Soft Tissue Swelling Research Articles

Effect of Compressive Shoulder Draping With Adhesive Incise Drape on Soft Tissue Swelling in Shoulder Arthroscopy: A Prospective Randomized Trial.

Soft tissue swelling in shoulder arthroscopy is common and may lead to complications. Measures aimed at reducing this phenomenon are routinely used with limited efficacy. The purpose of the study was to assess (1) soft tissue swelling of the shoulder (the operated site) and (2) soft tissue swelling of the neck, chest, and arm (the surrounding tissue) in patients with versus without compressive draping during shoulder arthroscopy. It was hypothesized that compressive draping of the shoulder with adhesive incise drape would reduce soft tissue swelling during shoulder arthroscopy. Randomized controlled trial; Level of evidence, 1. A total of 50 patients undergoing arthroscopic rotator cuff repair were prospectively randomized to either the study group (in which the shoulder was draped with adhesive incise drape tightened around the shoulder) or the control group (in which a standard shoulder arthroscopy drape was used). The circumferences of the shoulder, arm, chest, and neck were measured preoperatively and postoperatively and compared between the groups. The shoulder circumference in the standard draping group increased by 16% during the procedure (from 21.2 ± 1.5 cm preoperatively to 24.5 ± 1.7 cm postoperatively) compared with only 6% in the compressive draping group (from 21.0 ± 1.3 cm preoperatively to 22.3 ± 1.1 cm postoperatively) (P < .01). No serious postoperative complications were observed in either group. Compressive shoulder draping with adhesive incise drape was effective in reducing soft tissue swelling around the shoulder in arthroscopic rotator cuff repair compared with standard arthroscopic draping and was not associated with any adverse reactions. NCT03216590 (ClinicalTrials.gov identifier).

Transdermal delivery and exploration of preclinical anti-rheumatoid efficacy of pirfenidone embedded nanoemulgel in adjuvant-induced rat model

To avoid adverse effects associated with non-site-specific delivery and target major signaling pathways responsible for the inflammation in rheumatoid arthritis, the current study aims to formulate and evaluate the transdermally administered potential of pirfenidone nanoemulgel in rheumatoid arthritis. The pirfenidone was initially loaded into nanoemulsion by spontaneous nanoemulsification method. The optimized pirfenidone-loaded nanoemulsion diluted with distilled water has shown a droplet size of 9.46 ± 0.01 nm with uniform size distribution evaluated by photon correlation spectroscopy. The optimized pirfenidone nanoemulsion was converted into gel formulation by adding SEPINEO™ P600 gel base with the help of magnetic stirring. The optimized pirfenidone-loaded nanoemulgel has shown a viscosity of 769 ± 05 Pa s with an antigravity nature. Ex vivo permeation study of pirfenidone nanoemulgel in BALB/c mice skin resulted in 1.7 times higher permeation of pirfenidone than free pirfenidone loaded gel. The preclinical efficacy of pirfenidone-loaded nanoemulgel has shown promising results in the rheumatoid arthritis-induced rat model. The right hind paw thickness (##p < 0.01) and arthritis severity score (####p < 0.0001) in pirfenidone nanoemulgel treated group resulted in significant reduction than negative control on 25th day of study. The spleen (****p < 0.0001) and liver indices (**p < 0.01) in rat group treated with pirfenidone nanoemulgel were found to be significantly reduced than negative control. The serum levels of IL-1β (***p < 0.001) and IL-6 (**p < 0.01) were significantly decreased in the pirfenidone nanoemulgel treated group compared to negative control evaluated using enzyme linked immunosorbent assay. The radiographic images of pirfenidone nanoemulgel treated group showed reduction in swelling of soft tissue and bone erosion than negative control. The examination of the hind paw showed improved condition of paw joint with increased synovial space, reduction in the cellular infiltrates and decrease in the swelling of the joints in the pirfenidone nanoemulgel treated group.

