Bilateral Femoral Head Necrosis Research Articles

Avascular Necrosis of Bilateral Femoral Heads in a Patient with Fabry's Disease

The underlying cause of avascular necrosis (AVN) of the femoral head is often not apparent. We report the case of a 26 year old builder with a four month history of bilateral hip pain, and a diagnosis of bilateral femoral head avascular necrosis. Fabry's disease was identified as the probable cause. Since 2001, enzyme replacement therapy for Fabry's disease has become available, with a potential to influence the disease process, and this is of potential importance to clinicians treating AVN.

Aseptic necrosis of bilateral femoral heads after pregnancy

Aseptic necrosis, also known as avascular necrosis, ischemic necrosis, and osteonecrosis, is a pathological process caused by impaired blood supply to the affected bone that results in the death of osteocytes and bone marrow cells. Osteoclastic resorption of dead bone induces demineralization, trabecular thinning, and subsequent collapse of the joint surface with fracture of subchondral bone. A clinical diagnosis is made appropriately according to the patient’s symptoms, physical findings, and imaging results compatible with this disease. The precise prevalence of avascular necrosis is unknown; but in the United States, the number of newly diagnosed patients is estimated to be 10,000 to 20,000 per year [1]. Generally, most avascular necrosis of the femoral head is because of alcoholism, steroid use, and trauma. Excessive alcohol intake and usage of prolonged high doses of glucocorticoids are reported to account for more than 90% of cases [1]; other risk factors or conditions associated with avascular necrosis include Gaucher’s disease, pancreatitis, chemotherapy, decompression sickness (Caisson disease), and blood disorders, such as sickle cell disease and polycythemia. However, little is known about whether pregnancy is an etiological factor in femoral head osteonecrosis. We report the cases of two patients with bilateral osteonecrosis of the femoral head after pregnancy after ovulation induction and include a review of the literature. A healthy 27-year-old Taiwanese woman presented with right groin pain for 1 month after giving birth to a 2.8 kg female baby by normal spontaneous delivery (Gravida 1, Para 1, Abortion 0) at 40 weeks’ gestation 6 weeks before this episode. She had been treated with clomiphene citrate to increase the chance of becoming pregnant. The patient had no history of contraceptive drug use, trauma, alcohol drinking, steroid usage, hyperlipidemia, or ovarian hyperstimulation syndrome. Her weight gain during this pregnancy was 15 kg

Clinical analysis of pediatric uveitis in 102 children

Objective To analyze the onset, clinical manifestation, causation, complications of pediatric uveitis. MethodsOne hundred and two patients with uveitis under 16 year-old were retrospectively studied. They visited the clinic in Peking University First Hospital from November 1979 to December 2008. Their age ranged from 2.5 to 16 years old, with a mcan of 11.9 years. Routine exam was carried out, including visual acuity, slit lamp, fundus, and laboratory workup. The diagnosis and classification were made by the anatomic location according to the standard of The International Uveitis Working Group. The data of disease history, age of onset, manifestation, recurrence, causation, systemic diseases, complications, and lab examination were analyzed. Results A total of 102 patients (170 eyes)with pediatric uveitis were included in this study, 68 patients (66.6%) were bilateral cases. Anterior uveitis represented in 38 patients (37.3% ), intermediate uveitis in 19 (18.6%), posterior uveitis in 10 (9.8%),and panuveitis in 35 (34.3%). The disease duration was from five days to 2.4 years, with a mean of 3.6 months. The follow-up time was two weeks to more than ten years. The first three causes of pediatric uveitis were juvenile idiopathic arthritis, Vogt-Koyanagi Harada disease, and Behcet's disease. 36 patients were found with complications, and among them 19 had complicated cataract, seven had secondary glaucoma, five had corneal band dystrophy, 12 had iris synechia (both anterior and posterior), one had retinal detachment, two had eye atrophy, and one patient with juvenile idiopathic arthritis had bilateral femoral head necrosis because of the use of steroid and hip joint was replaced. There were ten children suffering more than two complications. Conclusions Pediatric uveitis is a possible blindness disease with variety of etiology and manifestations, and tends to cause complications. Early and special attention must be taken to avoid serious consequences. Key words: Uveitis/diagnosis; Child; Disease attributes

Multiple Complications in a Sickle Cell Disease Patient: A Case Report

Summary This case report illustrates the multiple complications experienced by a sickle cell anaemia patient. Although he enjoyed fairly good health till age 16 years; he subsequently suffered grade four bilateral femoral head necrosis, cerebella infarct and cerebral atrophy from cumulative effect of repetitive vasoocclussion, recurrent overwhelming septicaemia, fixed flexion deformities and decubitous ulcer as a sequelae of earlier complications. He eventually became bed ridden. Financial constraint seriously compounded these problems. The determinants, of which type of the wide-ranging complications of SCD a particular patient will eventually develop, remain elusive.

