Osteochondritis dissecans of the hip

Purpose: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the Outcome of this condition after treatment. Material and Methods: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calvé-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. Results: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. Conclusions: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended.

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Flakka-Induced Prolonged Psychosis

Case Reports in Psychiatry ◽

10.1155/2016/3460849 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2 ◽

Cited By ~ 5

Author(s):

Craig Crespi

Keyword(s):

Hot Spot ◽

Symptomatic Treatment ◽

Altered Mental Status ◽

Mental States ◽

South Florida ◽

Residual Symptoms ◽

History Of ◽

Synthetic Drug ◽

Paranoid Psychosis

In South Florida, there has been a highly addictive new synthetic drug flooding the streets for people looking for a cheap high. Alpha-PVP, better known as Flakka, is an illegal substance that sells on the streets for as little as $5 a hit and delivers an instant high that can last from hours to days with lingering effects for weeks after it has been ingested. Although people use Flakka for its potential euphoric high, symptoms are known to easily escalate into frightening delusions, paranoid psychosis, extreme agitation, and a multitude of other altered mental states. According to the National Institute on Drug Abuse, Florida appears to be the nation’s hot spot for reports of Flakka. In this case report, a 17-year-old female with no prior psychiatric diagnosis presents to the hospital under a 72-hour involuntary placement for altered mental status with agitation and psychotic behaviors. After multiple days of symptomatic treatment with benzodiazepines and antipsychotics, the patient became coherent enough to give a history of a “friend” putting Flakka in her food at school as a joke. Although she continues to have residual symptoms including psychomotor agitation and slowing of cognition, she was alert, oriented, and able to be discharged home with proper follow-up.

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A Rare Case of Calcifying Pseudoneoplasms of the Neural Axis in Lumbar Spine

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1719221 ◽

2021 ◽

Author(s):

Venkatesan Ravi ◽

Pammi Srinath

Keyword(s):

Histopathological Examination ◽

Previous History ◽

Neural Axis ◽

Intracranial Lesions ◽

History Of ◽

The Central Nervous System ◽

Radicular Symptoms ◽

The Right ◽

Weighted Sequences

AbstractCalcified pseudoneoplasm of the neural axis (CAPNON) is a very rare, non-neoplastic, calcified pathological entity occurring anywhere in the central nervous system (CNS). Overall, less than 100 cases were reported, of which less than 50% were from the spine. We present a case of a 53-year-old lady with a history of L4–L5 radiculopathy, known case of rheumatoid arthritis, and with no previous history of trauma, tumor or infection. MRI showed calcified intradural mass, extending into the right lateral recess, which was isointense on T1- and T2-weighted sequences. Fenestration on right side along with complete resection of the lesion was done. Mass was found adherent around the dura, extending in to right L5 nerve root foramen, and histopathological examination confirmed the diagnosis of CAPNON. At 6 months follow-up, the patient is pain-free with no radicular symptoms. This entity should be taken in as differential in cases of calcified intraspinal and intracranial lesions. Surgical resection is the treatment of choice.

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Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

BMJ Case Reports ◽

10.1136/bcr-2018-225252 ◽

2018 ◽

pp. bcr-2018-225252

Author(s):

Michelle Herberts ◽

Bradley Hicks ◽

Muhammad Rizwan Sohail ◽

Anil Jagtiani

Keyword(s):

Hepatic Cirrhosis ◽

Fluid Collection ◽

Abdominal Ultrasound ◽

Pelvic Abscess ◽

Ct Guided ◽

Bacterial Peritonitis ◽

Fluid Analysis ◽

Abdominal Ct Scan ◽

History Of

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

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Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis

Case Reports in Gastroenterology ◽

10.1159/000484130 ◽

2017 ◽

Vol 11 (3) ◽

pp. 718-723 ◽

Cited By ~ 2

Author(s):

Hirokazu Honda ◽

Takashi Ikeya ◽

Erika Kashiwagi ◽

Shuichi Okada ◽

Katsuyuki Fukuda

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Treatment ◽

Fluid Collection ◽

Outlet Obstruction ◽

Serum Lactate ◽

Rebound Tenderness ◽

Gastric Bezoar ◽

History Of ◽

Upper Abdominal

Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

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Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/03635465211011744 ◽

2021 ◽

pp. 036354652110117

Author(s):

Filippo Migliorini ◽

Nicola Maffulli ◽

Alice Baroncini ◽

Jörg Eschweiler ◽

Markus Tingart ◽

...

Keyword(s):

Systematic Review ◽

Family History ◽

Physical Examination ◽

Patient Characteristics ◽

Disease Type ◽

Radiographic Parameters ◽

Hip Disease ◽

History Of ◽

Present Systematic Review

Background: Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. Purpose: To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. Study Design: Systematic review; Level of evidence, 4. Methods: The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. Results: Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement ( P < .0001), preoperative acetabular index ( P = .01), and BMI ( P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. Conclusion: Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.

