scholarly journals Synovial chondromatosis as an etiology of ankle impingement: a case report

2021 ◽  
Vol 15 (2) ◽  
pp. 175-178
Author(s):  
Eli Ávila Souza Júnior
Keyword(s):  
Rare Case ◽  
Therapeutic Option ◽  
Synovial Chondromatosis ◽  
Published Data ◽  
Level Of Evidence ◽  
Common Cause ◽  
Ankle Impingement ◽  
Number Of Publications ◽  
Open Arthrotomy ◽  
Anterior Ankle Impingement

Anterior ankle impingement is a common cause of chronic pain in this site and has synovial chondromatosis, albeit rare, as one of its possible etiologies. Both arthroscopic approach and open arthrotomy are reported as therapeutic option, but the few published data showed that the first is believed to bring more advantages. In a recent study, one of the limitations found by the authors was the rareness of this condition in the ankle, and thus the small number of publications on the topic. We present the rare case of synovial chondromatosis of the ankle in a middle-aged man, which was clinically manifested as anterior impingement syndrome and treated arthroscopically, showing an atypical arboriform vascularization pattern. Level of Evidence V; Diagnostic Studies; Expert Opinion.

The Need for Consensus About Liver Transplantation For Patients With Neuropsychiatric Wilson’s Disease

2021 ◽  
pp. 152692482110028
Author(s):  
Alberto Ferrarese ◽  
Patrizia Burra
Keyword(s):  
Liver Transplantation ◽  
Patient Outcomes ◽  
Wilson’S Disease ◽  
Therapeutic Option ◽  
Copper Metabolism ◽  
Wilson's Disease ◽  
Published Data ◽  
Neurological Improvement ◽  
Effective Therapeutic Option

Liver transplantation is considered an effective therapeutic option for Wilson’s disease (WD) patients with hepatic phenotype, since it removes the inherited defects of copper metabolism, and is associated with excellent graft and patient outcomes. The role of liver transplantation in WD patients with mixed hepatic and neuropsychiatric phenotype has remained controversial over time, mainly because of high post-operative complications, reduced survival and a variable, unpredictable rate of neurological improvement. This article critically discusses the recently published data in this field, focussing in more detail on isolated neuropsychiatric phenotype as a potential indication for liver transplantation in WD patients.

scholarly journals Very rare case of Graves’ disease with resistance to methimazole: a case report and literature review

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199619
Author(s):  
Yusaku Mori ◽  
Munenori Hiromura ◽  
Michishige Terasaki ◽  
Hideki Kushima ◽  
Makoto Ohara ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Rare Case ◽  
Therapeutic Option ◽  
Lithium Carbonate ◽  
Graves Disease ◽  
High Dose ◽  
Hormone Concentration ◽  
Thyroid Hormone Concentration ◽  
Serum Thyroid Hormone ◽  
Inorganic Iodine

Background Methimazole (MMI) is used to treat hyperthyroidism in Graves’ disease. It is rare to encounter patients in whom hyperthyroidism cannot be controlled using high doses of MMI. Case presentation: A 21-year-old woman was referred to our hospital because of MMI-resistant Graves’ disease. Although her MMI dose had been increased to 120 mg/day, her serum thyroid hormone concentration was too high to be measured. Additional therapy with lithium carbonate, and then with dexamethasone and inorganic iodine, was initiated. After 14 days, the patient’s serum thyroid hormone concentration normalized, while she was taking 150 mg/day MMI, 800 mg/day lithium carbonate, 6 mg/day dexamethasone and 306 mg/day inorganic iodine, and total thyroidectomy was then performed. The patient was discharged 8 days after the thyroidectomy and experienced no major complications. Conclusions We have presented a rare case of Graves’ disease that was resistant to high-dose MMI. Combination therapy of MMI with lithium carbonate, dexamethasone and inorganic iodine may represent a therapeutic option for the preoperative preparation of patients with MMI-resistant Graves’ disease.