Comparison Between High- Resolution Ultrasonography and Conventional Radiography in the Diagnosis of Nasal Bone Fractures

Objectives to describe the diagnostic findings of ultrasonography in nasal bones fractures and to determine the validity of classical clinical practice assisted by radiography in the diagnosis of nasal bone fractures and compared it to the value of ultrasonograp-hy. A total sample of 53 patients (11 females and 42 males) at age range (14-40) years, with a differential diagnosis of nasal fracture based on history of nasal trauma and physical signs and symptoms of nasal bone fracture. All subjects had a true lateral soft tissue profile view of the face and high resolution ultrasonography in addition 8 patients had an occipitomental view based on physician request. The radiographs and ultrasound images of each subjects were analyzed and reports were recorded as either “positive” or “negative” according to the existence of nasal bone fracture with other details about the fracture if present (number of the fracture lines detected, the type of the fracture, its location and assessment of the soft tissue swelling and hematoma). The results were analyzed by various statistical testing methods (for sensitivity, specificity, positive and neg ative predictive value, and accuracy). The sensitivity to est ablished clinical diagnosis (based on crepitation and mobility ) in diagnosis of nasal bone fracture was 76.6% (23.4% false – v e rate). This figure is increased to 89.4% (10.6% false – ve rat e) when clinical decision is aided by radiography. Such a practice however is associated with low specificity (33.3%). Usi ng ultrasonography will increase both sensitivity and specificity to 100%. The conclusion of this study is the ultrasonography in diagnosis of nasal bone fracture is superior to radiography and it is recommended to shift the classical clinical approach from radiography to ultrasonog raphy in this context.

Hypertrophic osteopathy in a dog associated with chronic lung lobe torsion

AbstractA 6‐year‐old, male, neutered, crossbreed dog was presented with a history of lethargy, chronic cough, right thoracic limb lameness, bilateral distal thoracic limb swelling and non‐healing skin wounds. Computed tomography showed bilateral forelimb irregular periosteal reaction and chronic right cranial lung lobe torsion, with secondary bronchiectasis. The affected lung lobe was surgically excised, the right radius was biopsied, and postoperative antimicrobial therapy was prescribed. Histopathology and bacterial culture confirmed chronic lung lobe torsion, associated bacterial bronchopneumonia, and right radial hypertrophic osteopathy. Two months after starting treatment, the respiratory signs resolved and the soft tissue swelling and lameness markedly improved. To the authors’ knowledge, this is the first case report describing hypertrophic osteopathy suspected secondary to chronic lung lobe torsion in a dog.

Phalangeal microgeodic syndrome: a paediatric case series.

We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1years, ranging from 10.4 to 16.6years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.

Prevalence of radiographic findings in chronic osteomyelitis

BackgroundSimple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO.MethodsThis cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling.ResultsMost patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement.ConclusionsRadiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.

O-07 Lipodystrophy: A disease to be considered in diabetes clinics

Abstract Introduction Lipodystrophy syndromes are disorders with no adipose tissue. Lipodystrophy is classified based on the degree of adipose tissue deficiency, distinguishing between partial and generalized forms, and considering if it is inherited or acquired. The condition is characterized by ectopic steatosis, severe dyslipidemia, insulin resistance, and severe comorbidities including uncontrolled diabetes mellitus (DM), acute pancreatitis, hepatic cirrhosis, proteinuria, renal failure, and premature cardiovascular disease. Congenital Generalized Lipodystrophy (CGL, Berardinelli-Seip Syndrome) is inherited autosomal recessively. Four genetic mutations linked to CGL have been identified: AGPAT2, BSCL2, CAV1, and PTRF. This report describes a case of a patient with uncontrolled diabetes and other health conditions. The patient was diagnosed with CGL2 as an adult after admission to our facility. Clinical Case This case involves a 43-year-old female patient seeking help for glycemic control and menstrual cycle irregularities. She was diagnosed with DM at 24 and received care at multiple hospitals. Her mother, older brother, and three sisters were diagnosed with DM before the age of 40. Her BMI was 23.4 kg/m2. The physical examination revealed muscularly prominent lipoatrophy in the upper and lower limbs and acanthosis nigricans in the axilla. Additionally, the person had facial features resembling acromegaly, with enlarged extremities and swelling of soft tissues. Blood pressure was regulated with ramipril, hydrochlorothiazide, and amlodipine. She had used various insulin and OAD regimens in the past. Despite this, euglycemia was challenging to achieve, and she frequently needed to be hospitalized for diabetic ketoacidosis. Anti-glutamic acid decarboxylase, anti-insulin, and islet antibodies were negative. HbA1c level was 13.3% and C-peptide level was 2.5 ng/ml. Moreover, grade 3 hepatosteatosis and hypertriglyceridemia were present. Polyneuropathy and diabetic nephropathy were also identified. Acromegaly and cushing syndrome were excluded. After excluding acquired lipodystrophy syndromes, she was consulted to the genetics department for CGL. Next-gen sequencing found a homozygous missense mutation (c.666G&amp;gt;C; p.Met222Ile) in exon 5 of the BSCL2 gene. Following this result, the patient was diagnosed as CGL2. Caloric and fat restricted dietary was recommended. Fat intake was below 20-30% of total energy. The patient was treated with insulin aspart, glargine U300/mL, metformin, alpha lipoic acid, and fenofibrate. The patient's blood glucose was more regulated, did not apply to the emergency department. Family members were also given genetic counseling. Conclusion Lipodystrophy is rare however medical professionals must exercise caution and consider lipodystrophy as a possible diagnosis for non-obese individuals who have difficulty maintaining euglycemia, fatty liver disease, and elevated triglyceride levels. The physical examination is crucial for diagnosis.

