Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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We report six patients with soft tissue sarcoma mimicking traumatic hematoma. The lesions in these patients, showed huge hematomas and were characterized by rapid growth. Cytology of percutaneous; aspiration biopsy samples was performed in all six patients; however, in five patients, findings for malignant cells were negative. ⋯ We conducted a retrospective study in which we evaluated the clinical findings, the magnetic resonance (MR) images, and computed tomography (CT) scans of the soft tissue sarcomas forming huge hematomas in the lesion. MR imaging revealed the fine tumor mass with enhancement and characterized the hematoma in the lesion in a more precise fashion than did CT. We conclude that MR imaging is a suitable method for differentiating these soft tissue sarcomas from chronic traumatic hematoma.
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Malignant lymphoma is rarely found in skeletal muscle. In this article, we present two cases of malignant lymphomas that were located in skeletal muscle and caused rhabdomyolysis. One case was a primary skeletal muscle lymphoma (which is quite rare), and the other was a skeletal muscle metastasis of lymphoma. ⋯ Bone scintigraphy depicted widespread, diffuse accumulation of the radioisotope in the affected muscles of both patients, typical of rhabdomyolysis. Rhabdomyolysis may be a sequela of lymphoma, as a result of the tendency of malignant lymphoma to infiltrate diffusely into muscles, to affect multiple neighboring muscle compartments, and to metastasize into other soft tissues, as well as being a sequela of possible cytotoxic or humoral actions, all of which may increase the amount of muscle damage. When a patient presents with diffuse muscle swelling, one should consider a diagnosis of a hematogenous disease, which may cause rhabdomyolysis complicated by renal dysfunction.
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Case Reports
Calcified thoracic intervertebral disc at two levels as a cause of mid-back pain in a child: a case report.
An uncommon case of calcified disc at two levels in the thoracic spine is presented. A 12-year-old girl presented with intervertebral thoracic disc calcification from the levels D7-D8 and D11-D12. ⋯ Her symptoms were self-limiting and disappeared with bed rest, analgesics, and the use of a brace. The radiological changes were the same at 4-year follow-up, but the patient remained asymptomatic.
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We established a three-dimensional finite element method (FEM) model of the 4th and 5th vertebrae, using computed tomography (CT) images (2-mm slice thickness) of a healthy 29-year-old man. Because of the lack of specific data regarding the material characteristics of the nucleus pulposus of intervertebral discs, we used intradiscal pressure in the nucleus pulposus to establish the model. We referred to data from Nachemson and from Sato et al. regarding intradiscal pressure and to the methods of Shirazi-Adl for data for other material characteristics (see text for these references). ⋯ We also examined von Mises stress on the facet joint in normal and degenerative disc models. There was increased von Mises stress on the vertebral endplate in the anterior, center portions. von Mises stress on the annulus fibrosus increased in the posterior portion, the entrance to the neural foramen, and the exit of the neural foramen. von Mises stress was greater during flexion in the posterior portion; in particular, increasing to about 1.6 times the level seen with other postures. No changes were observed in von Mises stress on the vertebral endplates or annulus fibrosus in the degenerative disc model, but von Mises stress on the facet joints was about 2.5 times that seen in the normal disc model.
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The rat C5/6 facet joint is innervated multisegmentally from the C3 to the T3 dorsal root ganglia. Sensory fibers from the C3, C4, and C7-T3 dorsal root ganglia were reported to be innervated nonsegmentally through the paravertebral sympathetic trunks, while those from the C5 and C6 dorsal root ganglia were reported to segmentally innervate the C5/6 facet joint. The presence of calcitonin gene-related peptide-immunoreactive nerve fibers has been proved in the facet joints, but their ratios have not been studied. ⋯ Of the fluoro-gold-labeled neurons, the ratios of calcitonin gene-related peptide-immunoreactive C3, C4, C45 C6, C7, C8, T1, T2, and T3 dorsal root ganglion neurons were 30%, 22%, 43%, 47%, 21%, 19%, 25%, 36%, and 40%, respectively. The ratios of calcitonin gene-related peptide-immunoreactive neurons in the C5 and C6 dorsal root ganglia were significantly higher than those in the C3, C4, C7, and C8 dorsal root ganglia. In the physiological condition in rats, the neurons of the C5 and C6 dorsal root ganglia may have a more significant role in pain sensation of the facets than other dorsal root ganglion neurons.