Simultaneous quadruple dislocations of the hand in a motorcyclist: A case report.

Herein we present a case of four simultaneous dislocations of the hand resulting from a motorcycle accident in a young man. In this case, the 1st CMC, MCP, and IP joints of the right hand were dislocated along with right perilunate dislocation. Perilunate dislocation was treated with open reduction and internal fixation. Close reduction of IP and CMC was done and CMC was fixed by pins. MCP dislocation was treated by open reduction and pinning in addition to collateral ligament and capsular repair. In follow-up excellent functional activity and range of motion were observed.

Mycobacterium tuberculosis-induced multiple tenosynovial masses with rice bodies: A case report.

Key clinical message: Tenosynovitis with rice bodies is a rare presentation, diagnosable by MRI. Surgical excision is the preferred treatment for tendon sheath masses containing rice bodies. The etiology was Mycobacterium tuberculosis in our case, highlighting the need to consider extrapulmonary TB in atypical presentations, ensuring effective treatment. Abstract: Rice body tenosynovitis is a rare clinical phenomenon with various etiologies. Inflammatory diseases such as rheumatoid arthritis and tuberculosis have been shown to be associated with this condition. Herein we report a 46-year-old male who presented with multiple masses of the dorsal and volar aspects of the left wrist. The masses did not cause significant pain or limitation of motion. Magnetic resonance imaging showed the presence of numerous hypointense bodies in the masses. During the surgical procedure, separate cysts originating from the synovitis of both the extensor and flexor compartments were identified along with white rice bodies within them. Masses were excised and Xpert MTB/RIF assay on the rice bodies was conclusive of M. tuberculosis (TB). The patient was discharged on anti-TB medications with no complication or recurrence after 1 year of follow-up.

Association between Latest Activated Sites in the Left Ventricle and Akinetic Segments in Patients with Ischemic Cardiomyopathy.

Background: It is not clear whether the latest activation sites in the left ventricle (LV) are matched with infracted regions in patients with ischemic cardiomyopathy (ICM). We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM. Methods: Data were analyzed in 106 patients (age = 60.5 ± 12.1 y, male = 88.7%) with ICM (ejection fraction ≤ 35%) who were refractory to pharmacological therapy and were referred to the echocardiography department for an evaluation of the feasibility of cardiac resynchronization therapy. Wall motion abnormalities, time to peak systolic myocardial velocity (Ts) of 6 basal and 6 mid-portion segments of the LV, and 4 frequently used dyssynchrony indices were measured using 2-dimensional echocardiography and tissue Doppler imaging (TDI). To evaluate the influence of the electrocardiographic pattern, we categorized the patients into 2 groups: patients with QRS ≤ 120 ms and those with QRS >120 ms. Results: A total of 1 272 segments were studied. The latest activation sites (with longest Ts) were most frequently located in the mid-anterior (n = 32, 30.2%) and basal-anterior segments (n = 29, 27.4%), while the most common sites of akinesia were the mid-anteroseptal (n = 65, 61.3%) and mid-septal (n = 51, 48.1%) segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration ≤ 120 ms (Φ = 0.707; p value ≤ 0.001). Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM.

Magnetic resonance imaging investigations of position of conus medullaris in adolescent idiopathic scoliosis as a peripheral neuropathy.

Adolescent idiopathic scoliosis (AIS) is a structural 3-dimensional deformity the spine, which is occurring between 10 years of age and skeletal maturity and it mostly affects prepuberbal girls. The etiology of AIS remains unknown and seems should be multifactorial. According to the theories, there could be a shorter spinal cord or a higher location of the conus medullaris and disproportionate growth in neuro-osseous system. This study wants to investigate the position of the conus medullaris in AIS patients with a large curve magnitude in comparison with healthy adolescents. 94 AIS patients consisting of 25 males and 69 females between 11 and 25 years old, based on physical examination and standing posteroanterior roentgenography of the total spine with a Cobb angle more than 40 degrees was chosen. The main curve magnitude of every AIS patient was measured by the Cobb method. Apex of deformity was determined based on SRS definition. Patients' deformity were calcified based on Lenke classification. Magnetic resonance imaging examinations of the total spine were performed in the AIS group, by means of a 1.5-T magnetic resonance imaging system. The position of conus medullaris was defined according to the method by saffiudin et al and was assessed based on the age, sex, type of deformity, severity of deformity, kyphosis, lordosis, flexibility, apical vertebra, stable vertebra. The mean age of patients were 16.34 with 6.77 of conus medullaris position in mean, which was lower one-third of L1. Our study showed no significant correlation between the position of conus medullaris with age, weight, preoperative curve, flexibility, types of deformity based on Lenke classification and degree of kyphosis and lordisis. In conclusion, there is the same mean and the distribution of the conus medullaris locations for AIS patients and normal populations.