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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Scintimetry and intracapsular pressure recordings were performed in 10 painful hips in children. Maximum intracapsular pressures were recorded with the hip in extension or in 90 degrees of flexion. Minimum pressures were recorded with the hip in semiflexion. Extremely high pressures were recorded in extension/maximum internal rotation. In 3 cases the pressure exceeded the estimated systolic blood pressure. There was a close correlation between the volume of aspirated fluid and intracapsular pressure. In a case of septic arthritis, ischemia in the epiphysis was noted scintigraphically. This ischemia was reversed following decompression by aspiration.
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PMID:Intracapsular pressure in hip synovitis in children. 188 71

We evaluated the residual deformity and late treatment of thirty-four hips of thirty-one children who had had septic arthritis when they were less than one year old. The hips were classified into four groups on the basis of radiographic changes. Type-I deformity (five hips) involved transient ischemia of the epiphysis, with or without mild coxa magna, and these hips did not need reconstruction. Type-II deformity (eleven hips) included deformity of the epiphysis, physis, and metaphysis, and these hips needed an operation to prevent subluxation; the goals of the operation included improvement in acetabular coverage, improvement in abductor efficiency by epiphyseodesis or transfer of the greater trochanter, and equalization of limb-length discrepancy by epiphyseodesis of the contralateral limb. Type-III deformity (five hips) involved malalignment of the femoral neck, with extreme anteversion or retroversion or with a pseudarthrosis of the femoral neck that necessitated a realignment osteotomy of the proximal part of the femur or bone-grafting of the pseudarthrosis. Type-IV deformity (thirteen hips) included destruction of the femoral head and neck, with persistence of only a remnant of the medial base of the femoral neck. In the hips that had a Type-IV deformity, the complex clinical problems, which included severe limb-length discrepancy and incompetent articulation of the hip, necessitated operations such as Pemberton osteotomy, trochanteric arthroplasty, arthrodesis, epiphyseodesis of the contralateral limb, and lengthening of the ipsilateral tibia. The functional result was satisfactory in all five hips that had a Type-I deformity, in seven of eleven that had a Type-II deformity, in three of four that had a Type-III deformity, and in only four of thirteen that had a Type-IV deformity.
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PMID:Sequelae and reconstruction after septic arthritis of the hip in infants. 239 85

A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.
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PMID:Salmonella septic and aseptic arthritis in sickle-cell disease. A case report. 268 Feb 1

Early detection of an inflammatory process involving bone and joints is very important in children with extremity pain. We reviewed the efficacy and pitfalls of three-phase bone scans in 100 consecutive children with acute extremity pain. Sixty-one of the subjects showed abnormalities on bone scans. The sensitivity and specificity of three-phase bone scans for acute osteomyelitis were 84% and 97%, respectively. Sensitivity and specificity for both acute septic joint and cellulitis were 93% and 100%, respectively. Pitfalls in interpretation of three-phase bone scans include simulation of infection by fracture and obscuration of osteomyelitis by septic arthritis, prior antibiotic treatment, and the occasional "cold" defect due to ischemia.
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PMID:Scintigraphic evaluation of extremity pain in children: its efficacy and pitfalls. 387 40

This study was aimed at assessing the MR patterns of transient osteoporosis of the hip and, consequently, the role of MRI in the diagnosis and follow-up of this condition. Even though this condition was originally observed in pregnant women, young or middle-aged men are most frequently affected. There is a spontaneous onset of pain, usually progressing over several weeks. The patients have no risk factors for osteonecrosis; they may have a history of minor trauma and there is a possible relationship to the third trimester of pregnancy. Laboratory values are negative. Pain may be severe enough to cause the patient to limp and to impair joint function. The possible causes of transient osteoporosis have been debated by many authors and include trauma, synovitis, neurovascular dysfunction and transient or reversible ischemia. Transient osteoporosis is a self-limiting disease which does not require surgical treatment. The differential diagnosis of transient osteoporosis of the hip is very important because this condition may simulate cancer, septic arthritis, osteomyelitis or avascular necrosis. We report the initial and follow-up features of transient osteoporosis of the hip on the MR images of 6 patients (M/F = 5/1; age: 37-49 years, mean: 41.8 years). The right side was involved in 3 patients, the left side in 2 patients. The patient with bilateral transient osteoporosis was a woman in the 3rd trimester of pregnancy. In all patients, MRI was performed with an 0.5 T MR unit. The MR changes in our 6 patients were rather uniform and included heterogeneous decrease in the signal intensity of the affected bone marrow on T1-weighted images and increased signal intensity on T2-weighted and STIR images, with no evidence of focal lesions. This pattern is known as the "bone marrow edema" (BME) pattern. All the patients received conservative treatment. The clinical symptoms and the MR abnormalities regressed completely within 6-10 months, with no late sequelae. To conclude, this follow-up MR study demonstrates the transient, reversible character of transient osteoporosis of the hip. Until the natural history of the BME pattern is better understood, we suggest a conservative management of this condition, especially in the patients with no risk factors for osteonecrosis. Radiographic and MR follow-up is recommended.
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PMID:[Transient osteoporosis of the hip in magnetic resonance imaging]. 750 20

