Unusual localization of chondrocalcinosis: The sternoclavicular joint: Case report and review of the literature

BackgroundChondrocalcinosis is a metabolic arthropathy rarely affecting the anterior chest wall (ACW).Aim of the workTo report here a case of a polyarticular chondrocalcinosis with an uncommon localization in the sternoclavicular joints (SCJs), revealed by computed tomography (CT).Case reportA 76-year old female presented to the Rheumatology outpatient clinic Kassab orthopedics institute with low back pain. The history goes back to 4 months prior to her presentation when she developed mechanical back pain that progressively worsened during the last month, becoming inflammatory with prolonged morning stiffness. She had no history of fever or weight loss and no symptoms in the cervical spine, shoulders, chest wall, hips or knees. Physical examination revealed limited range of motion of hips, cervical and lumbar spine and bilateral swelling of SCJs without tenderness on pressure or mobilization. Biochemical investigations showed normal levels of inflammatory markers, phosphorus and calcium. Conventional radiographs showed multiple areas of calcification in the intra-vertebral discs, joint space narrowing of sacroiliac (SI) and coxofemoral joints. Chest wall radiograph appeared normal. ACW and pelvic CT were done to further delineate the cause. It showed intra-cartilaginous bilateral calcifications of SCJs, sacroilliac, intervertebral discs, coxofemoral joints and pubic symphysis. The final diagnosis was polyarticular chondrocalcinosis. The patient received analgesics, non-steroidal anti-inflammatory drugs and had functional rehabilitation sessions. Conclusion: This case points to the rare localization of chondrocalcinosis in the SCJ and should be considered especially in an elderly female. Early recognition is necessary in order to initiate an appropriate and prompt treatment.     

Ectopic thyroid: two cases

Ectopic thyroid is a rare condition (1/4000 to 1/8000 among patients with hypothyroidism). The underlying etiological pathogenic mechanisms remain unknown. Diagnosis is established on the basis of imaging findings. We report two cases of hypothyroidism in adult females who had ectopic sublingual thyroid glands. The first patient was a 20-Year-old woman who had been treated for hypothyroidism since the age of 13 Years before the diagnosis of ectopic thyroid 7 Years later. In both patients, the thyroid gland was palpable. In the first patient the physical examination revealed an ectopic sublingual gland. Scintigraphy confirmed the diagnosis in both patients. The CT-scan and MRI were positive in the second patient. Hormonal substitution therapy using L-thyroixine was given.     

Rheumatologic manifestations of sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It has various clinical features. The most commonly affected organs are the lung, the lymph nodes, the eyes and the skin. Involvement of the musculoskeletal system is far less common and may be inaugural. Articular involvement is dominated by Lofgren syndrome and acute polyarthritis. Abarticular manifestations are often confounded with arthritis. Bone locations are dominated by sarcoidosis dactylitis and osteolysis. Muscular involvement is often unknown and can appear as 3 clinical features: spread form, myositique form or pseudotumoral form. Calcium balance disturbances are dominated by hypercalcemia which is often asymptomatique, but sometimes it reveal the sarcoidosis. Treatment of rheumatologic disorders often involves non steroidal antiinflammatory drugs, corticosteroids and methotrexate. Biological therapies such as the anti-TNFa and the anti-CD20 were showed to be effective in some case reports of severe and refractory disease.     

Comparison between standardized periapical and bitewing radiographs in assessing alveolar bone loss

Readability and alveolar bone level were compared in 455 sets of standardized radiographs each consisting of four periapical (PA) and two bitewing (BW) films. BW radiographs showed significantly higher proportions of unreadable sites in the canines and the mesial surface of first premolars (P less than 0.0001), while PA radiographs exhibited significantly higher proportions of unreadable sites in the distal surface of second molars (P less than 0.0001). Alveolar bone level was assessable in a total of 10016 sites, and the comparison showed identical readings in 82% of the sites. In the maxilla, a significantly higher proportion of sites exhibited larger bone loss measurements (P less than 0.0001) and more sites with significantly higher mean values (P less than 0.005) in BW than in PA films. Mandibular sites showed the opposite trend. The majority of the sites revealed a Pearson's correlation coefficient (r) ranging between 0.60 and 0.82. No significant difference between mean bone loss measurements in the two types of radiographs for all the sites was found. It was concluded that the two radiographic techniques may be used interchangeably in epidemiologic studies.     

Melatonin ingestion before intradialytic exercise improves immune responses in hemodialysis patients

International Urology and Nephrology - The present study aimed to investigate the effects of melatonin (MEL) intake on systemic inflammation and immune responses during intradialytic exercise....