Superior digestive tract side effects after prolonged treatment with NSAIDs in patients with osteoarthritis

INTRODUCTION

Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract.

PATIENTS AND METHODS

30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena.

RESULTS

The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions).

CONCLUSIONS

The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer.

Macrophage response in patients diagnosed with aseptic necrosis of the femoral head presenting different risk factors

Aseptic necrosis of the femoral head is a condition caused by partial or total interruption of blood supply to the femoral head. The diminished blood supply causes necrosis of the cellular elements and of the bone marrow, followed by the collapse of the bone structure, events that ultimately lead to the destruction of the bone tissue, the appearance of local pain and loss of function in the affected coxofemoral joint. The importance of this condition is that it mainly affects young adults aged 30-50 years, active from a socio-professional standpoint, and increased life expectancy. The material studied to achieve CD68 immunostaining was represented by bone fragments from the area of necrosis and from the adjacent areas of the femoral heads, harvested from 39 patients when performing hip arthroplasty surgery. The patients were diagnosed with aseptic necrosis of the femoral head and hospitalized in the Clinic of Orthopedics and Traumatology, Emergency County Hospital of Craiova, Romania, from June 2014 to January 2015. The 39 patients included in the study were divided into four categories according to presented risk factors (alcohol, alcohol and smoking, trauma, corticosteroids). All the 39 cases had positive immunostaining for CD68, macrophage being highlighted both in the area of necrosis and in the adjacent areas. We noted significant differences in the number and arrangement of macrophages in patients presenting different risk factors. The highest number of macrophages was present in patients presenting a risk factor corticosteroids, and the lowest number of macrophages was found in patients who had trauma as the main risk factor.

A complex assessment of patients with knee osteoarthritis and Baker's cyst: observational study

In our observational study, we performed the clinical and functional examination, analyzed imagistic and histological findings and evaluated the correlation between previous aspects in patients with primary knee osteoarthritis (PKOA) and Baker's cyst (BC). The correlations were made to better understanding of BC in patients with PKOA and optimal choosing for treatment. Seventy patients with painful PKOA (ACR criteria) and BC were assessed. We evaluated knee pain using a 100 mm VAS and functional status using the pain, stiffness and functional subscales of WOMAC index. All patients were imagistic examined (ultrasonography and MRI). Thirty-eight patients with PKOA and simple BC respond to conservative treatments. Thirty-two patients with PKOA and complex BC need surgical removal (arthroscopic decompression ± open excision in larger cysts). For these patients, it is performed histological assessment. Any medical team that manages a PKOA patient with BC may develop the treatment plan based upon not only the size of BC, symptoms and other associated conditions but also on the WOMAC scoring and complex anatomic and histological data about BC.

Pseudorheumatoid disability man with chronic tophaceous gout: a case report

Gout is a type of inflammatory arthropathy that affects the peripheral joints and results from the accumulation of monosodium urate (MSU) crystals in the synovial fluid and other tissues. This disease is the most common form of inflammatory arthritis in men over 40 years of age. The fundamental biochemical abnormality in gout is an increase in serum urate (SU) concentration. These needle-like crystals induce not only acute episodes of inflammatory process into the surrounding area, but also, in the long-term history of the disease, chronic inflammation that is associated with changes in articular and periarticular structures. The next step caused by deposited MSU crystals is represented by the tophus formation and chronic gouty synovitis. The presence of tophi has been associated with greater physical functional disability in gout patients. We presented a case of severe chronic tophaceous gout in a 48-year-old man with chronic hand arthritis and urolithiasis, to point the significance of complex assessment (clinical, functional, imagistic and histological exams) in the diagnosis of a soft tissue lesion, especially in hands.

Periarticular diffuse neurofibroma of the upper limb

The diffuse neurofibroma is an uncommon subtype of neurofibroma that has received little attention in the imaging literature. Most common in ages 10-30, in males and females, with a slight predilection for the trunk, then head and neck, then limbs. May become very large, but very rarely undergo malignant transformation. Treatment of diffuse neurofibromas (not associated with NF1) is often surgical resection. Complete resection is often difficult because of the extensive and infiltrative nature of many of these lesions. To our knowledge, the diffuse neurofibroma has been reported extremely rarely within the shoulder girdle. In this report, we presented an adult patient, without NF1 diagnosed, who developed invalidate status of left upper limb due to a giant diffuse neurofibroma involving the left brachial plexus, with a high growth diffuse pattern and plexiform architecture imagistic, grossly and without results at both surgical interventions. The diagnosed was by MRI and sonographic imaging and histopathologic examination. His immediately survival perspective was not affected but the functionality of the left upper limb was severe reduced.