scholarly journals Whole Body Vibration Exercises and the Improvement of the Flexibility in Patient with Metabolic Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Danúbia da Cunha Sá-Caputo ◽  
Pedro Ronikeili-Costa ◽  
Rafaelle Pacheco Carvalho-Lima ◽  
Luciana Camargo Bernardo ◽  
Milena Oliveira Bravo-Monteiro ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Muscle Power ◽  
Whole Body Vibration ◽  
Whole Body ◽  
Mineral Density ◽  
Level Of Evidence ◽  
Body Vibration ◽  
Pubmed Database ◽  
Number Of Publications

Vibrations produced in oscillating/vibratory platform generate whole body vibration (WBV) exercises, which are important in sports, as well as in treating diseases, promoting rehabilitation, and improving the quality of life. WBV exercises relevantly increase the muscle strength, muscle power, and the bone mineral density, as well as improving the postural control, the balance, and the gait. An important number of publications are found in the PubMed database with the keyword “flexibility” and eight of the analyzed papers involving WBV and flexibility reached a level of evidence II. The biggest distance between the third finger of the hand to the floor (DBTFF) of a patient with metabolic syndrome (MS) was found before the first session and was considered to be 100%. The percentages to the other measurements in the different sessions were determined to be related to the 100%. It is possible to see an immediate improvement after each session with a decrease of the %DBTFF. As the presence of MS is associated with poorer physical performance, a simple and safe protocol using WBV exercises promoted an improvement of the flexibility in a patient with MS.

Morphology of Tibiotalar Osteophytes in Anterior Ankle Impingement

2001 ◽  
Vol 22 (4) ◽  
pp. 313-317 ◽  
Author(s):  
Wayne S. Berberian ◽  
Paul J. Hecht ◽  
Keith L. Wapner ◽  
Richard DiVerniero
Keyword(s):  
Ankle Impingement ◽  
Anterior Ankle Impingement

scholarly journals The Cliff Sign: A New Radiographic Sign of Hip Instability

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880717 ◽  
Author(s):  
Jonathan D. Packer ◽  
James B. Cowan ◽  
Brian J. Rebolledo ◽  
Kotaro R. Shibata ◽  
Geoffrey M. Riley ◽  
...  
Keyword(s):  
Femoral Head ◽  
Preoperative Diagnosis ◽  
Interobserver Reliability ◽  
Radiographic Finding ◽  
Synovial Chondromatosis ◽  
Pigmented Villonodular Synovitis ◽  
Angle Measurement ◽  
Continuous Variables ◽  
Level Of Evidence ◽  
Hip Reduction

Background: The preoperative diagnosis of hip microinstability is challenging. Although physical examination maneuvers and magnetic resonance imaging findings associated with microinstability have been described, there are limited reports of radiographic features. In patients with microinstability, we observed a high incidence of a steep drop-off on the lateral edge of the femoral head, which we have named the “cliff sign.” Purpose: (1) To determine the relationship of the cliff sign and associated measurements with intraoperative microinstability and (2) to determine the interobserver reliability of these measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 115 consecutive patients who underwent hip arthroscopy were identified. Patients with prior hip surgery, Legg-Calve-Perthes disease, fractures, pigmented villonodular synovitis, or synovial chondromatosis were excluded, resulting in the inclusion of 96 patients in the study. A perfect circle around the femoral head was created on anteroposterior pelvis radiographs. If the lateral femoral head did not completely fill the perfect circle, it was considered a positive cliff sign. Five additional measurements relating to the cliff sign were calculated. The diagnosis of microinstability was made intraoperatively by the (1) amount of traction required to distract the hip, (2) lack of hip reduction after initial traction release following joint venting, or (3) intraoperative findings consistent with hip microinstability. Continuous variables were analyzed through use of unpaired t tests and discrete variables with Fisher exact tests. Interobserver reliability (n = 3) was determined for each measurement. Results: Overall, 89% (39/44) of patients with microinstability had a cliff sign, compared with 27% of patients (14/52) without instability ( P < .0001). Conversely, 74% of patients with a cliff sign had microinstability, while only 12% of patients without a cliff sign had instability ( P < .0001). In women younger than 32 years with a cliff sign, 100% (20/20) were diagnosed with instability. No differences were found in any of the 5 additional measurements. Excellent interobserver reliability was found for the presence of a cliff sign and the cliff angle measurement. Conclusion: We have identified a radiographic finding, the cliff sign, that is associated with the intraoperative diagnosis of hip microinstability and has excellent interobserver reliability. Results showed that 100% of young women with a cliff sign had intraoperative microinstability. The cliff sign may be useful in the preoperative diagnosis of hip microinstability.

