Algodystrophy of the knee anatomo-radiological study of a case

Summary Presentation of a case of algodystrophy (i.e., Sudeck's dystrophy) of the left knee, affecting the femur, tibia and patella. It was brought on by a simple movement made while playing tennis and it recurred subsequently accompanied by algodystrophy of the corresponding foot. Histological study of the biopsy material showed the classical image of cortical and cancellous bone atrophy with non-specific remodelling which explained the increased uptake on the scintigraph as well as the repairing of the bone tissue observed on the X-rays. Reasons are given for the choice of the term algodystrophy to describe the condition.     

Schwangerschaftsinduzierte Algodystrophie

Pregnancy-induced algodystrophy is per se a rare, possibly too rarely diagnosed disease, since patients with algodystrophy may be misdiagnosed as having unspecific backache, musculoskeletal problems, and ligament pain associated with pregnancy. However, when clinical signs of beginning algodystrophia are present, immediate investigations and therapy are necessary for relief of pain and in order to prevent complications. The aim of this paper is to summarize our current knowledge on this disease. Furthermore, the clinical course and diagnostic evaluation are described in two cases with pregnancy-induced algodystrophy. The authors question the common distinction between pregnancy-induced and post-pregnancy algodystrophy, which result in a disturbed bone and calcium metabolism, but discuss both entities similary.     

Pyogenic osteomyelitis in Gaucher's disease]

Gaucher's disease is a sphingolipidosis which may be accompanied by severe pain in the bones. We report a case of Bacteroides fragilis osteomyelitis consecutive to surgical biopsy. The bone pain may be due to ischaemia of the bone or to a pyogenic osteomyelitis which is iatrogenic in most cases. The clinical and paraclinical features of these two entities are described after a review of the literature, and the main complementary examinations leading to their diagnosis are presented.     

Algodystrophy and venous thrombosis of the lower extremities. Diagnostic discussion. Apropos of 3 cases

The authors report 2 cases of probable algodystrophy of the lower extremities, associated to a definite deep venous thrombosis. They discuss the relationships between the two diseases and the difficulties of the differential diagnosis in light of a third case where the algodystrophy is definite and manifests itself as a deep venous thrombosis confirmed by phlebography. They insist on the absolute need to rule out a deep venous thrombosis before considering the exceptional diagnosis of algodystrophy with pseudo-phlebitic manifestations.     

Acute respiratory distress syndrome of the adult

In a 43-year-old female patient after a bland influenzal infection suddenly an acute life-threatening picture of a disease with severe dyspnoea developed. Radiologically a distinct interstitial oedema was to be seen. According to the clinical and paraclinical data the case in question was the benign for of an acute dyspnoea syndrome of the adult. Etiology and therapy of the acute dyspnoea syndrome are shown. This picture of a disease should be included into the differential-diagnostic consideration in acute conditions of dyspnoea.     

Notfall eines septischen Charcot-Fußes

Severe courses of the disease in patients with diabetic foot syndrome are observed again and again in clinical podiatric institutions. Diabetic foot syndrome requires specialized detailed knowledge of the pathophysiology and of the altered clinical symptomatic and necessitates an interdisciplinary cooperation. This case report illustrates such a severe course and offers the basis for discussion on the clinical approach in emergency patients with diabetic foot syndrome.     

Psoriasis arthropathica and seronegative rheumatoid arthritis--differential diagnostic considerations

For differential-diagnostic considerations concerning seronegative arthritides two groups of patients with 25 patients each of the disease groups psoriasis arthropathica and serologically negative rheumatoid arthritis were selected. The differentiation of the two diseases was performed by clinical, paraclinical and radiological findings. When there are no typical psoriatic changes of skin and/or nails and there is an empty family anamnesis concerning this dermatosis, respectively, the coordination of seronegative arthritides is considerably rendered more difficult. Here the radiomorphological investigations particularly of the sacroiliacal joint and/or of the spine essentially contribute, since the arthritis of the sacroiliacal joint is to seen in high incidence in psoriasis arthropathica. Out of the number of the paraclinical values the determination of the complement factor C 4 and of immunoglobulin M gets the importance of a sign of differentiation, in which case C 4 in the psoriasis arthropathica and the immunoglobulin M in the seronegative rheumatoid arthritis are statistically significantly increased. The problems of the often difficult differential diagnosis between the two groups of disease can be clarified only by complex clinical examinations, paraclinical parameters and subtile radiodiagnosis. A close interdisciplinary cooperation between experienced dermatologists, rheumatologists and radiologists seems reasonable.     