A multidisciplinary approach in patients with femoral neck fracture on an osteoporotic basis

INTRODUCTION

Osteoporosis is a common affection characterized by a reduction of bone mass that affects mostly women after menopause. It currently leads to fractures, especially of the spine and hip thus enhancing the costs of medical care. There are many factors that contribute to its development, leading to various strategy lines to deal with it.

AIM

The present study aims at showing how a multidisciplinary, multifactorial approach can be effective in treating and preventing new osteoporotic fractures.

MATERIAL AND METHODS

The study included 17 patients that had replacement arthroplasty for femoral neck fractures. Bone tissue fragments were obtained from all of them and analyzed by pathology specialists. A dual-energy X-ray absorptiometry exam was also performed on each patient. In the end, the data was collected and processed by rehabilitation experts in order to establish proper therapy.

RESULTS

The hip fracture incidence was two times more frequent in women than in men, higher in the 71-80-year-old group. By analyzing the bone fragments atrophy could be seen, especially in the femoral neck as well as lamellae and osteon reduction and bone architecture alterations.

CONCLUSIONS

Surgical or pharmacological treatments alone are not sufficient for handling osteoporosis. Strategies such as preventing falls, a proper diet, treating associated conditions and a well-established exercise program need to be considered. Specialists from several areas such as pathology, orthopedics, endocrinology, internal medicine and rehabilitation should work together to design the best approach to deal with osteoporosis.

Hypothesis of microfractures by buckling theory of bone's trabeculas from vertebral bodies affected by osteoporosis

Osteoporosis has become in recent years a public health problem considered a true "silent epidemic", by increasing the number of osteoporosis fractures in the world as a result of increased number of persons 3rd group of age by increasing life expectancy and reducing physical effort and the emergence of sedentary occupations, increasing incidence of obesity, diabetes, liver disease and kidney by applying widely corticosteroid therapy. Starting from the macroscopic and microscopic aspects of the bone spongy tissue affected by osteoporosis, from vertebral bodies, we try to explain the modality of damaging the bone micro-structure by buckling phenomenon, knowing that the bone tissue has at trabecular level, an elasticity degree and supports high levels of mechanical forces.

Multiple right schwannoma

We report a case of multiple schwannoma in a 63-year-old woman, with histopathological and ultrasound analyses, treated by surgical resection. Our patient presented two masses of ulnar nerve and one mass of superficial fibular nerve, both in the right side of the body. All tumors were encapsulated and the microscopic aspects were represented through two tissue types, cellular tissue (Antoni A) with areas of nuclear palisading (Verocay bodies) and more myxoid, less cellular tissue (Antoni B). A careful clinical examination usually determines the level of involvement without identifying the exact pathology. The tumors were easy to remove without affecting the nerves. Surgical exploration is necessary both as a diagnostic and therapeutic procedure. By presenting this case we wanted to emphasize that presence of schwannoma tumors in the peripheral nerves--ulnar and superficial fibular, and suggest a schwannomatosis case--a rare form of neurofibromatosis (a genetic disorder growths of Schwann cells and other cells that support peripheral nerves), that has only recently been recognized.

[Dextrocardia of post right pneumonectomy]

The negative pressure achieved in the hemi thorax in the case of lung pneumonectomy has consequences on the mediastinum organ statics. This condition results through the other lung expansion. These changes are common, but rare in adult lung pneumonectomy. In the case of right lung pneumonectomy, the mediastinum moves to the operated part and disturbs the function of the vessels and cavities with thin wall or low pressure (vena cava, right atrium). These aspects are not observed in the case of left lung pneumonectomy. Taking this into consideration the authors present the case of a young woman with right lung pneumonectomy, an intervention made in childhood, at ten years old. After sixteen years of evolution a serious mediastinum re-shuffle was discovered, the heart was moved in the right hemi thorax, with a dextrocardia like aspect. This case is interesting because it raises positive and differential diagnosis problems--dextrocardia, associated disorders, serious complications.