scholarly journals Drug-induced thrombocytopenia: pathogenesis, evaluation, and management

Hematology ◽  
2009 ◽  
Vol 2009 (1) ◽  
pp. 153-158 ◽  
Author(s):  
James N. George ◽  
Richard H. Aster
Keyword(s):  
Single Dose ◽  
Causal Relation ◽  
Severe Thrombocytopenia ◽  
Antithrombotic Agents ◽  
Drug Induced ◽  
Level Of Evidence ◽  
Common Cause ◽  
Fibrinogen Binding ◽  
Immune Mediated ◽  
Drug Dependent

AbstractAlthough drugs are a common cause of acute immune-mediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Most cases of drug-induced thrombocytopenia (DITP) are caused by drug-dependent antibodies that are specific for the drug structure and bind tightly to platelets by their Fab regions but only in the presence of the drug. A comprehensive database of 1301 published reports describing 317 drugs, available at www.ouhsc.edu/platelets, provides information on the level of evidence for a causal relation to thrombocytopenia. Typically, DITP occurs 1 to 2 weeks after beginning a new drug or suddenly after a single dose when a drug has previously been taken intermittently. However, severe thrombocytopenia can occur immediately after the first administration of antithrombotic agents that block fibrinogen binding to platelet GP IIb-IIIa, such as abciximab, tirofiban, and eptifibatide. Recovery from DITP usually begins within 1 to 2 days of stopping the drug and is typically complete within a week. Drug-dependent antibodies can persist for many years; therefore, it is important that the drug etiology be confirmed and the drug be avoided thereafter.

Arthroscopic Treatment of Anterior Ankle Impingement

1997 ◽  
Vol 18 (7) ◽  
pp. 418-423 ◽  
Author(s):  
Alberto Branca ◽  
Luigi Di Palma ◽  
Carmelo Bucca ◽  
Camilla Sagarriga Visconti ◽  
M. Di Mille
Keyword(s):  
Preoperative Evaluation ◽  
Stage Iv ◽  
Ankle Arthroscopy ◽  
Stage Iii ◽  
Joint Cartilage ◽  
Ankle Impingement ◽  
Radiological Classification ◽  
Invasive Techniques ◽  
Anterior Ankle Impingement

Ankle arthroscopy has recently allowed the elaboration of less invasive techniques for the treatment of anterior impingement. Its indications, advantages, and drawbacks in this application are discussed. Between 1987 and 1994, 133 patients were treated for ankle impingement. Among them, 58 patients, 37 men and 21 women (mean age, 28.5 years), who had failed a trial of conservative treatment were treated by means of tibiotalar arthroscopy. Twenty-seven were athletes engaged in sports with abnormal stressing of the ankle. According to McDermott's radiological classification, there were 15 stage I cases, 23 stage II, 13 stage III, and 7 stage IV. Preoperative evaluation with a modified version of McGuire's scoring system gave 50 cases rated as “poor” (<60 points) and 8 cases rated as “fair” (60–67 points). Treatment consisted of removal of adhesions, cartilage shaving, and removal of the bone impingement with powered instruments, curettes, or small osteotomes. Follow-up was from 8 to 62 months (mean, 21.5 months). The postoperative McGuire ratings were 37 good, 13 fair, and 8 poor. There were no major complications. Recurrence of impingement was observed in four cases of stage III and IV. The conclusion is drawn that ankle arthroscopy is a sound method for the treatment of anterior impingement. Even in cases with severe joint cartilage impairment, it plays a therapeutic role as a means of postponing a possible arthrodesis.

scholarly journals The academic productivity and impact of the University of Toronto Neurosurgery Program as assessed by manuscripts published and their number of citations

