Kienb?ck's disease and gout.

A relationship between gout and Kienbock's disease has been proposed on the basis of a previously published case report. A review of patients at our institution identified a single case with the combination of both Kienbock's disease and gout. We believe that the association is coincidental.     

Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension?

Acute fractures of the scaphoid were randomly allocated for conservative treatment in a Colles'-type plaster cast with the wrist immobilised in either 20 degrees flexion or 20 degrees extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed after six months the wrists which had been immobilised in flexion had a greater restriction of extension. We recommend that acute fractures of the scaphoid should be treated in a Colles'-type cast with the wrist in slight extension.     

Revisiting the pathogenesis of podagra: why does gout target the foot?

This invited paper provides a summary of a keynote lecture delivered at the 2011 Australasian Podiatry Conference. Gout is the most prevalent inflammatory arthropathy. It displays a striking predilection to affect the first metatarsophalangeal joint as well as joints within the mid-foot and ankle. A number of factors are known to reduce urate solubility and enhance nucleation of monosodium urate crystals including decreased temperature, lower pH and physical shock, all of which may be particularly relevant to crystal deposition in the foot. An association has also been proposed between monosodium urate crystal deposition and osteoarthritis, which also targets the first metatarsophalangeal joint. Cadaveric, clinical and radiographic studies indicate that monosodium urate crystals more readily deposit in osteoarthritic cartilage. Transient intra-articular hyperuricaemia and precipitation of monosodium urate crystals is thought to follow overnight resolution of synovial effusion within the osteoarthritic first metatarsophalangeal joint. The proclivity of gout for the first metatarsophalangeal joint is likely to be multi-factorial in origin, arising from the unique combination of the susceptibility of the joint to osteoarthritis and other determinants of urate solubility and crystal nucleation such as temperature and minor physical trauma which are particularly relevant to the foot.     

Funeral oration in praise of Auguste Bérard given by C.P. Denonvilliers during the 20 October 1852 session of the Paris Society of Surgery

In 1843 Auguste Bérard created the Société de chirurgie de Paris which later took the name of the Académie de chirurgie dissolved in 1793 by the French Revolution. Auguste Bérard was forty years old in those days. He had just been appointed Professor of clinical surgery and became the first President of the Société de chirurgie de Paris. Three years later, his colleagues were mourning for him.     

MRI vs. arthroscopy in the diagnosis of cartilage lesions in the knee. Can MRI take place of arthroscopy?

INTRODUCTION: The accuracy of magnet resonance imaging in diagnosing cartilage lesions is discussed controversially. The sensitivity of this examination ranges from 15 % to 96 %. Clinical evidence demonstrates that cartilage lesions, diagnosed by MRI, were not confirmed in arthroscopy. The purpose of this prospective study was to analyse the practicability of replacing arthroscopy by MRI in diagnosis of cartilage lesions. PATIENTS AND METHODS: 195 patients with acute or chronic knee pain were examined by reason of a pathological clinic result by MRI preoperatively. In group A (n = 86), a standard program was performed in the radiological department of German Army Hospital (sagittal STIR TSE und PD TSE, coronary und transversal T2 FFE [TR = 660 ms, TE = 18 ms, FA = 30 degrees, 512er-Matrix]), in 21 patients (subgroup AK) a cartilage specific sequence (fs T1 W FFE) without gadolinium was added. Patients in group B (n = 88) were examined in a private outpatient clinic (sagittal T1 SE, T2 SE and T2 FLASH [TR = 608 ms, TE = 18 ms, FA = 20 degrees, 256er-Matrix]) with the use of gadolinium. A clear clinical diagnosis had to be performed before MRI examination. RESULTS: 156 lesions of the cartilage were detected arthroscopically. The sensitivity of the examination was in group A 33 %; group B 53 %; group AK 38 %, specificity in group A 99 %; group B 98 % and group AK 98 %. The positive and negative predictive values were in group A 75 %/98 %; group B 48 %/98 % and in group AK 50 %/97 %. CONCLUSION: MRI was not able to detect reliable cartilage lesions. Until now, arthroscopy is the golden standard to detect cartilage lesions.     

Shockwave application in calcifying tendinitis of the shoulder – prediction of outcome by imaging

This prospective study examined 62 patients (65 shoulders) with chronic courses of calcifying tendinitis of the shoulder before and after low-energy extracorporeal shockwave application (ESWA) in order to identify variables associated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulders were obtained in order to document the size and morphology of the calcifications and the contrast media reactions in areas of interest (deposit, synovia, bursae), respectively. In addition, a clinical evaluation was performed. After ESWA (mean follow-up 18.2 months), clinical evaluations of all 65 shoulders revealed an increase in the Constant score from 44% to 78% (p < 0.0001). While size (p = 0.61) and morphology (p = 0.7) of the deposits before ESWA were not associated with the clinical outcome, negative contrast reactions around the deposits (p = 0.0001), synovia (p = 0.0049) and bursae (p < 0.01) were associated with improved clinical outcomes. After the total study group was divided into two groups, one with Constant scores ≥ 75% (n = 43) and the other with scores < 75% (n = 22), the positive predictive value (ppv), specificity (sp) and sensitivity (se) were determined for the negative reaction around the deposit (ppv: 0.94; sp: 0.95; se: 0.38), synovia (ppv: 0.84; sp: 0.82; se: 0.49) and bursae (ppv: 0.86; sp: 0.86; se: 0.44). In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients with chronic calcifying tendinitis, the absence of contrast enhancement, especially around the deposit, is a strong predictive parameter of a positive clinical outcome of ESWA. Received: 23 November 1999     

Self-neglect in the case of the elderly. Where are we now?

Self-neglect in an elderly person is a behavior that threatens his/her own health and safety. It is present when a person refuses to adequately feed, water, shelter, or clothe himself, refuses medication or medical care, and personal safety measures. MATERIAL AND METHOD: This is a multicentric study of self-neglect in three geriatric units from Finland, Greece and Romania The medical, social, psychological and behavioral profile analysis was based on a questionnaire; this questionnaire relied on existing studies and social, economic and medical facts in the three countries. The cognitive function, nutritional status, and the presence or absence of depression have also been assessed. RESULTS AND DISCUSSIONS: The data obtained until now support the importance of self-neglect among the elderly. The social-medical network should not only identify, diagnose, prevent, and treat the elderly affected by the phenomenon of self-neglect, but also educate the society to help them and, moreover, to prevent their marginalization.     

Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect

Background

To examine the safety and efficacy of Masquelet’s technique as a surgical method for treating the first metatarsophalangeal joint in cases of gout accompanied by a massive bone defect.