It is clear that the late clinical symptomatology and the patency of forearm arterial repairs have been contradictory. This study, during which the relationship between the symptomatology and patency has been studied, explores the influence of the local hemodynamic changes and the effect of microsurgical technique on patency rates. Thirty-five patients with a total of 44 arterial injuries were treated. Hemodynamic studies were done intraoperatively, and all patients were evaluated postoperatively with a neurologic, vascular, clinical examination and by radiodiagnostic methods. An overall patency of 77.2% was found. Color-Doppler ultrasonography (CDU) failed by 14.2% as compared with angiography, which did not fail. High blood pressure on the distal stump led to significantly reduced patency rates. Eight patients without nerve problems were found to be symptomatic as a result of the poor patency rate. Many factors are observed to influence patency rate. The nonpatent forearm artery can be symptomatic in anatomically and hemodynamically varied hands. CDU was more reliable for hemodynamic evaluation; conversely, angiography was more dependable for arterial morphology. The results of this study suggest that to correlate the clinical symptomatology and the patency rates, all arterial repairs should be assessed both clinically and radiodiagnostically.
Polyarticular joint manifestations as the predominant symptom of non-Hodgkin's lymphoma (NHL) are quite rare. In the absence of peripheral lymph node and visceral involvement, lymphomas presenting as polyarthritis create a problem for the patients as another rheumatic disease. We present a case that had been diagnosed with rheumatoid arthritis because of symmetrical articular symptoms. The patient later developed severe pain and marked swelling in her right fourth finger, and a diagnosis of septic arthritis and osteomyelitis complicating rheumatoid arthritis was assumed. The final diagnosis of NHL with synovial involvement could be made only after histopathologic examination of a biopsy specimen obtained from the amputated finger. This is the first case report demonstrating direct synovial involvement of a small joint in a patient with NHL presenting with polyarthritis. Articular and periarticular involvement of multiple joints shown by MRI in this patient suggests that direct synovial involvement may be responsible for the polyarticular symptoms in such patients.
A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis.
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