2015 ◽  
Vol 123 (3) ◽  
pp. 561-570 ◽  
Author(s):  
Christopher S. Lozano ◽  
Joseph Tam ◽  
Abhaya V. Kulkarni ◽  
Andres M. Lozano
Keyword(s):  
The United States ◽  
Published Data ◽  
Full Time ◽  
Gini Coefficients ◽  
Academic Activity ◽  
University Of Toronto ◽  
Number Of Publications ◽  
The University ◽  
Number Of Citations ◽  
The Impact

OBJECT Recent works have assessed academic output across neurosurgical programs using various analyses of accumulated citations as a proxy for academic activity and productivity. These assessments have emphasized North American neurosurgical training centers and have largely excluded centers outside the United States. Because of the long tradition and level of academic activity in neurosurgery at the University of Toronto, the authors sought to compare that program's publication and citation metrics with those of established programs in the US as documented in the literature. So as to not rely on historical achievements that may be of less relevance, they focused on recent works, that is, those published in the most recent complete 5-year period. METHODS The authors sought to make their data comparable to existing published data from other programs. To this end, they compiled a list of published papers by neurosurgical faculty at the University of Toronto for the period from 2009 through 2013 using the Scopus database. Individual author names were disambiguated; the total numbers of papers and citations were compiled on a yearly basis. They computed a number of indices, including the ih(5)-index (i.e., the number of citations the papers received over a 5-year period), the summed h-index of the current faculty over time, and a number of secondary measures, including the ig(5), ie(5), and i10(5)-indices. They also determined the impact of individual authors in driving the results using Gini coefficients. To address the issue of author ambiguity, which can be problematic in multicenter bibliometric analyses, they have provided a source dataset used to determine the ih(5) index for the Toronto program. RESULTS The University of Toronto Neurosurgery Program had approximately 29 full-time surgically active faculty per year (not including nonneurosurgical faculty) in the 5-year period from 2009 to 2013. These faculty published a total of 1217 papers in these 5 years. The total number of citations from these papers was 13,434. The ih(5)-index at the University of Toronto was 50. CONCLUSIONS On the basis of comparison with published bibliometric data of US programs, the University of Toronto ranks first in terms of number of publications, number of citations, and ih(5)-index among neurosurgical programs in North America and most likely in the world.

Arthroscopic Treatment of Anterior Ankle Impingement Syndrome in Dancers

2005 ◽  
Vol 26 (11) ◽  
pp. 908-912 ◽  
Author(s):  
Aneel Nihal ◽  
Donald J. Rose ◽  
Elly Trepman
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Case Series ◽  
Scar Tissue ◽  
Nonoperative Treatment ◽  
Impingement Syndrome ◽  
Arthroscopic Treatment ◽  
Dance Performance ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

Background: The purpose of this study was to evaluate the results of arthroscopic treatment of anterior bony and soft-tissue impingement of the ankle in elite dancers. Methods: The study is a case series retrospectively reviewed. In the period between 1990 and 1999, 11 elite dancers (12 ankles) had ankle arthroscopy after a diagnosis of anterior ankle impingement that markedly interfered with their dancing. Initial nonoperative treatment failed in all subjects. Previous ankle trauma was noted in all subjects. There were seven women and four men (average age 28 years). Tibiotalar exostoses were radiographically noted in six ankles. Standard anteromedial and anterolateral arthroscopic portals and instrumentation were used for resection of bone spurs and debridement of impinging soft tissues. Patients were nonweightbearing for 5 days after surgery and had postoperative physiotherapy. Results: Nine dancers returned to full dance activity at an average of 7 weeks after surgery. One patient did not return to dance performance because of concurrent unrelated orthopaedic problems, but he resumed work as a dance teacher; he developed a recurrent anterior tibial spur that was successfully resected at a second arthroscopy 9 years later. Another dancer developed postoperative scar-tissue impingement and stiffness; she had a repeat arthroscopy 4 months after the initial procedure and subsequently returned to dance performance. All patients eventually had marked postoperative improvement in pain relief and dance performance. Conclusions: Arthroscopic debridement is an effective method for the treatment of bony and soft-tissue anterior ankle impingement syndrome in dancers and has minimal morbidity.

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