knees, using the transpatellar tendon approach, the dummy passed through the infrapatellar fat pad. In 7 cases with the transpatellar approach and in 22 cases with the lateral approach, we were unable to reach the medial posterior compartment of the knee joint. It was usually easier to insert the arthroscopic dummy into the posterior fossa if the knee joint was held at 35 to 40° of flexion of the knee than at 90° of flexion. In 88 of 100 knees, the dummy could be passed from the transpatellar approach into the lateral posterior fossa and in 77 of 100 knees from the lateral approach. Patella baja was found in 16 knees (8%). Since the transpatellar tendon approach should not be used in these cases, it means that this technique cannot be used in all cases. From an anatomical point of view, the transpatellar tendon method thus does not offer any major advantages compared to the standard lateral one. © 1980, SAGE Publications. All rights reserved

Long-term results of treatment including creation of a gutter and muscle transposition for chronic sclerosing osteomyelitis [Kronik sklerozan osteomiyelit tedavisinde oluklaştirma ve kas taşima tekniginin uzun dönem sonuçlari]

PubMed ID: 20134219Objectives: We evaluated long-term results of treatment including creation of a gutter and muscle transposition in patients with chronic sclerosing osteomyelitis (CSO). Methods: Between 1980 and 1996, 11 patients (5 women, 6 men; mean age 36 years; range 17 to 69 years) with CSO were treated with creation of a gutter and muscle transposition. Seven patients had femoral, and four patients had tibial involvement. The main complaint was pain. The patients were evaluated with respect to complaints and radiologically (Xray, computed tomography, and magnetic resonance imaging) after a mean follow-up of 12.4 years (range 6 to 24 years). Results: During the follow up period, all the patients remained symptom-free without the need for antibiotic treatment except for one patient with tibial involvement, whose pain recurred after five years. The patient's complaint disappeared following reoperation with the same technique. Histologic examination of surgical biopsies showed nonspecific changes consistent with low-grade chronic osteomyelitis. Cultures were negative in all cases. Control radiographies showed no progression of sclerosis. Computed tomography showed cortical bone formation surrounding the transposed muscle, and magnetic resonance imaging showed fatty degeneration in the transposed muscle, without any signs of active osteomyelitis. Conclusion: The aim of gutter creation and muscle transposition is to increase blood supply to the diseased bone segment, without the need for microsurgical interventions and secondary reconstructive procedures. Our long-term results show that this technique is efficacious in patients with femoral and tibial involvement. © 2009 Turkish Association of Orthopaedics and Traumatology

B12 deficiency in chronic idiopathic urticaria: complication of Helicobacter pylori infection or reflection of an autoimmune process?

21st Congress of the European-Academy-of-Allergology-and-Clinical-Immunology -- JUN 01-05, 2002 -- NAPLES, ITALYWOS: 000186177500969European Acad Allergol Clin Immono

Elevation of serum eosinophil cationic protein, soluble tumor nec1rosis factor receptors and soluble intercellular adhesion molecule-1 levels in acute bronchial asthma

PubMed ID: 12530121Asthma is a disease characterized by chronic airway inflammation. Many inflammatory cells and molecules contribute to its pathogenesis, Soluble tumor necrosis factor receptors (sTNFRs) and soluble intercellular adhesion molecule-1 (sICAM-1) play regulatory roles in the inflammation. But their roles in the inflammation of asthma have not been well defined. This study was done to examine the changes in serum levels of these molecules in acute asthmatic patients. The concentrations of eosinophilic cationic protein (ECP), sTNF-RI, sTNF-RII, and sICAM-1 were measured in sera of 24 asthmatic patients during acute attack, in 18 patients at 24 h, and in 10 patients at 7 days after attack and in sera of 14 healthy control subjects by ELISA method. Serum levels of ECP, sTNF-RI, sTNF-RII and sICAM-1 in the patients with asthma during attack were significantly higher than those of the controls (p < 0.001, p < 0.01, p < 0.05, p < 0.05 respectively) and stayed high up to the 7th day. In conclusion, high serum levels of sTNF-RI, sTNF-RII and sICAM-1 suggest that these molecules may contribute to the regulation of allergic inflammation and may reflect the severity of inflammation in the airway of asthmatic patients