Arthroscopically assisted closed reduction for displaced lateral humeral condyle fractures over 4 mm in children

IntroductionLateral humeral condyle fractures (LHCFs) are the most common intra-articular fracture occurring at the elbow in children. Conventional treatment for displaced pediatric LHCFs is open reduction and percutaneous pinning, and few studies have regarded the efficacy of arthroscopic-assisted techniques. We aimed to evaluate the efficacy of anatomic reduction via elbow arthroscopy for pediatric humeral lateral condyle fractures with displacements >4 mm. MethodsA total of 32 children with LHCFs featuring displacements >4 mm were enrolled in this retrospective study. Arthroscopically assisted reduction was performed as the primary treatment approach. For simple displaced fractures, arthroscopically assisted reduction was directly employed with intermittent intra-articular irrigation. For fractures with distal fragment rotation, the rotated fragments were firstly realigned into a simple displaced position under fluoroscopy before proceeding with arthroscopy. The success rate of arthroscopically assisted reduction and clinical outcomes at the latest follow-up were assessed, and complications related to the procedure were monitored. ResultsTwenty-nine of 32 (90.62 %) enrolled cases were successfully treated with arthroscopically assisted reduction. Failure cases were attributed to soft tissue swelling, which hindered the manipulation of the fracture fragments for reduction or fixation. We subsequently adapted the surgical procedure, resulting in a significant increase in the success of arthroscopically assisted reduction, rising from 71.43 % to 96 %. Among the 29 successfully treated cases, excellent functional outcomes were observed in 18 cases, and 11 cases showed good outcomes. Regarding the carrying angle outcomes, 28 patients achieved excellent results, with one patient having a good outcome. The most frequent radiographic finding after surgery was lateral spur formation without further negative effects. Only one case of superficial infection occurred, promptly healing with topical management. No significant complications such as neurovascular injury or compartment syndrome were observed. ConclusionArthroscopically assisted anatomic reduction provides a promising alternative to open reduction for LHCFs with displacements exceeding 4 mm, offering direct visualization of the articular surface and minimizing soft tissue dissection.

Design and development of an herbal anti-arthritic gel incorporating Alstonia scholaris latex

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease leading to bone and joint damage. The current study reports the development of an herbal anti-arthritic gel formulation incorporating the latex of Alstonia scholaris (AS). Six batches of topical herbal gels (G1-G6) were formulated by dispersion method using different concentrations of AS latex (0.5 % to 3.0 % w/w) in Carbopol 934 (1.5% w/w) gel base. The gels were evaluated for various physicochemical properties using standard methods and G4 was selected as an optimized formulation based on the desirable properties of a topical gel. The in vivo anti-arthritic potential of G4 was evaluated using a complete Freund’s adjuvant (CFA)-induced arthritic rat (Sprague Dawley) model for 28 days. Assessment of various arthritic parameters including hematological and biochemical parameters and radiography of hind legs in arthritic rats was carried out. The developed herbal gels were found to be uniform and stable. The G4 gel formulation showed a maximum drug release of 95.22% following Higuchi kinetic model. The topical application of G4 gel exhibited significant (p<0.05) anti-arthritic activity compared to diseased rats. The herbal gel G4 effectively restored the arthritic, hematological and biochemical parameters in arthritic rats. Radiographic analysis demonstrated its ability to reduce soft tissue swelling and thus prevented bone degeneration and the narrowing of joint spaces. These results supported that the developed herbal gel may offer a novel therapeutic approach in the treatment of RA with fewer side effects, good patient compliance, high efficacy, and low cost.