Isolated jejunal tuberculosis mimicking Crohn disease. Diagnosis by push video-enteroscopy

Intestinal tuberculosis is relatively unfrequent in Western countries, but immigrants and AIDS patients remain groups at particular risk for this disease. The diagnosis of intestinal tuberculosis is often difficult to establish because of close similarities with other conditions, in particular Crohn's disease. We report a case of jejunal tuberculosis in a 33-year-old man with severe weight loss and unexplained fever. The diagnosis was obtained on histological examination of the distal jejunum biopsies performed during pushed video-enteroscopy. Interestingly, culture of the biopsies and specific PCR remained negative. Dramatic improvement was observed during the first days of antituberculous treatment. The main clinical and paraclinical manifestations of intestinal tuberculosis are also reviewed, as well as recent epidemiologic observations and new developments in diagnosis and treatment.     

Diagnostic and therapeutic aspects of subarachnoidal hemorrhage from the viewpoint of emergency medicine]

The subarchnoidal haemorrhage is an acute disease which has a high lethality and, therefore, in every case presents an indication for admission into an intensive-therapeutic department. It often occurs in younger age groups and appears more frequently than is assumed in general. Despite impressive clinical symptoms (suddenly beginning stabbing headache, vomiting and disturbances of consciousness of various degree of severity) the picture of the disease is not exactly diagnosed almost in every case. From 1970 to 1974 we treated 105 patients with subarachnoidal haemorrhages. In this paper is referred to the most important clinical and paraclinical parameters. Diagnostic and therapeutic possibilities are discussed.     

Value of vascular tests in the diagnosis and therapeutical indications of pulmonary embolism on a pneumological background (author's transl)]

The diagnosis of mislaying forms of pulmonary embolism, where even angiography was not pathognomonic, induced the use of a phlebography on lower limbs in patients where this diagnosis was suspected. The revelation of a distal thrombo-phlebitis and even more so an iliocaval one, becomes a major value when the clinical and paraclinical data remained arguable. The comparative study of diagnostic usual clinical and paraclinical elements (radiographies, E.C.G., gasometries and scintigraphies) confirmed, in 22 patients, the value of phlebography. On a pneumological background, it is useful to perform this examination, most of the time : a) on patients over 55, when a cardiorespiratory decompensation remained unexplained in a patient with chronic respiratory insufficiency, or even an unproved hemoptysis; b) but mostly before 55, in case of painful pneumopathy above all if it is bilateral and recurring, or in case of paroxysmal bronchospasm without atopic ground, when a belated asthma could be thought of. Finally vascular tests induced the fitting in situ of a clamp or "umbrella" in the vena cava in 7 patients out of 22.     

Three brothers with algodystrophy of the hip.

We describe the clinical features of algodystrophy of the hip in 3 brothers, probably the first familial presentation of this disease to be reported. The symptoms and evolution of the disease are as usually described. The familial presentation suggests a genetic predisposition. HLA typing showed an identity of antigenic formula in the 3 brothers, a rare coincidence.     

Aortic dissection with normal aortography and x-ray computed tomography. A diagnostic trap not to be ignored

We are reporting the case of a 63 y.old patient whose initial clinical examination and ultrasonographic data had led to the diagnosis of acute aortic dissection. Only an emergency surgical procedure was able to confirm the diagnosis, after failure of angiography and CT-scan to do so. In the light of this example, we are presenting a reminder of the sensitivity of various paraclinical examinations, classically accepted to establish this diagnosis.     

Ultrasonographic and FDG-PET imaging in active giant cell arteritis of the carotid arteries

Inflammation of the arterial wall has been demonstrated by 18 Fluoro-Deoxyglucose PET imaging in patients with Takayasu's and temporal arteritis. We used ultrasonography and FDG-PET for structural and metabolic imaging of the carotid artery to diagnose giant cell arteritis without biopsy. In a 72 years old patient with isolated clinical and paraclinical signs of severe systemic inflammation ultrasonogaphy showed concentric hypoechogenic mural thickening of the carotidarteries and high FDG uptake in the left carotid, both axillary and subclavian arteries and the aorta. Clinical and paraclinical abnormalities showed a typical response to steroid treatment. In conclusion a combined approach using ultrasound and FDG-PET seems to be helpful in the diagnosis of GCA of large arteries particularly in patients with atypical manifestations of the disease and negative or unavailable biopsy of the temporal artery.     