Avascular necrosis of bilateral femoral head as a result of long-term steroid administration for radiation pneumonitis after tangential irradiation of the breast

We report a patient with avascular necrosis of the bilateral femoral head resulting from long-term steroid administration for radiation pneumonitis that occurred after tangential irradiation of the breast. The patient was a 50-year-old postmenopausal woman with breast cancer, stage IIIB (T4bN0M0) in the right C area. Following wide excision of right breast carcinoma and level III axillary lymph node dissection, whole-breast X-ray irradiation was given, at a dose of 2 Gy per fraction; the total dose was 50 Gy. On day 84 after the initiation of radiation therapy, she developed radiation pneumonitis. As the lung shadow expanded to the contralateral lung, she received steroid medication. Despite the steroid medication, the symptoms were exacerbated; therefore, she underwent steroid pulse administration with subsequent oral steroid medication. She improved immediately, but subsequently the radiation pneumonitis relapsed three times when the steroid medication was stopped. The period of medication was 423 days and the cumulative amount of steroids was 7365 mg before complete resolution occurred. In the 19 months after she stopped the steroid administration, she developed avascular necrosis (AVN) of the bilateral femoral head. This was regarded as a complication of the steroid treatment. Patients treated with long-term or high-dose steroid administration have been suggested to be at great risk of developing AVN, but this hypothesis remains controversial. The probability of AVN occurrence may be very small, but it should be considered as one of the complications of steroids, which are often used to treat radiation pneumonitis.

Long-term results after consolidation radiotherapy on residual disease < 1 cm in 106 stage III ovarian cancer patients

5039 Background: Attempts to increase survival of stage III ovarian cancer patients (pts), with macroscopic complete response at second-look laparotomy, have included prolonged chemotherapy, dose intensification, and consolidation radiotherapy. We present long term survival of 106 pts treated between 1983 and 1993 for stage III ovarian adenocarcinoma with first-look debulking, cisplatin-based chemotherapy, second-look surgery with a residual disease < 1 cm and consolidation radiotherapy. Method: Median age was 52 years (range 16–73). Residual disease after first look surgery was < 1 cm for 40,5 % of pts. Residual disease < 1 cm was obtained in all pts after second look surgery, with 33% of pts without residual disease. Radiation was performed using a linear accelerator. The whole abdomen dose was 22 Gy with antero-posterior fields and a maximal kidney dose of 20 Gy. 71 pts received a 25 Gy pelvic boost. 33 patients received an additional 12 Gy lombo-aortic boost. Results: Median follow-up was 14 years. Radiation was stopped for acute toxicity in 11 pts. Long term toxicities included radiation enteritis in 21 pts with 9 pts requiring surgery for bowel obstruction, radiation cystitis in 4 pts, acute leukemia in 2 pts, dysmyelopoiesis in 1 pt, skin cancers in the radiation field in 1 pt, bilateral femoral head necrosis in 1 pt. 4 pts died because of radiation complications. Second cancer was diagnosed in 12 pts with 7 breast adenocarcinomas, 3 colon adenocarcinoma, 1 non-small cell lung cancer, and 1 pancreatic cancer. Overall survival (OS) at 5 and 10 years was respectively 53% and 36 %. The main prognostic factor was residual disease after initial surgery, with a 10-year survival of 54 % with no or microscopic residual disease, 48 % with < 1 cm residual disease, 25 % with 1–2 cm residual disease. Conclusion: Long term survival of our patients compares favorably to those of similar patients treated in phase II studies with consolidation high-dose chemotherapy (5 year survival < 40%), at the price of high toxicity incidence (3,7 % of toxic deaths). No significant financial relationships to disclose.

Long-term results after consolidation radiotherapy on residual disease &lt; 1 cm in 106 stage III ovarian cancer patients

