ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Calf pseudothrombophlebitis is defined as the acute onset of nontraumatic, nonthrombotic painful swelling of the calf after knee synovitis. The name underscores the clinical similarities between this condition and “true” femoral/popliteal thrombophlebitis pointed out by Baker more than a century ago. A variety of arthritic conditions of the knee, primarily chronic, can be complicated by calf pseudothrombophlebitis. Pseudothrombophlebitis as a complication of Lyme arthritis has been mentioned in clinical reviews of the disease, but to our knowledge, no documented cases of such association were published. Furthermore, pseudothrombophlebitis in the setting of Lyme disease is particularly challenging, both from the diagnostic and therapeutic points of view.Herein, we describe three children who developed pseudothrombophlebitis as a presenting feature of Lyme disease. One of the patients is described in detail, and the clinical findings on the whole group are summarized.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Whether methotrexate can be safely administered during the perioperative period to rheumatoid arthritis patients undergoing arthroplasties is an issue that has not been resolved to date. We are describing our attempt to conduct a case-controlled, multicenter study addressing this issue. The estimated sample size of approximately 140 patients proved to be difficult to recruit. Complications were all mild, but there tended to be more perioperative complications in the methotrexate-treated than in the placebotreated patients. Possible explanations for the failure to complete the study are discussed.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Rapidly destructive arthritis with relatively noninflammatory joint fluids has been described at shoulders as well as at other large joints under a variety of names in older persons. Because this syndrome frequently is not recognized, we have reviewed our experience with such cases. After excluding patients with known causes such as avascular necrosis, Paget's disease, neuropathic arthropathy, endocrine disorders, radiographic evidence of chondrocalcinosis, and hemodialysis, we have seen 20 such patients who are described in this report. All were over age 67, and 16 were women. Seventeen patients had shoulders involved; 6 had destructive arthritis at the knees. Many other patients had multiple sites affected. Six patients also had erosive osteoarthritis of small joints.All patients had diffuse cartilage loss and juxta-articular bone destruction. Patients had been symptomatic a mean of 3.5 years at the time of the study. Bony sclerosis on x-ray was more common than reported in previous series. Joint effusions were bloody or clear. All fluids had strongly positive alizarin red S positive chunks; apatites were confirmed in all 7 studied by electron microscopy. Nine had calcium pyrophosphate dihydrate crystals. The latter were somewhat more commonly associated with bony sclerosis, but crystal types did not explain all differences seen in x-ray patterns.Destructive arthropathy of the elderly involves many large joints in addition to the shoulders, and some patients also have erosive osteoarthritis of fingers. Although calcium pyrophosphate dihydrate crystals were present in many patients along with apatites, the role of crystals is not clear. Radiographic patterns may be more diverse than previously suggested by some researchers, so that the spectrum of idiopathic destructive arthritis reported may depend on selection criteria. It is important to be aware of this noninfectious cause of severe joint destruction at a variety of joints.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Thirty adult fibromyalgia syndrome subjects were randomly assigned to a massage therapy, a transcutaneous electrical stimulation (TENS), or a transcutaneous electrical stimulation no-current group (Sham TENS) for 30-minute treatment sessions two times per week for 5 weeks. The massage therapy subjects reported lower anxiety and depression, and their cortisol levels were lower immediately after the therapy sessions on the first and last days of the study. The TENS group showed similar changes, but only after therapy on the last day of the study. The massage therapy group improved on the dolorimeter measure of pain. They also reported less pain the last week, less stiffness and fatigue, and fewer nights of difficult sleeping. Thus, massage therapy was the most effective therapy with these fibromyalgia patients.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The spectrum of hepatic disease in systemic lupus erythematosus (SLE) ranges from subclinical elevations of liver enzymes to rare reports of hepatic arteritis and infarction. Whether liver disease occurs as a consequence of (or is merely coincident with) lupus activity is not known. In our example, an episode of unexplained acute hepatitis occurred in association with pancytopenia. Both responded to increased doses of prednisone and were believed to be manifestations of SLE. The importance of hepatic disease and its contribution to morbidity and mortality in patients with SLE is controversial. Based on a critical review of the literature, we conclude that, although liver disease in SLE occurs more frequently than previously believed, it is usually limited to asymptomatic hepatomegaly and/or isolated elevations in liver function tests.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although non-traumatic entrapment of the posterior interosseous nerve is very uncommon, one cause of this is synovitis of the elbow due to rheumatoid arthritis. Inability to extend the fingers at the metacarpophalangeal joints is the usual presenting feature, and the main differential diagnosis is extensor tendon rupture. Treatment with a corticosteriod injection of the elbow joint has a 43% success rate, whereas early surgical nerve decompression with or without synovectomy results in good or excellent nerve recovery in all cases reported, even in cases of failed joint injection. If treatment is delayed, resulting in chronic denervation, then tendon transfers are an option.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pure red cell aplasia (PRCA) is a rare hematologic disorder characterized by a severe progressive anemia and a marked decrease or absence of red cell precursors on bone marrow examination. PRCA can occur in the course of many other diseases of which thymoma is the most common. Rarely, PRCA has occurred in patients with connective tissue disorders, the most common being systemic lupus erythematosus (SLE), with 13 cases reported to date in the English literature. In this subset of patients, PRCA can be difficult to manage, and a high rate of mortality has been reported. Multiple therapeutic modalities have been reported, with no clear consensus on the optimal treatment. To date, splenectomy has not been reported in this subset of patients.We describe a patient with SLE who developed PRCA. Prednisone was the initial treatment, but unacceptably high doses were required to control the disease. Intravenous gamma globulin was given with prompt but temporary improvement. The patient subsequently underwent splenectomy with resolution of the PRCA. The patient continues to have a normal hemoglobin 3 years after splenectomy despite no interim therapy. This case represents the 14th case of PRCA occurring in patients with SLE and is the first case of PRCA in SLE treated with splenectomy. Splenectomy should be considered as a therapeutic modality in the management of corticosteroid-refractory PRCA occurring in patients with SLE.

ISSN:1076-1608    

出版商:OVID    

年代:1996

数据来源: OVID