Revue du rhumatisme (English ed.)
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Clay-shoveler's fracture is a fatigue fracture of a lower cervical or upper thoracic spinous process. This occupational injury occurs primarily in workers who shovel heavy loads for long periods of time. ⋯ A review of clay-shoveler's fracture is presented. Emphasis is put on the legal aspects that can raise problems for rheumatologists, radiologists, occupational physicians and physicians performing expert evaluations of patients filing compensation claims.
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Acrodermatitis chronica atrophicans is a delayed manifestation of Lyme disease caused by a Borrelia burgdorferi subspecies, B. afzelii. Although rheumatic manifestations are rare, they can result in deformities of the fingers and toes if they are not treated promptly. ⋯ The diagnosis of acrodermatitis chronica atrophicans rests on a history of a tick bite, a suggestive skin biopsy histology and a positive Western blot for B. afzelii. A positive response to antimicrobial therapy is also required. Acrodermatitis chronica atrophicans, a common condition in central and northern Europe, can cause joint manifestations and persistent finger deformities in the absence of early treatment.
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Comparative Study
Prospective study of the prevalence of bronchiectasis in rheumatoid arthritis using high-resolution computed tomography.
A prospective study of the prevalence of bronchiectasis in rheumatoid arthritis was conducted over an 18-month period in 46 patients (34 women and 12 men with a mean age of 60.1 years) meeting 1987 American College of Rheumatology criteria for rheumatoid arthritis. All patients underwent high-resolution computed tomography of the chest, whose results were confronted with a number of clinical, laboratory test and lung function testing parameters. Bronchiectasis or bronchiolectasis was found in 23 patients (50%) and was the most common abnormality detected by high-resolution computed tomography. ⋯ Among the patients with bronchiectasis, those with respiratory symptoms (n = 10) were more likely to have a history of lung disease and those without respiratory symptoms (n = 13) were more likely to have a diagnosis of bronchiectasis secondary to rheumatoid arthritis; no other differences were found between these two subgroups. Routine use of high-resolution computed tomography, a technique capable of demonstrating silent bronchiectasis, showed that bronchiectasis was the most common lung change in rheumatoid arthritis in our study. At the time of the study, there was no evidence that presence of bronchiectasis was associated with more severe joint or lung symptoms.
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Review Case Reports
Can an osteoporotic vertebral fracture cause compression of the spinal cord or cauda equina.
A 78-year-old woman developed an osteoporotic fracture of L2 followed two months later by spinal cord compression. Imaging study findings suggested a malignancy but a biopsy showed osteonecrosis, of which there was no evidence on the imaging studies. Osteonecrosis may be the cause of neurologic compromise associated with osteoporotic vertebral fractures.