5039 Background: Attempts to increase survival of stage III ovarian cancer patients (pts), with macroscopic complete response at second-look laparotomy, have included prolonged chemotherapy, dose intensification, and consolidation radiotherapy. We present long term survival of 106 pts treated between 1983 and 1993 for stage III ovarian adenocarcinoma with first-look debulking, cisplatin-based chemotherapy, second-look surgery with a residual disease < 1 cm and consolidation radiotherapy. Method: Median age was 52 years (range 16–73). Residual disease after first look surgery was < 1 cm for 40,5 % of pts. Residual disease < 1 cm was obtained in all pts after second look surgery, with 33% of pts without residual disease. Radiation was performed using a linear accelerator. The whole abdomen dose was 22 Gy with antero-posterior fields and a maximal kidney dose of 20 Gy. 71 pts received a 25 Gy pelvic boost. 33 patients received an additional 12 Gy lombo-aortic boost. Results: Median follow-up was 14 years. Radiation was stopped for acute toxicity in 11 pts. Long term toxicities included radiation enteritis in 21 pts with 9 pts requiring surgery for bowel obstruction, radiation cystitis in 4 pts, acute leukemia in 2 pts, dysmyelopoiesis in 1 pt, skin cancers in the radiation field in 1 pt, bilateral femoral head necrosis in 1 pt. 4 pts died because of radiation complications. Second cancer was diagnosed in 12 pts with 7 breast adenocarcinomas, 3 colon adenocarcinoma, 1 non-small cell lung cancer, and 1 pancreatic cancer. Overall survival (OS) at 5 and 10 years was respectively 53% and 36 %. The main prognostic factor was residual disease after initial surgery, with a 10-year survival of 54 % with no or microscopic residual disease, 48 % with < 1 cm residual disease, 25 % with 1–2 cm residual disease. Conclusion: Long term survival of our patients compares favorably to those of similar patients treated in phase II studies with consolidation high-dose chemotherapy (5 year survival < 40%), at the price of high toxicity incidence (3,7 % of toxic deaths). No significant financial relationships to disclose.

Decreased Quick percentage, acquired factor X deficiency, hemarthrosis and ecchymosis: amyloidosis

A 68-year-old woman suffered from spontaneous hemarthrosis of the right elbow joint in april 1994. Cutaneous ekchymoses had been noted since summer 1993. Prothrombin time was prolonged (Quick percentage 40-50%) and was not corrected by prolonged administration of vitamin K. Coagulation studies showed isolated factor X (FX) deficiency without circulating FX inhibitor. This suggested the diagnosis of systemic amyloidosis which was retrospectively confirmed in small bowel biopsy specimens obtained one year before. Bilateral femoral head necrosis and femoral neck fracture due to amyloidosis, necessitated orthopedic surgery. The patient died four weeks postoperatively after several episodes of bleeding complications. Isolated FX deficiency may be hereditary but should--in the clinical context--also evoke the diagnosis of systemic amyloidosis. The possible bleeding tendency associated with amyloidosis is not attributable to acquired FX deficiency alone, but may also be caused by amyloid deposition in the microvasculature leading to acquired vascular hemorrhagic diathesis.

Contribution to the Diagnosis of Idiopathic Femoral Head Necrosis by Scintigraphy with 99mTc-MDP Assessed Quantitatively by Computer

The authors have studied by quantification the bone uptake of 99mTc-MDP in femoral head necrosis in order to evaluate in an objective manner conventional scintigraphy, and thus to increase the sensitiveness and efficacy of an exploration for an early diagnosis of these patients. Twenty cases of femoral necrosis have been studied, diagnosed in all cases by histopathological analysis; in twelve of them the process was unilateral and in the other eight bilateral. All explorations were carried out with 99mTc-MDP, a gamma camera and a PDP 11/40 computer for the quantitative study with the obtention of indices relating the activity between the femoral heads and, of these, to a normal vertebra. Quantification in the control group showed that the uptake of the nuclide was similar in both femoral heads and is lower than this in the vertebra. In all cases of unilateral necrosis the abnormal deviations of the indices relating the pathological head to the contralateral head and the lumbar vertebra were significant. In bilateral femoral head necrosis, an increase has been observed in all indices, although only the index relating the contralateral femoral head suspect of a lesion to vertebral activity was statistically significant. The proposed method for quantifying can be carried out easily and is very useful for diagnosing femoral necrosis since it improves the results of a subjective assessment of the scintigraphic image and can earlier detect the abnormal uptake of the lesion.

A Case Report of Idiopathic Aseptic Necrosis of Bilateral Femoral Heads and Humeral Heads

One case, male, 37 years old, suffering from pain and restriction of joint motion of bilateral hips and shoulders was reported. Roentgenograms of bilateral hips showed marked deformity of the femoral heads due to destruction of the subchondral bone matrix. Intraosseous venography showed marked retardation of venous return. Total hip replacement (W-Huggler type) was performed on the right hip with success. Left hip will be treated with W. -Huggler total hip replacement. In microscopic observation of the excised femoral head, osteoblasts, osteoclasts and foreign body giant cells were observed. The intima of arterioles in the joint capsule showed peculiar thickening, differing from atherosclerosis.