Lymphoblastic lymphoma presenting as soft-tissue swelling – A single-center experience

Abstract: BACKGROUND: Lymphoblastic lymphomas (LBL) are a rare, aggressive type of non-Hodgkin lymphomas and constitute 2% of all lymphomas. It is classified as T-lymphoblastic lymphoma (T-LBL) and B lymphoblastic lymphoma (B-LBL) and resembles acute lymphoblastic leukemia (ALL), with no or limited bone-marrow involvement. LBL rarely present as soft-tissue swellings. Soft-tissue involvement is more common in B-LBL than in T-LBL. They occur predominantly in adolescents and young adults and have a prognosis similar to ALL. OBJECTIVE: p&gt;The aim was to study the clinical characteristics, treatment response, and survival of patients with lymphoblastic lymphoma presenting with soft-tissue swelling. SETTINGS AND DESIGN: This was a retrospective study of eight adolescent and adult patients with lymphoblastic lymphoma presenting with soft-tissue swelling conducted in the Department of Medical Oncology at a tertiary cancer center in India. STATISTICAL ANALYSIS: The baseline patient characteristics, treatment details, and response assessment were analyzed using descriptive statistics. Overall survival (OS) and progression-free survival were obtained by the Kaplan–Meier method, using the SPSS version. 11. MATERIALS AND METHODS: We present the clinical features, imaging, diagnosis, treatment, and outcome of eight cases of lymphoblastic lymphoma presenting with soft-tissue swellings. Patients above 14 years of age treated over 12 years were included in the study. RESULTS: There were five males and three females. The median age at diagnosis was 24 years. Common presenting complaints were swelling, pain, and paraparesis. The sites of involvement were the epidural mass, thigh, calf, breast, and anterior chest wall. The diagnosis was confirmed by immunohistochemistry. Seven patients were diagnosed with B-LBL and one with T-LBL. They were treated with intensive chemotherapy (six patients with Berlin–Frankfurt–Munster protocol and two with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Three patients received consolidation radiotherapy and one received palliative radiotherapy. Seven patients attained remission after induction chemotherapy and four of them are currently alive at a median follow-up of 48 months. The 2-year OS was 71.4%. CONCLUSION: Even though rare, lymphoblastic lymphoma should be considered a differential diagnosis in patients presenting with soft-tissue swelling and should be managed with systemic chemotherapy similar to ALL.

Гистиоцитоз из клеток Лангерганса у детей

Langerhans cell histiocytosis (LCH) is a pathology rarely encountered in clinical practice. This disease has a multifaceted clinical picture, multiorgan damage, a varied course and presents significant diagnostic difficulties due to the lack of generally accepted international algorithms. In the early stages of the disease, patients turn to pediatricians, traumatologists or dermatologists, which leads to frequent diagnostic errors and inadequate therapy. Doctors of various specialties should pay attention to patients with soft tissue swellings, recurrent otitis and dermatitis in the absence of effect from the therapy and promptly refer them to an oncologist. The article presents an analysis of cases of Langerhans cell histiocytosis in children of the Oncohematology Department of the Children’s Republican Clinical Hospital in Kazan over a ten-year period, indicating the characteristic initial features of the disease for early diagnosis at the outpatient stage.

Presumed concurrent medial coronoid process fracture is a frequent radiographic finding in dogs and cats with humeral condylar fractures.

