Upper Extremity Compartment Syndrome in a Patient with Acute Gout Attack but without Trauma or Other Typical Causes

We report the case of a 30-year-old Polynesian male with a severe gout flare of multiple joints and simultaneous acute compartment syndrome (ACS) of his right forearm and hand without trauma or other typical causes. He had a long history of gout flares, but none were known to be associated with compartment syndrome. He also had concurrent infections in his right elbow joint and olecranon bursa. A few days prior to this episode of ACS, high pain and swelling occurred in his right upper extremity after a minimal workout with light weights. A similar episode occurred seven months prior and was attributed to a gout flare. Unlike past flares that resolved with colchicine and/or anti-inflammatory medications, his current upper extremity pain/swelling worsened and became severe. Hand and forearm fasciotomies were performed. Workup included general medicine, rheumatology and infectious disease consultations, myriad blood tests, and imaging studies including Doppler ultrasound and CT angiography. Additional clinical history suggested that he had previously unrecognized recurrent exertional compartment syndrome that led to the episode of ACS reported here. Chronic exertional compartment syndrome (CECS) presents a difficult diagnosis when presented with multiple symptoms concurrently. This case provides an example of one such diagnosis.

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Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2020-0086 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Shahana Perveen ◽

Karmaine A. Millington ◽

Suchitra Acharya ◽

Amit Grag ◽

Vita Boyar

Keyword(s):

Differential Diagnosis ◽

Compartment Syndrome ◽

Upper Extremity ◽

Preterm Neonate ◽

Review Of Literature ◽

Case Presentation ◽

Ischemic Limb ◽

History Of ◽

Hand Amputation ◽

Work Up

AbstractObjectivesTo describe challenges in diagnosis and treatment of congenital neonatal gangrene lesions associated with history of maternal coronavirus disease 2019 (COVID-19) infection.Case presentationA preterm neonate was born with upper extremity necrotic lesions and a history of active maternal COVID-19 infection. The etiology of his injury was challenging to deduce, despite extensive hypercoagulability work-up and biopsy of the lesion. Management, including partial forearm salvage and hand amputation is described.ConclusionsNeonatal gangrene has various etiologies, including compartment syndrome and intrauterine thromboembolic phenomena. Maternal COVID-19 can cause intrauterine thrombotic events and need to be considered in a differential diagnosis.

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Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique

Hand ◽

10.1177/1558944716669799 ◽

2016 ◽

Vol 12 (5) ◽

pp. NP58-NP61 ◽

Cited By ~ 4

Author(s):

Elizabeth A. Miller ◽

Anna L. Cobb ◽

Tyson K. Cobb

Keyword(s):

Case Report ◽

Compartment Syndrome ◽

Single Incision ◽

Invasive Technique ◽

Compartment Pressure ◽

Chronic Exertional Compartment Syndrome ◽

Exertional Compartment Syndrome ◽

Before And After ◽

History Of ◽

Forearm Pain

Background: Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. Methods: Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. Results: Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. Conclusions: This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

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Crystal Arthropathy in the Setting of Total Knee Arthroplasty

Case Reports in Orthopedics ◽

10.1155/2020/7613627 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Joseph C. Brinkman ◽

Kade S. McQuivey ◽

Justin L. Makovicka ◽

Joshua S. Bingham

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Joint Infection ◽

Ground Level ◽

Fracture Dislocation ◽

Acute Gout ◽

Orthopedic Surgeons ◽

History Of ◽

Total Knee ◽

Gout Flare

We present a case of an 82-year-old female with a history of right total knee arthroplasty 11 years prior. She was admitted after a ground-level fall and developed progressive pain and swelling of her right knee. She had no history of complications with her total knee replacement. Radiographs of the knee and hip were negative for acute fracture, dislocation, or hardware malalignment. Knee aspiration was performed and revealed inflammatory exudate, synovial fluid consistent with crystal arthropathy, and no bacterial growth. She was diagnosed with an acute gout flare, and her symptoms significantly improved with steroids and anti-inflammatory treatment. Orthopedic surgeons should be aware of the potential for crystal arthropathy in the setting of total joint arthroplasty and evaluate for crystals before treating a presumed periprosthetic joint infection.

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THU0444 INCIDENCE OF ACUTE GOUT FLARE IN PATIENTS INITIATED ON INTRAVENOUS BUMETANIDE FOR ACUTE CONGESTIVE HEART FAILURE EXACERBATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3309 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 459.1-459

Author(s):

S. Jeong ◽

I. Tan

Keyword(s):

