Intra-articular Localized Haemangioma of the Knee Mimicking Localized Pigmented Villonodular Synovitis: A Case Report.

Intra-articular synovial haemangioma of the knee is a benign tumour. However, diagnostic delay leads to degenerative changes in the cartilage and osteoarthritis due to recurrent haemarthrosis. Therefore, treatment should be performed immediately. We report the case of a localized synovial haemangioma arising from the medial plica in a 38-year old female presenting with pain and restricted range of motion in the right knee joint. Initially, we diagnosed this case as a localized pigmented villonodular synovitis (LPVS) based on MRI and arthroscopic findings and performed only arthroscopic en bloc excision of the mass and synovectomy around the mass for diagnostic confirmation. Fortunately, there was no difference in the treatment approaches for LPVS and localized haemangioma and the synovial haemangioma had not recurred at the 3-month postoperative follow-up with MRI. The patient's clinical symptoms resolved and had not relapsed two years after surgery.

Anaesthetic management of a patient with relapsing polychondritis undergoing laparoscopic surgery.

We describe the anaesthetic management of a patient with relapsing polychondritis who underwent laparoscopic cholecystectomy. We failed to secure a patent airway with a ProSeal laryngeal mask airway, probably because of the deformity of the larynx. The glottis was small and it was only possible to pass a 5.5 mm cuffed endotracheal tube into the trachea. Positive pressure ventilation with 5 cm H2O positive end-expiratory pressure and surgery were safely performed. In relapsing polychondritis, recurrent inflammation and destruction of laryngeal and tracheobronchial cartilage causes airway obstruction, and various sizes of tracheal tubes and other airway manipulation devices should be prepared.

Characteristics of frequent pediatric emergency department users.

The purpose of this study was to examine the medical and demographic characteristics of patients who frequently seek emergency care at a pediatric emergency department (ED). Registration information of ED visits during the study period from 11/1/87 to 5/31/92 (4.6 years) was stored in a data base. Patients with 10 or more ED visits during this study period were considered to be "frequent" ED users. Outpatient and inpatient medical records of these patients were manually reviewed. Demographics, chronic conditions, and the acute conditions for each ED visit were coded and analyzed. During the study period, there were 79,049 ED patient visits under 21 years of age. Of the patients born after 1970, there were 47,451 visits by patients seen one or two times, 25,883 visits by patients seen three to nine times, and 5178 visits by 357 patients seen in the ED ten times or more. Ninety-nine patients were seen more than 15 times, 39 patients were seen more than 20 times, 17 patients were seen more than 25 times, and 10 patients were seen more than 30 times. Two hundred sixty-five of the 357 frequent ED users (74%) had chronic disease conditions. Two hundred and twenty-three of them had good functional status, 25 had mild or moderate impairment in carrying out activities of daily living, and 17 had severe impairment of function. The most common chronic medical conditions were recurrent wheezing (226), neurologic conditions (33), gastrointestinal conditions (13), cardiac conditions (12), and endocrine conditions (9). The other 92 were assessed as healthy children. Patients' immunization status were up to date as of the last ED visit during the study period in 329 patients (92%). Pediatricians were the primary care providers in 339 patients (95%). Medical insurance status of patients follows: private insurance (38%), military (0.3%), Medicaid or state assistance (60%), and no insurance (1.4%). Polynesian ethnic groups were over-represented in the cohort of frequent ED users. We conclude that cultural differences appeared to be an important factor associated with frequent ED use by healthy persons. Medical care resources as measured by immunizations, insurance, and identification of a primary care physician did not appear to be deficient in this cohort of frequent ED users. Since recurrent wheezing is a dominant chronic condition among frequent ED users, pediatric emergency medicine training programs may consider the inclusion of the chronic management of wheezing in their curriculum.

MR imaging of the temporomandibular joint: a cadaver study of the value of coronal images.

Recent studies comparing cryosectional anatomy of the temporomandibular joint (TMJ) to its MR appearance have shown that the assessment of disk displacement is inaccurate when based on the sagittal plane alone. This article describes the MR appearance of the normal and abnormal (positional and osseous changes) TMJ in the coronal plane and compares these findings with their cryosectional anatomy. Twenty-two TMJs from unselected frozen cadavers were embedded in paraffin. Coronal and sagittal MR imaging was performed; specimens were then cut in the same plane as the coronal images. Disk position by cryosection was normal in 14 cases and abnormal in eight cases. Coronal MR images alone correctly depicted the TMJ disk position in 17 cases (77%) (13 normal, four abnormal). Complementary sagittal images were necessary for diagnosing anterior displacement in two cases (9%). MR was inaccurate in three cases (14%) of severe degenerative joint disease. Bone condition was correctly diagnosed on the basis of coronal images alone in all cases. Our study shows that coronal MR imaging alone of the TMJ in cadavers accurately shows disk position in 77% of cases. Complementary sagittal images were of benefit in the diagnosis of an additional 9% with anterior displacement. Disk position was assessed inaccurately in either plane in patients with severe degenerative joint disease. For a full MR assessment of the TMJ for disk position and bone condition, we recommend imaging in both coronal and sagittal planes.

A rational approach to the differential diagnosis of arthritic disorders.

Numerous musculoskeletal and collagen diseases can affect the cervical spine and TMJs as well as other joints in the body, resulting in pain and dysfunction. A rational approach has been presented to aid in the differential diagnosis of these disorders when they involve the TMJs. When systemic inflammatory diseases such as gout, psoriatic arthritis, and rheumatoid arthritis are suspected, the patient should be seen jointly with a rheumatologist to better manage medication and rehabilitation of the patient. Although rheumatologic diseases may appear complex, they can be differentiated and managed with minimal difficulty for the dentist. Early relief of acute pain and long-term successful management, however, will depend on the clinician's ability to understand the disease process, establish an accurate diagnosis, and apply the proper therapeutic measures.

The effects of bicarbonate on blood coagulation.

The anticoagulant effects of sodium and potassium bicarbonate were investigated with use of fresh human whole blood obtained from normal healthy volunteers. Results from prothrombin and thrombin clotting time determinations demonstrated that bicarbonate can interfere with the clotting process. Clinical data obtained from patients who received intravenous administration of sodium bicarbonate supported these findings.

Evaluation of radiopharmaceuticals for the detection of acute myocardial infarction in man.

The accuracy of the scintigraphic diagnosis of acute myocardial infarction with 99mTc-pyrophosphate, 99mTc-tetracycline and 99mTc-glucoheptonate was assessed in 63 patients, 43 of whom had clinical evidence of acute myocardial infarction. In 15, studies with both 99mTc-tetracycline and 99mTc-pyrophosphate were performed. Accuracy was greatest with 99mTc-pyrophosphate (17/17 true positives, 8/10 true negatives) contrasted with 99mTc-tetracycline (12/25 true positives, 6/11 true negatives) and 99mTc-glucoheptonate (3/13 true positives, 2/2 true negatives). 99mTc-pyrophosphate was the most sensitive tracer for the detection of acute myocardial infarction. The diagnostic accuracy with 99mTc-glucoheptonate was poor.