Management of haemophilic arthropathy.

Despite the tremendous benefit offered by primary prophylaxis, recurrent joint bleeding with progression to chronic synovitis and haemophilic arthropathy is still a daily concern for the multidisciplinary health care teams managing patients with severe haemophilia or haemophilia complicated by inhibitor development. Advanced stages of arthropathy could be prevented by regular assessment of musculoskeletal status and thus early detection of symptoms, daily rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training. Patient's education and psychological counselling are crucial. New tools such as magnetic resonance imaging are promising for the monitoring of these patients and might promote early detection of arthropathy and thus appropriate preventive measures to avoid further joint deterioration can be implemented. Medical synovectomy such as radionucleide synoviorthesis is a simple and non-invasive procedure that often delays the need for surgery which despite considerable improvement in techniques and postoperative rehabilitation remains a high-risk strategy in patients with severe haemophilia, especially those with inhibitors. In these high risk patients, availability of specific clotting factors such as activated prothrombin complex concentrate (FEIBA, Baxter, Vienna, Austria) and more recently, recombinant factor VIIa (rFVIIa, NovoSeven, Bagsvaerd, Denmark) has allowed to perform effective and safe orthopaedic procedures. The on-going EUREKA study will undoubtedly provide additional information about the optimal use of rFVIIa in this context.

[Imaging findings of muscle traumas in sports medicine]. / Le muscle du sportif.

Traumatic muscular pathology is frequent in the athlete. Usually, these lesions heal spontaneously leaving no sequelae. One must be able to predict how long the healing process will last in order to avoid a long period of inactivity and to protect the patient from a recurrent tear. Medical imaging can define the precise location and severity of muscle traumas and detect critical elements that will delay complete repair. Sonography is the most useful and the least expensive imaging technique for analyzing muscular trauma. It provides a good study of muscle fibers, tendons, and aponeurosis but is limited in its poor visualization of the deep structures such as hamstring tendons and the difficulty in detecting muscular scar. MRI is the most sensitive imaging technique for analyzing muscular trauma. However, muscular fibers themselves are not visualized with MRI. It remains a secondary technique, adapted to the insufficiencies of sonography. Nevertheless, the exact place of medical imaging in traumatic muscular pathology remains and leaves the door open to many later studies.

[The value of ultrasonographic monitoring in mandibular lengthening using the Ilizarov principle. Preliminary results]. / Intérêt de la surveillance échographique dans les allongements mandibulaires selon le principe d'Ilizarov, Résultats préliminaires.

From a review of the literature and a clinical case, we demonstrate the value of ultrasonographic monitoring of mandibular distraction according to the Ilizarov's protocol. Unlike X rays, sonography offers early and reliable pictures of the ossification process. The ultrasonic image matches the histological aspect obtained in the course of experiment. A more accurate monitoring of the regenerating area is thus made possible.

MR diagnosis of lipoid pneumonia.

High signal intensity on both T1 and T2 spin-echo sequence was found with magnetic resonance imaging in one case of lipoid pneumonia related to mineral oil aspiration. This finding, rather specific of lung parenchyma infiltrated by lipids, may help for the diagnosis of lipoid pneumonia.

Magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder.

OBJECTIVES: To describe magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder. PATIENTS AND METHODS: Twenty patients with idiopathic adhesive capsulitis of the shoulder underwent magnetic resonance imaging involving two spin-echo T2-weighted sequences with fat saturation and two spin-echo T1-weighted postgadolinium sequences; for all sequences, sections were obtained in the oblique coronal and transverse axial planes. Findings were compared to those obtained using the same imaging protocol in 15 patients with clinical manifestations of rotator cuff tear. RESULTS: Postgadolinium enhancement of the joint capsule and synovial membrane was seen in the rotator interval in all 25 adhesive capsulitis patients and in the axillary recess in 22 of the 25. Only one of the 15 rotator cuff tear patients had this finding. In both groups, postgadolinium enhancement occurred in the subacromial bursa, in the rotator cuff tendons, and in the acromioclavicular joint. No significant rotator cuff tears were found in any of the adhesive capsulitis patients. CONCLUSION: In difficult cases, magnetic resonance imaging with gadolinium injection can contribute to the diagnosis of idiopathic adhesive capsulitis of the shoulder.

Radiographic assessment of hip and knee osteoarthritis. Recommendations: recommended guidelines.

Pathological lesions of osteoarthritis, demonstrated by conventional radiography, can be assessed by scoring systems and/or measurement with a quite acceptable reproducibility. Scores are recommended for a rough staging of osteoarthritis and of bone changes. Measurement is recommended for assessment of joint space narrowing progression. A good assessment of progression implicates a perfect reproducibility of the radiographic image of the joint. Accuracy of standard radiograph is improved by some views such as the hip profile and the schuss view.

Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience.

Lateral trochlear inclination (LTI) of the knee was compared on magnetic resonance (MR) images obtained in 30 patients with patellar instability (PI) and 30 patients with nonspecific internal knee derangement. Differences in LTI values between the two populations were significant (P <.001). Reproducibility of the measurement was judged excellent with an intraclass correlation superior to 0.98. Below a threshold value fixed at 11 degrees, LTI appears to be an excellent diagnostic test of PI with a sensitivity of 0.93 (28/30), a specificity of 0.87 (26/30), and an accuracy of 0.90 (54/60).