To report the prevalence of presumed concurrent medial coronoid process fractures in a series of cases of humeral condylar fractures and evaluate factors influencing the presence of a suspected fracture of the medial coronoid process. 48 dogs and 7 cats, with a total of 57 humeral fractures. Medical records of dogs and cats diagnosed with a humeral condylar fracture with radiographs were reviewed between October 2013 and March 2022. Species, sex, neutered status, age, weight, and the nature of the trauma were noted. Radiographs were assessed for the configuration of humeral condylar fracture, the presence of a suspected fractured medial coronoid process (MCP), number of MCP fragments, nature of fracture, degree of radioulnar incongruity, soft tissue swelling, and elbow luxation/subluxation. A presumed fracture of the MCP was seen in 26 of 57 cases. Comminution of the condylar fracture was the only parameter that had a positive effect on the presence of a possible fractured MCP. Body weight was significantly associated with size of the suspected fractured MCP. The presence of this fracture was not associated with the type of humeral condylar fracture. The size of the presumed fractured MCP fragment was positively correlated with body weight. There was a high prevalence of presumed fractured MCPs in dogs with humeral condylar fractures (almost 50%) and even more so in animals with comminuted fractures. The consequences of suspected fractured MCP associated with humeral condylar fractures and whether dogs and cats would benefit from removal of the fragment remain unknown.

Evaluation of hand infections in the emergency department using point-of-care ultrasound.

We aimed to evaluate the utility of point-of-care ultrasound (POCUS) in the assessment of hand infections that present to the emergency department (ED) and its impact on medical decision making and patient management. We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections (SSTI) of the hand between December 2015 and December 2021. Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand. We then reviewed patients' electronic health records (EHR) for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, consultations, impact of POCUS on patient care and final disposition. We included a total of 50 cases (28 male, 22 female) in the final analysis. The most common presenting symptoms and exam findings were pain (100%), swelling (90%), and erythema (74%). The most common sonographic findings were edema (76%), soft tissue swelling (78%), and fluid surrounding the tendon (57%). POCUS was used in medical decision making 68% of the time (n=34), with the use of POCUS leading to changes in management 38% of the time (n=19). POCUS use led to early antibiotic use (11/19), early consultation (10/19), and led to the performance of a required procedure (8/19). The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times, abscess 12/16 times, and cellulitis 14/20 times. POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

Extra-Lymphatic Filariasis: A Study of Three Interesting Cases

Filariasis is a chronic disabling parasitic disease that causes a major public health problem in tropical countries like India. Wuchereria bancrofti is associated with almost 99.4% of cases. Filariasis not only affects the structure and function of lymphatic vessels but is also associated with extra-lymphatic pathology and diseases. Lymphatic filariasis is commonly found throughout the tropics and subtropics. While lymph nodes are the common sites, unusual sites include the breast, spleen, subcutaneous tissue, thyroid, bone marrow, urinary tract, sputum, bronchial washing, pleural and pericardial fluid. Patients from endemic areas presenting with swelling should be evaluated for filariasis. Here in present case series, the authors discussed three cases: filariasis of the breast with fibroadenoma, soft-tissue nodule, and splenic lesions, due to their extreme rarity and unusual sites. In the first case, 20 years old female patient presented with a lump in the left breast. The complete blood cell (CBC) revealed eosinophilia, but peripheral smears did not show the presence of microfilariae. On Fine Needle Aspiration Cytology (FNAC), smears showed Wuchereria bancrofti microfilaria in the background of fibroadenoma. The patient was treated with Diethylcarbamazine (DEC) for 21 days. Repeat CBC revealed a decrease in the absolute eosinophil count. Lumpectomy for fibroadenoma was performed, which showed fragments (dead) of the microfilarial parasite. The association of filariasis with fibroadenoma is possibly due to pre-existing subclinical filariasis when the neoplasm developed, as the patient hails from an endemic area. Filariasis presenting as a soft-tissue nodule is an uncommon incidence. In the second case discussed here, 30 years old female patient had soft-tissue swelling over the left elbow. Peripheral smear only revealed eosinophilia without any parasites. On FNAC, smears showed Wuchereria bancrofti microfilaria, along with lymphoid cells and a few eosinophils. The swelling subsided with DEC treatment, and repeat CBC showed a decrease in the absolute eosinophil count. The third case discussed here, involved an unknown 35 years old male, who was brought dead to the hospital. No clinical details were available. On autopsy, the spleen showed multiple white patches, ranging in size from 0.2 to 0.5 cm in diameter. All other organs were unremarkable. Microscopy showed many granulomas and numerous dead fragmented microfilariae. It was a case of isolated splenic filariasis, which is a rarely diagnosed entity. These unique cases will raise awareness of diagnosing and instituting proper therapy.