Medical records and radiographs were reviewed from 20 foals with caudal femoral condylar lesions. Osseous lesions were classified radiographically into 3 categories. Type-I lesions were characterized by a discrete area of radiolucency within the subchondral bone of the caudal aspect of a femoral condyle and were associated with septic arthritis and osteomyelitis. Type-II lesions had localized, osseous irregularities involving < 50% of the femoral condyle. Type-III lesions had widespread irregularities involving a large area of the condyle, and in 5 foals with type-III lesions, there was a thin osseous fragment displaced from the condyle and free in the femorotibial joint pouch. Foals with type-I and -III lesions were severely lame and often required assistance to stand. Foals with type-II lesions were not as lame, but lameness was evident at the trot and was exacerbated by flexion of the affected stifle. Cytologic evaluation of the synovial fluid from foals with type-I lesions was compatible with septic arthritis, whereas synovial fluid from foals with type-II and -III lesions was not septic. Surgical exploration and debridement were performed in 4 foals. Two foals with type-II lesions are currently performing athletically. The remaining 2 foals, in which surgery was performed, had type-III lesions; both of those foals were euthanatized at surgery because of the severity of the lesions. Follow-up information was available in 5 foals that did not have surgery. Two foals with type-I lesions and 1 foal with a type-III lesion were sound 1 year after diagnosis. One foal with a type-II lesion had residual lameness that prevented performance, and 1 foal with a type-III lesion was salvaged for breeding. Eleven foals were euthanatized and available for postmortem examination. Gross examination of the joints in foals with type-I lesions revealed a subchondral bone defect with intact articular cartilage in 3 of 4 foals examined. In 1 foal with a type-II lesion, a gross examination was performed, which revealed a focal indentation of the articular cartilage and on cross section had a retained cartilaginous core. Postmortem examination of 4 foals with type-III lesions revealed a large, denuded area with a shell-like cartilage fragment free within the joint. Two additional foals within this same group had marked irregularity of the articular cartilage with deep reticulation in the articular surface. In 2 of 3 foals examined with type-I lesions, histologic examination revealed suppurative osteomyelitis. The third foal in this group had changes compatible with focal ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Lesions of the caudal aspect of the femoral condyles in foals: 20 cases (1980-1990). 844 10

Avascular osteonecrosis of the femoral head (AONFH) usually goes through the four stages described by Arlet and Ficat: normal radiographs, heterogeneity and sclerosis of the femoral head, subchondral fracture with an individualized sequestrum, and secondary osteoarthritis. Arlet and Ficat individualized a specific pattern of AONFH which they called ischemic hip disease, in which cartilage damage seen as concentric joint space loss precedes the bony alterations. Although radiological and pathological studies of ischemic hip disease have been published, no clinical data are available. We report the case of a 65-year-old man admitted for a 1-month history of severe hip symptoms with concentric joint space loss but no osteophytes. Laboratory tests and examination of fluid aspirated from the hip ruled out septic arthritis and inflammatory hip disease. Two magnetic resonance imaging (MRI) studies done 1 month apart showed diffuse edema involving not only the femoral head but also the neck and trochanter, as well as major synovial hypertrophy. This atypical MRI appearance prompted synovial membrane and pertrochanteric core biopsies, which showed reactive synovitis and stage IV osteonecrosis, respectively. The pain, disability, and joint space loss worsened. Total hip arthroplasty was performed 1 month after the biopsy. Histological examination of the femoral head showed diffuse necrosis; no evidence of another condition was found on histological sections of the entire synovial membrane. This case corroborates the hypotheses put forward by Lequesne that some cases of rapidly destructive hip osteoarthritis may be ascribable to ischemia.
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PMID:Can ischemic hip disease cause rapidly destructive hip osteoarthritis? A case report. 1185 62

Sickle cell anaemia is an autosomal recessive genetic condition producing abnormal haemoglobin HbS molecules that result in stiff and sticky red blood cells leading to unpredictable episodes of microvascular occlusions. The clinical and radiological manifestations of sickle cell anaemia result from small vessel occlusion, leading to tissue ischemia/infarction and progressive end-organ damage. In this paper we discuss and illustrate the various musculoskeletal manifestations of sickle cell disease focusing primarily on marrow hyperplasia, osteomyelitis and septic arthritis, medullary and epiphyseal bone infarcts, growth defects, and soft tissue changes.
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PMID:Musculoskeletal manifestations of sickle cell anaemia: a pictorial review. 2149 Jul 66

A 72-year-old man undergoing emergency arthroscopic irrigation and debridement of the left knee joint due to pyogenic arthritis developed cauda equina syndrome after spinal anesthesia with 0.5% hyperbaric tetracaine mixed with epinephrine. Epinephrine was added to local anesthetic to prolong the duration and to increase the quality of spinal anesthesia. There was no paresthesia on needle placement. We injected anesthetics twice because the first subarachnoid injection failed. The patient experienced impaired sensation in the perineal region and alterations in bowel and urinary habits. Magnetic resonance imaging revealed spondylolisthesis and disc protrusion (L4-5), with spinal stenosis (L5-S1), but did not show suspicious lesions such as hematoma and abscess. We suggest the causative factors are temporary neural compression due to his spinal diseases and spinal cord ischemia due to decreased spinal blood flow because of epinephrine. We also cannot rule out the tetracaine neurotoxicity.
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PMID:Cauda equina syndrome after spinal anesthesia: A case report. 3062 70