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A Case of Human Hepatic Alveolar Echinococcosis Accompanied by Lung and Brain Metastases

The Korean Journal of Parasitology ◽

10.3347/kjp.2021.59.3.291 ◽

2021 ◽

Vol 59 (3) ◽

pp. 291-296

Author(s):

Chuanchuan Liu ◽

Haining Fan ◽

Ri-li Ge

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Alveolar Echinococcosis ◽

Radical Resection ◽

Symptomatic Treatment ◽

Human Case ◽

Pathological Examination ◽

Hepatic Alveolar Echinococcosis ◽

History Of

Alveolar echinococcosis (AE) is considered as a fatal zoonosis caused by the larvae of Echinococcus multilocularis. The lungs and brain are the most common metastatic organs. We report a human case of hepatic alveolar echinococcosis accompanied by lung and brain metastasis. In particular, the patient had a history of tuberculosis and the lung lesions were easily misdiagnosed as lung abscesses. The lesions of liver and lung underwent radical resection and confirmed as alveolar echinococcosis by pathological examination. The patient had no surgical complications after operation and was discharged after symptomatic treatment. Unfortunately, the patient later developed multiple intracerebral AE metastases. We required the patient to take albendazole orally for life and follow up.

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A Dynamic Follow-Up of Pneumonia Caused by Coronavirus Disease 2019 (COVID-19) on CT Scan

Iranian Journal of Radiology ◽

10.5812/iranjradiol.102847 ◽

2020 ◽

Vol 17 (2) ◽

Author(s):

Li Zhao ◽

Bo Chen ◽

Ya’nan Huang ◽

Minxia Yang ◽

Jianfeng Yang ◽

...

Keyword(s):

Left Lung ◽

Symptomatic Treatment ◽

Basic Reproductive Number ◽

Reproductive Number ◽

Rt Pcr ◽

Pharyngeal Swab ◽

Long Time ◽

History Of ◽

Polymerase Chain

: Coronavirus disease (COVID-19) broke out in Wuhan, China. It is a highly contagious respiratory disease, the basic reproductive number (RO value) for COVID-19 has been reported as 2.68 with an epidemic doubling time of 6.4 days. In this case report, a 50-year-old man presented with a history of fever and chills. Chest radiographs failed to find any abnormality, and computed tomography (CT) showed ground glass shadow of the upper lobe of the left lung. Real-time polymerase chain reaction (RT-PCR) of the patient’s pharyngeal swab was positive for COVID-19 nucleic acid. The course of the disease developed from mild to severe, then improved and recovered. The patient underwent antiviral drugs, low dose of glucocorticoids, symptomatic treatment, and immunoglobulin for human intravenous injection. We report this long time follow-up case of COVID-19.

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Osteochondritis Dissecans of the Head of the Talus

Foot & Ankle International ◽

10.1177/107110079701800610 ◽

1997 ◽

Vol 18 (6) ◽

pp. 365-368 ◽

Cited By ~ 12

Author(s):

A. Mark Dolan ◽

David M. Mulcahy ◽

Michael M. Stephens

Keyword(s):

Osteochondritis Dissecans ◽

Radiological Features ◽

History Of

We present a case of osteochondritis dissecans of the head of the talus, without a history of trauma. The clinical and radiological features and a 2-year and 3-month follow-up are discussed.

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Screws Are Not Needed when Secure Interference Fit of Uncemented Acetabular Components is Adequate: A 5- to 15-Year Follow-up with Clinical and Radiological Analysis

Hip International ◽

10.5301/hipint.5000459 ◽

2017 ◽

Vol 27 (3) ◽

pp. 267-272 ◽

Cited By ~ 1

Author(s):

Eduardo García-Rey

Keyword(s):

Primary Stability ◽

Interference Fit ◽

Press Fit ◽

Hip Disease ◽

Surgical Preparation ◽

Hip Rotation ◽

Acetabular Components ◽

Mid Term Results ◽

Cup Position

Purpose Even with good surgical preparation, adequate primary stability of the acetabular component is not always achieved after primary total hip replacement (THR). We hypothesise that adequate bone preparation for appropriate cortical loading would allow us to avoid screw use. Methods A total of 791 uncemented cups were analysed to compare the need for screws to obtain primary fixation in 5 different designs. Arthritic hips with inflammatory arthritis or severe congenital hip disease were excluded. A press-fit technique was first tried in all hips and screws were only used when strictly needed. Radiological acetabular shape and postoperative cup position were assessed in all hips. The mean follow-up was 9.6 ( 5 – 15 ) years. Results Screws were required in 155 hips (19.6%). We could not detect any difference in the percentage of screw use between designs. We found that female patients (odds ratio [OR] 2.06; 95% confidence interval [CI], 1.41-3.02) and cups with a greater distance to the hip rotation centre on the postoperative radiograph (OR 1.69; 95% CI, 1.17-2.45) had a higher risk for screw use. A greater anteversion of the cup had a lower risk for screw use (OR 0.96; 95% CI, 0.94-0.99). At latest follow-up no hips had needed revision for aseptic loosening. Conclusions Good intraoperative technique is not enough to avoid screw use since more accurate cup position and reconstruction of the hip rotation centre are required for an adequate interference fit. A press-fit technique can provide similar mid-term results to screw use in hips without severe deformities.

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