Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients.

OBJECTIVE: To date, early diagnosis of stress fractures depends on magnetic resonance imaging (MRI) or bone scan scintigraphy, as radiographs are usually normal at onset of symptoms. These examinations are expensive or invasive, time-consuming, and poorly accessible. A recent report has shown the ability of ultrasonography (US) to detect early stress fractures. Our objective was to evaluate sensitivity and specificity of US versus dedicated MRI (0.2 Tesla), taken as the gold standard, in early diagnosis of metatarsal bone stress fractures. METHODS: A case-control study from November 2006 to December 2007 was performed. All consecutive patients with mechanical pain and swelling of the metatarsal region for less than 3 months and with normal radiographs were included. US and dedicated MRI examinations of the metatarsal bones were performed the same day by experienced rheumatologists with expertise in US and MRI. Reading was undertaken blind to the clinical assessment and MRI/US results. RESULTS: Forty-one feet were analyzed on US and dedicated MRI from 37 patients (28 women, 9 men, mean age 52.7 +/- 14.1 yrs). MRI detected 13 fractures in 12 patients. Sensitivity of US was 83%, specificity 76%, positive predictive value 59%, and negative predictive value 92%. Positive likehood ratio was 3.45, negative likehood ratio 0.22. CONCLUSION: In cases of normal radiographs, US is indicated in the diagnosis of metatarsal bone stress fractures, as it is a low cost, noninvasive, rapid, and easy technique with good sensitivity and specificity. From these data, we propose a new imaging algorithm including US.

Arthritis due to Mycobacterium xenopi: a retrospective study of 7 cases in France.

BACKGROUND: Mycobacterium xenopi is a nontuberculous mycobacterium responsible for opportunistic and nosocomial infections, chiefly of the lung; few cases of bone and joint infection have been reported. From July 1989 through May 1993, an outbreak of 58 cases of nosocomial discitis due to M. xenopi infection following percutaneous nucleotomy occurred in a French hospital. Peripheral M. xenopi arthritis seems exceedingly rare. We conducted a study to assess the epidemiological and clinical patterns of M. xenopi arthritis. METHODS: We retrospectively reviewed cases of M. xenopi arthritis reported from May 1993 through October 2004. RESULTS: We identified 7 cases, all of which occurred after invasive surgical procedures were performed on the affected joint, suggesting a nosocomial pattern of infection. Two patients may have been contaminated at the hospital where the M. xenopi discitis outbreak occurred. No source was identified in the other 5 patients. Despite the probable nosocomial nature of the infections, the diagnosis was delayed (mean time until diagnosis, 50 months). Repeated collection of deep tissue specimens for bacteriological analysis seemed crucial to the diagnosis. The treatment relied on combination antimicrobial therapy and surgery. Among 11 cases of M. xenopi osteoarticular infection reported in the literature from 1975 to 2005, (arthritis in 9 cases and osteitis in 2), none were nosocomial. CONCLUSION: A high index of suspicion should be maintained to ensure the diagnosis of M. xenopi arthritis before chronic monoarthritis and before the development of irreversible joint damage.

Prognostic value of early computed tomography in radiculopathy due to lumbar intervertebral disk herniation. A prospective study.

OBJECTIVE: To prospectively evaluate the relationship between the early computerized tomography (CT) features of disk herniation and the clinical outcome in patients with recent-onset sciatic or femoral neuralgia treated conservatively. Early CT is often used, despite the absence of data on usefulness for predicting outcomes. METHODS: Of 78 patients with sciatica or femoral neuralgia of less than 1 month's duration, presumably due to a disk herniation, 75 were found by CT to have a disk herniation at the expected level. All patients were treated conservatively. The 60 patients who were reassessed clinically after 3 months were included in the study. Based on the results of the clinical assessment, the patients were classified as having a good outcome (complete or partial recovery) or a poor outcome. CT findings were compared in these two groups. RESULTS: None of the features of disk herniation studied on the CT scans were significantly correlated with the clinical outcome. A larger herniation or presence of a free fragment was more common in the good outcome group, but the differences were not statistically significant (P= 0.07). CONCLUSION: In this study, early CT scan did not predict the clinical outcome of patients with nerve root pain from lumbar disk herniation. None of the CT criteria was associated with a poor clinical outcome. Early CT scan has no prognostic value in this setting.

Bronchiectasis in a patient with CREST syndrome.

Bronchiectasis is an uncommon pulmonary manifestation of systemic sclerosis (SSc). We report the case of a 70-year-old woman with CREST syndrome and vasculitis who developed multifocal symptomatic bronchiectasis. The bronchiectasis and immunosuppressive therapy precipitated severe lower respiratory tract infection, which was fatal within a few months. The concomitant occurrence of bronchiectasis and SSc raises the possibility of a pathophysiological relationship. Several hypotheses can be put forward to explain the occurrence of bronchial wall damage leading to bronchiectasis. Whatever the mechanism, cases of bronchiectasis in patients with SSc should be reported to make physicians aware of the substantial risk associated with this combination.