Actualités physiopathologiques et thérapeutiques dans l’asthme sévère

Asthma is an inflammatory airway disease which presentation is highly heterogeneous. Last two decades provided new clinical and basic data concerning asthma physiopathology that make global understanding much complex. Phenotypes based on clinical settings and paraclinical investigations from large cohorts confirm old paradigm (eosinophilic vs. non-eosinophilic asthma) but also introduce new concepts (obesity-related asthma, late onset asthma, etc.). Conversely, improvement of big data analytics allows to initiate new cohorts aiming at better understanding the pathophysiology underlying those phenotypes and unraveling new ones. However, clinical and therapeutic impacts of those big data need to be further detailed. In parallel, biotherapies and innovative techniques as bronchial thermoplasty become available for severe asthmatic patients who did not respond to specific treatment in the past. Development of a personalized medicine in severe asthma becomes an important challenge for tomorrow. This review will focus on new pathophysiological concepts arisen from large cohorts and new therapeutic strategies available and in progress for severe asthma.     

乾县2011年上半年手足口病流行病学调查研究

目的分析乾县手足口病发病情况,以及潜在的暴发因素,为手足口病的防治制定应急预案。方法对乾县2011年上半年手足口病每例患者的发生进行流行病学分析。结果截至2011年6月20日12时,我县共报告手足口病104例,重症病例10例,死亡1例,报告发病率为17.72/10万,重症报告率为10.58%,死亡率为0.17/10万,病死率0.96%。重症发病率比去年同期上升十倍。报告的10例重症病例中,临床诊断10例,实验室诊断1例,其中7例已治愈,3例正在住院积极治疗中,目前病情稳定。结论疫情报告及时,疫区严格消毒,患者及时隔离治疗,减少了二代病人发生（1例重症死亡是村所截留病人延续治疗所致）。     

Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol

The authors report the case of a 28 year old alcoholic who was admitted to hospital for cardiac failure in 1982 due to a dilated cardiomyopathy. The clinical and paraclinical signs disappeared after cessation of alcohol intake. Three years after abstaining from alcohol, the electrocardiogram, echocardiogram and isotopic ventriculography are normal. This case illustrates the necessity of absolute cessation of alcohol intake in patients with dilated cardiomyopathies.     

Screening and early diagnosis of disorders of the arterial blood supply]

After a short reference to the significance of the screening examinations and early diagnosis for the secondary prevention in disease of the heart and the circulatory system the authors give a survey on the methods of screening examinations and the early diagnosis bening at disposal nowadays in organic disturbances of the arterial bloods supply. Anamnestic, clinical and paraclinical methods are cited, in which cases the paraclinical methods are subdivided into haemostasiological, haemodynamic and biochemical examinations.     

糖尿病Charcot足

糖尿病Charcot足是发生在病程较长的糖尿病患者足部的一种骨关节的慢性进展性疾病。目前其发病机制有神经创伤理论和神经血管理论等多种学说。由于尚无统一的临床和放射学诊断标准,许多病例被延误诊断,导致严重的关节破坏、畸形及溃疡,甚至截肢。近年来,随着骨扫描及核磁共振成像等技术的应用,糖尿病Charcot足得到了早期的诊断和治疗。     

Effect of guanethidine on the natural history of post-traumatic algodystrophy.

OBJECTIVES--To determine the effect of intravenous regional guanethidine on post-traumatic algodystrophy. METHODS--Ten of 20 consecutive patients with algodystrophy after Colles' fracture were treated with serial intravenous regional guanethidine blockades and the other 10 were treated with physiotherapy alone. Patients were assessed before and after each block and then monthly over a six month period. RESULTS--The treated patients had subjective and objective improvements in the assessed features of algodystrophy; treatment resulted in a significant reduction in finger tenderness at five and six months. CONCLUSIONS--Guanethidine blockade induces short term benefits in the symptoms of algodystrophy but improves finger tenderness only in the long term.     

A new case of rheumatoid nodulitis

A new case of rhumatoid nodulitis is reported in à 28 year old man presenting with rapidly regressive arthralgia, numerous rhumatoid nodules and metatarsal lesions without signs of associated arthritis. The biochemical profile was non-specific; serology was weakly positive for rhumatoid factor; there was no obvious immunological disorder (no circulating immune complexes, total complement and its various fractions within normal limits). The clinical findings, treatment and classification of this condition are discussed with reference to six other published cases with a similar clinical and paraclinical features.