Heart Failure ◽

Uric Acid ◽

Retrospective Cohort ◽

P Value ◽

Acute Gout ◽

Readmission Rates ◽

History Of ◽

Heart Failure Exacerbation ◽

Gout Flare ◽

Gout Flares

Background:Heart failure is a prevalent and ever-increasing public health concern associated with significant morbidity, mortality, and financial burden. Therefore, identifying any factors that worsen the outcome of patients with heart failure is crucial to the nation’s medical and financial health.One of the major comorbidities associated with heart failure is gout. Gout is a clinical syndrome of joint inflammation resulting from the deposition of monosodium urate crystals, causing painful and swollen arthritis. Acute gout flares in the context of acute heart failure (AHF) exacerbations result in longer lengths of stay and form an independent risk factor for increased readmissions or death1. The use of loop diuretics in treating patients with AHF exacerbations may cause new onset of gouty arthritis or recurrence of established gout by increasing serum uric acid levels. Uric acid alone is implicated as an independent predictor of mortality in patients with chronic heart failure2.Objectives:In this study, we aim to better characterize the incidence of acute gout flares in patients being treated with intravenous bumetanide for AHF exacerbations.Methods:This single-center retrospective cohort study included adult patients within an urban tertiary-care center hospital between 5 August 2016 and 30 June 2018. Chart review was performed to identify 130 patients who were hospitalized for AHF exacerbations, received intravenous (IV) bumetanide, and developed an acute gout flare for a total of 176 cases (Figure 1).Figure 1Patient SelectionPatients were identified as having an acute gout flare if the primary treating physician(s) documented a clinical picture congruous with acute gout (e.g., onset of a painful, swollen, or erythematous joint) and administered conventional treatment for acute gout including non-steroidal anti-inflammatory agents (NSAIDs), steroids, colchicine, urate-lowering therapies, and/or intra-articular joint injection with symptomatic improvement.Results:The annualized incidence of acute gout while receiving IV bumetanide for a heart failure exacerbation is 7.17%.There was no statistical difference in age, gender, race, or BMI among patients who developed acute gout compared with those who did not develop acute gout while receiving IV bumetanide.An acute gout flare that occurred during treatment of AHF with IV bumetanide increased hospital length of stay (LOS) by 3 days (mean LOS 15.2 days in those who had acute gout, mean LOS 11.6 days in those who did not [p-value 0.277]).Patients who received allopurinol during their hospitalization for AHF exacerbation had lower 30-day readmission rates for any cause (p-value 0.017, Table 4). There was no reduction in the 30-day readmission rate in patients who received colchicine without allopurinol during their hospitalization for AHF exacerbation. Those with a history of gout had higher readmission rates than those without a history of gout (p-value 0.007).Conclusion:Gout is known to be a weighty contributor to patients’ morbidity and mortality in heart failure, and the occurrence of acute gout flare in AHF exacerbations may be precipitated by the use of loop diuretics. We show that the use of IV bumetanide in patients hospitalized for AHF exacerbations is associated with a 7.17% yearly incidence of acute gout flares. Furthermore, patients with a history of gout were found to have higher readmission rates, and those who received allopurinol during their hospitalization had lower readmission rates.References:[1]Thanassoulis G, Brophy JM, Richard H, Pilote L. Gout, Allopurinol Use, and Heart Failure Outcomes.Arch Intern Med. 2019;170(15):1358-1364.[2]Struthers AD, Donnan PT, Lindsay P, Mcnaughton D, Broomhall J, Macdonald TM. Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study.Heart. 2002;87(3):229-234.Disclosure of Interests: :None declared

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A Comparison of Two Models Predicting the Presence of Chronic Exertional Compartment Syndrome

International Journal of Sports Medicine ◽

10.1055/a-1342-8209 ◽

2021 ◽

Author(s):

Emeline Vignaud ◽

Pierre Menu ◽

Yannick Eude ◽

Yves Maugars ◽

Marc Dauty ◽

...

Keyword(s):

Compartment Syndrome ◽

Risk Score ◽

Clinical History ◽

Post Exercise ◽

Chronic Exertional Compartment Syndrome ◽

Muscle Hardness ◽

Exertional Compartment Syndrome ◽

Clinical Models ◽

De Bruijn ◽

A Prospective Study

AbstractClinical history and physical examination are usually not sufficient to diagnose leg chronic exertional compartment syndrome (CECS). Two predictive clinical models have been proposed. The first model by De Bruijn et al. is displayed as a nomogram that predicts the probability of CECS according to a risk score. The second model by Fouasson-Chailloux et al. combines two signs (post-effort muscle hardness on palpation or hernia). To evaluate those models, we performed a prospective study on patients who were referred for possible CECS. 201 patients underwent intra-compartmental pressure at 1-min post-exercise (CECS if ≥ 30 mmHg) – 115 had CECS. For the De Bruijn et al. model, the risk score was 7.5±2.2 in the CECS group and 4.6±1.7 in the non-CECS group (p<0.001) with an area under the ROC curve of 0.85. The model accuracy was 80% with a sensitivity of 82% and a specificity of 78%. Concerning Fouasson-Chailloux et al. model, the accuracy was 86%; the sensitivity and the specificity were 75 and 98%, respectively. The De Bruijn et al. model was a good collective model but less efficient in individual application. In patients having both muscle hardness and hernia, we could clinically make the diagnosis of CECS.