Influence of magnetotherapy on various systems of the body and on the process of wound healing in children with cleft lip and palate

In this article we present the results of magnetic therapy on the wound healing process in children with cleft lip and palate after cheiloplasty surgery. At the same time, there is an improvement in metabolic processes in tissues, which contributes to their proper nutrition and restoration.Inflammation and associated soft tissue swelling are eliminated. Locally, blood vessels dilate and blood supply improves. The pain is relieved.Magnetotherapy is a method of physiotherapy that uses magnetic fields of varying strengths and frequencies for the treatment, rehabilitation or prevention of diseases. To carry it out, stationary and portable devices have been developed. The principle is simple: one or more electromagnetic applicators are installed on certain areas of the body, or the patient is placed in a large-diameter magnetic chamber or on a special mattress. The method is based on the fact that a magnetic field affects electrically charged particles moving in the human body. They are found in biological fluids - blood, lymph, cytoplasm of cells. Under the influence of a magnet, weak electric currents arise in these environments. They cause many responses: metabolism, blood properties, the speed of transmission of nerve impulses change, microcirculation and the delivery of oxygen and micronutrients improve. This leads to the following effects: reduction of tissue swelling, suppression of the inflammatory process, local anesthesia, reduction of blood viscosity, normalization of blood pressure, acceleration of healing and tissue restoration, stimulation of the immune system.

Desmoplastic Fibroma: a benign neoplasm mimicking a malignancy

A four-year-old African male patient presented to our clinic with a two-month history of a fi rm, warm lesion involving the right side of his face. The lesion presented as a bleeding papillary mass in the 85/46 region that extended to the floor of the mouth, causing displacement of the tongue (Figure 1A-B). Upon cone-beam computed tomography (CBCT) examination, an expansile homogenous intermediate density lesion was noted with complete destruction of the bucco-lingual cortical bone. Discernible extensions were identified in the anteroposterior plane from the region of the 84 to the posterior mandible involving the right corpus, developing 46, angle and ramus but spared the condyle and coronoid processes. The lesion extended inferiorly below the epiglottis and showed a reduction of the hypopharynx. Marked bucco-lingual expansion with soft tissue swelling was noted (Figure 2A-D). An incisional biopsy was performed under general anaesthesia, and histological examination rendered a diagnosis of desmoplastic fi broma (DF).

Pott’s puffy tumor a subdurální absces jako komplikace akutní rinosinusitidy – kazuistika

Summary Rhinogenic inflammatory intracranial complications are relatively rare, but they are very serious and can be fatal. The diagnosis is mainly based on anamnesis, objective examination, imaging methods and laboratory findings. Our case study is devoted to an intracranial complication of sinusitis of a 17-year-old patient. It was a subperiosteal abscess with simultaneous subdural abscess in the frontal region and osteomyelitis of the frontal bone. The patient came to the otorhinolaryngology clinic at Jičín Regional Hospital with prolonged rhinosinusitis, after already receiving primary therapy of oral aminopenicillin with a temporary effect. An objective examination revealed slight swelling in the area of the root of the nose and eyelids, rhinoendoscopic swelling of the mucous membranes with mucopurulent secretion in the middle nasal passage on the left. The original suspicion of an orbital complication of rhinosinusitis was ruled out by a CT scan. The patient was hospitalized and treated with intravenous antibiotics, corticoids and the nasal cavity was treated locally and the inflammatory parameters decreased gradually. During hospitalization, swelling of soft tissues progressed frontally, without neurological symptoms. Due to the suspicion that there was an intracranial complication of rhinosinusitis, a CT scan of the paranasal sinuses and brain was performed. The radiologist diagnosed subdural empyema and osteomyelitis of the frontal bones. An acute transfer to the neurosurgery clinic of the University Hospital in Hradec Králové for intravenous antibiotic therapy and surgical intervention by a neurosurgeon and otorhinolaryngologist was arranged. Postoperative healing was favourable. Key worlds paranasal sinuses – sinusitis – subdural abscess – osteomyelitis

