Biomedical subjects
Publications and source records attributed to J C Gerster.
Two old patients with a rapid destructive arthropathy of the hip with osteolysis of the femoral head are presented. X-Rays show chondrocalcinosis. The other common causes of destructive arthropathy have been dismissed. Although the exact mechanism of osteolysis remains unclear, chondrocalcinosis might be involved in the destructive process.
OBJECTIVE: To evaluate the utility of computed tomography (CT) of the knee joint for detecting intraarticular tophaceous deposits. METHODS: A prospective study of 16 patients with gout affecting the knee was conducted. A condition for inclusion in the study was the presence of needle-shaped crystals with negative birefringence in the knee joint synovial fluid. Conventional radiography and CT were performed in each case. RESULTS: Intraarticular opacities in the capsule and the synovium, consistent with the presence of tophaceous deposits, were found in 5 of the 16 patients (9 knee joints). The mean duration of gout was longer in the patients with intraarticular tophi than in those without tophi, and 2 of the patients with tophi had poor tolerance to antihyperuricemic therapy. CONCLUSION: Intraarticular opacities considered to represent tophi were observed in approximately one-third of the patients. The presence of tophi correlated with a longer duration of the disease and a poor tolerance to medication. We therefore suggest that CT of the knees could be useful in the assessment and followup of certain patients with gout.
OBJECTIVE: To establish if computed tomography (CT) imaging, which has proved helpful in detecting intra-articular tophi in gout, can also be used to document gouty enthesopathy and tendinopathy. METHODS: Three patients with tophaceous gout and clinical involvement of the Achilles tendon (two cases) or patellar tendon (one case) were assessed with CT examination and plain radiographs. RESULTS: In the first two cases, CT images revealed linear or nodular high attenuation opacities within the substance of the Achilles tendons and their calcaneal insertion. In case 3, dense linear opacities were seen within the patellar tendon and within its tibial insertion. No such opacities of the tendons and entheses were seen on standard radiographs of these patients. CONCLUSIONS: CT appears to be the imaging method of choice for demonstrating monosodium urate deposits in entheses and tendons in tophaceous gout.
Among 4620 synovial fluid specimens examined in our laboratory from 1989 through 1992, 18.3% contained crystals (calcium pyrophosphate dihydrate, 55.7%; monosodium urate, 42%). Both calcium pyrophosphate dihydrate and monosodium urate crystals were found in 17 patients, usually in specimens obtained from the knee. Only five of these 17 patients had a known history of gout. Among the patients with a mixed crystal composition, the females had a higher mean age (78.5 years) than the males (53.2 years), in keeping with the fact that gout is exceedingly rare in premenopausal women. The two youngest men (40 and 45 years) had a history of meniscectomy, which is a known risk factor for early chondrocalcinosis.
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We describe the case of a 40-year-old-woman with an acute arthritis of the left shoulder. Synovial fluid aspirated from the joint cavity appeared purulent but contained few leucocytes and no birefringent crystals. It was, however, rich in apatite crystals. A communication between the subacromial bursa and the gleno-humeral cavity through the rotator cuff could be demonstrated by sonography. The acute arthritis was secondary to the intra-articular rupture of a peri-articular calcification.
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We describe the case of a 5-year-old boy who presented with parvovirus B19 associated arthritis of the left knee lasting for 6 weeks. Other features included flu-like symptoms, a mild "slapped cheek" sign, and a macular, erythematous, lace-like rash over the chest and limbs. The analysis of the synovial fluid showed a high white cell count with a predominance of polymorphonuclear cells. The characteristic features related to parvovirus B19 associated arthropathy in children are reviewed.
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Edematous benign polyarthritis of the elderly (syndrome of remitting seronegative synovitis with pitting edema) affects Caucasians aged over 60, predominantly males. The symptoms involve constant edema of the hands and often of the feet, with pain and muscular weakness. These symmetric edemas are accompanied by arthritis of the extremities and the large joints. The onset of the syndrome is acute, ranging from some days to a few weeks, characterized by inflammation but no rheumatoid factor. Treatment is similar to that of the classic form of rheumatoid arthritis. The evolution, however, is always favorable within a year, without subsequent sequelae. The etiology remains undetermined.
Acute periarthritis is a typical example of apatite arthropathy related to intratendinous calcifications. The attack may be followed by virtually complete radiological disappearance of the calcification. Within the joint one may exceptionally demonstrate the presence of hydroxyapatite crystals in the synovial fluid during a fluxional flare-up of arthrosis or in the fluid withdrawn from the humeral joint following rupture of calcification in the glenohumeral cavity. More frequently, the crystals are detected in the synovial fluid from joints damaged by advanced destructive arthrosis. These crystals are sometimes associated with calcium pyrophosphate crystals (mixed pyrophosphatic and apatitic arthropathy).
Skin pigmentation changes in systemic sclerosis have been known since the end of the last century. Many different aspects have been described. We report the case of a 48-year-old man with severe progressive systemic sclerosis who presented many different types of pigmentation changes of skin, but particularly a severe hyperpigmentation. This clinical observation suggests that local factors, including repetitive friction, trauma or variations in skin temperature, may influence the development, distribution and severity of pigmentation abnormalities in patients with systemic sclerosis. Physical treatments (connective tissue massage and lymphatic drainage) were very beneficial for our patient (healing of skin ulcerations and decrease of pigmentation.