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EXERTIONAL COMPARTMENT SYNDROME OF THE UPPER EXTREMITY

Hand Clinics ◽

10.1016/s0749-0712(21)00405-4 ◽

1998 ◽

Vol 14 (3) ◽

pp. 477-482 ◽

Cited By ~ 1

Author(s):

Michael J. Botte ◽

Jan Fronek ◽

Robert A. Pedowitz ◽

Heinz R. Hoenecke ◽

Reid A. Abrams ◽

...

Keyword(s):

Compartment Syndrome ◽

Upper Extremity ◽

Exertional Compartment Syndrome

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Nutritional dermatoses and its association with anemia and systemic illness

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20182399 ◽

2018 ◽

Vol 4 (3) ◽

pp. 306

Author(s):

Som J. Lakhani ◽

Nishit K. Surti ◽

Mrugal V. Doshi ◽

Sanket R. Panchasera ◽

Vivek N. Vasvani ◽

...

Keyword(s):

Clinical Signs ◽

Nutrient Deficiency ◽

General Medicine ◽

Clinical History ◽

Nutritional Deficiencies ◽

Deficiency Anemia ◽

Elderly Age ◽

Systemic Involvement ◽

History Of ◽

Morbid Conditions

Background: Mucocutaneous changes may be a “tell-tale” signs of multi nutrional deficiency including anemia. Some are very characteristic of a specific nutrient deficiency, while other signs may overlap and will reflect multiple deficiency states.Methods: To scrutinize clinical signs of multi nutritional deficiencies accompanied with anemia, this observational clinical study of 75 patients (adult and adolescents) was undertaken. Patients were selected from out-patient and in-patient department (OPD and IPD) of dermatology as well as General Medicine ward including medical ICU. Relevant investigations were carried out whenever required. Detail clinical history of diet, tuberculosis as well as HIV disease, worm infestation, other co-morbid conditions and alcohol intake were taken. Clinical signs of nutritional deficiencies like of Pellagra, Kwashiorkor, Beriberi, Ariboflavinosis and other signs of avitaminosis and micronutrient deficiency were looked for in all such patients.Results: Of 75 patients, 37 were male (M) and 38 female (F). One of the important findings was that one third patients were admitted in ICU and in 60 of 75 patients risk factors could be identified. Mental illness, ICU admission, elderly age, systemic illness and alcohol consumption were the predisposing factors. Iron deficiency anemia was the commonest anemia followed by dimorphic anemia with other multinutrional manifestations. Clinical signs which were observed due to multinutritional deficiency were of pellagra dermatosis, kwashiorkor, koilonychia with pale tongue and mucous membranes, angular cheilosis, hair changes of various types and other signs due to systemic involvement.Conclusions: Anemia may be associated with other nutritional abnormality which is reflected in changes in the skin, mucous membrane, hairs and nails. Nutritional dermatosis and anemia can be part of systemic illness which maybe reflected as deficiency of multiple nutritive factors.

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Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200061 ◽

2020 ◽

Vol 41 (5) ◽

pp. 336-340

Author(s):

Yasmin Hamzavi Abedi ◽

Cristina P. Sison ◽

Punita Ponda

Keyword(s):

Retrospective Chart Review ◽

Clinical History ◽

Specific Ige ◽

Exact Test ◽

Ara H 1 ◽

Sige Level ◽

History Of ◽

Laboratory Procedures ◽

Ige Mediated ◽

The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

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59. General medicine residents' perception of the mini-CEXs

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2820 ◽

2007 ◽

Vol 30 (4) ◽

pp. 61

Author(s):

S. Malhotra ◽

R. Hatala ◽

C.-A. Courneya

Keyword(s):

Internal Medicine ◽

Medical Education ◽

Focus Group ◽

Qualitative Study ◽

Focus Groups ◽

General Medicine ◽

Clinical History ◽

Phenomenological Approach ◽

Medical Teacher ◽

The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

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Stepping up detection, response, preparedness and readiness measures for “COVID-19”- A Pandemic

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3442 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1042-1047

Author(s):

Khushbu Balsara ◽

Deepankar Shukla

Keyword(s):

Health Care ◽

Health Care Workers ◽

Clinical History ◽

Frontline Workers ◽

Diagnostic Assays ◽

Care Workers ◽

Short Period ◽

History Of ◽

Detection Response ◽

Care Worker

In a very short period of time, “COVID-19” has seized the consciousness globally by making remarkable changes in our day to day living and has superintended as a public health emergency globally. It has high radar of transmission, affecting an individual at work to frontline workers. The measures and planning for a response plays a key role from drawing up an emergency committee and this follows an equation which broadly deals with epidemiological to clinical history of the patient, management steps from isolation, screening, diagnostic assays for identification and treatment. The application of an organized plan with secure structure aids in better performance, increases efficacy of management and saves time. Also saves time for a health care worker to g through routine levels of channels of administration if already a familiar way of operation is known for such situations. Thus, planning and developing a ‘blueprint of approach’ towards management of patient while facing such situation is a must. This review provides an insight to the measures for detection, response and preparedness of the hospital and health care workers should largely be inclusive of; also highlights the measures to be taken at every step after coming in contact with a positive case of “COVID-19”.

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