Role of fine needle aspiration cytology (FNAC) in head and neck lesions in coastal population at a tertiary care hospital – A study of 500 cases

Head and neck swellings are a very common presentation encountered by clinicians and patients across all age groups. Various lesions give rise to head and neck lumps. Swellings can arise from soft tissues, lymph nodes, thyroid gland, salivary glands etc. FNAC being minimally invasive, quick and inexpensive helps in differential diagnosis of head and neck masses.A retrospective study was conducted at Karwar institute of medical sciences Karwar from January 2018 to December 2021 in coastal population, to evaluate the role of FNAC in palpable head and neck masses and also to study their distribution and To evaluate the diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing Head and neck lesions and cyto-histopathological correlation (wherever possible). 500 patients with head and neck swelling underwent FNAC. FNAC diagnosis was correlated with detailed clinical history and investigations. Out of 500 fine needle aspiration procedures 35.6% (178) were of lymph node, 33.8% (169) were of thyroid, 9.6% from salivary gland (48), 17.8% (89) from skin and soft tissue swellings and 3.2% (16) inconclusive. The present study concluded that most of the swellings in head and neck region are benign and affect females more than males. Overall accuracy rate more than 90% and diagnostic accuracy in differentiating non-neoplastic lesions from neoplastic lesions is well established. Our study found that fine needle aspiration cytology to be an easy, safe, rapid, convenient, least invasive, accurate and relatively complication-free outpatient method for diagnosis of lesions of the head and neck

Chronic tophaceous gout – A case report

Gout is an inflammatory arthritis associated with functional impairment and impact on quality of life. It arises when the tissues are supersaturated with urate leading to the formation of mono sodium urate crystals in and around the joints. This causes an inflammatory cascade resulting in secretion of several proinflammatory cytokines and neutrophil recruitment into the joint.A 60 years old male patient presented with complaints of swelling in the posterior aspect of left elbow since 2 years and pain since 15 days. Examination revealed soft tissue swellings in multiple joints including metatarsophalangeal joint. Renal function tests show increased Uric acid (8.6mg/dl). On Gross examination, we received fibrofatty mass measuring 3.5x1.5x1 cm. Cut-section showed white flakes ? Calcifications. On microscopy, sections studied show fibrocollagenous tissue with several tophi made up of pink eosinophilic material surrounded by foreign body giant cell reaction and lymphocytes. There are several cystic spaces filled with calcareous debris.Hyperuricemia is the key risk factor for gout and is considered prerequisite for mono sodium urate crystal formation. Urate under excretion through kidney is the major mechanism for hyperuricemia. Tophus formation is the cardinal feature of advanced gout.

EROSIVE TEMPOROMANDIBULAR JOINT DISORDER IN A PATIENT WITH ULCERATIVE COLITIS: RAREMANIFESTATION OF ARTHROPATHIES, CASE REPORT

Temporomandibular Joint (TMJ) involvement in patients with ulcerative colitis (UC) is a rare manifestation. To the best of our knowledge there are only two cases in the literature reported the presence of TMJ involvement in a patient with UC. We report a case of 23-year-old female with a two-year history of UC she was complaining of unilateral temporomandibular jaw pain, the pain was severe enough to affect her daily activities, she was not able to speak and there was a limitation of mouth opening. The patient was only able to open her mouth for 2.5 cm. C-reactive protein and erythrocyte sedimentation rate were high, rheumatoid factor was negative. The computed tomography (CT) of the mandible and teeth reveals flattening with erosion of the condylar process of the left mandibular joint without the presence of joint effusion or soft tissue swelling. Our patient was managed by biological treatment Ustekinumab for 6 months, as a result the patient improved and she was able to open her mouth up to 4 cm. Clinicians should be aware of the importance of biological treatment in these circumstances, TMJ arthritis in UC patients is considered a rare and unusual picture of extraintesinal IBD manfistations.