years respectively, accrdcntally in'llalli(f Freon 12'gas which had leaked from Ifn'Air t:onditioning'systenl of B ship. The parients had bllen tlfttnipped. m II small· uriventllated arllll for approximately 5-10,mw•• They were admitted to our hospital half an hour later.
UNDER the Constitution of India, responsibility for local government lies with the State government, which has the powers to determine the structure, functions and financial resources ofits municipal authorities", For historical reasons, municipal government has yet to flourish in India as a self-reliant and virile institution, and in spite of sporadic attempts substantially to disentangle it from the state government and its field agencies, the laws and administrative practices have remained as unimaginative and static as ever. State governments, in general, have continued to playa rather negative role, restricting the initiative, discretion or assumption of responsibility on the part of the urban local bodies. The laws enacted so far with regard to Statemunicipal relations have failed to provide a local planning and administrative machinery capable of executing functions assigned to municipal bodies in approved development Plans. Today the State-municipal relationship in India more, perhaps, than in any other country needs to be critically examined in the context of the national commitment to planned development -economic, social and cultural.
Objectives:
Large joint monoarticular tuberculous involvement is rare. It may not be associated with classical clinical features. Hence, it is difficult to differentiate from other conditions similarly involving the large joints. Our study aimed to study the characteristics of large joint monoarthritis on magnetic resonance imaging.
Material and Methods:
We reviewed the radiology database for large joint tubercular arthritis cases over 2 years. In total, there were 21 patients. Male: female ratio was 11:10. The mean age was 34.14 ± 15.82 years with a range of 8–57 years. We diagnosed tuberculosis (TB) based on histopathological examination or response to antitubercular therapy.
Results:
Knee was most frequently involved (47%; n = 10) followed by wrist and elbow in 3 patients each (14.28%). Concomitant active pulmonary TB was absent in all of our patients. Grade I synovial thickening was seen in eight patients, Grade II in four, and Grade III in seven. It was uniform in all the cases. Grade 1 bone marrow edema was seen in 06 patients, Grade III in 13, and none in 02. There was soft-tissue edema in 12 patients and soft-tissue collection in 2. Bone erosions were seen in 16 patients with rim enhancement in nine patients. Central erosions were seen in eight, while central and peripheral erosions in eight. On T1-weighted images, the signal intensity was hyperintense 10 and isointense in 11 patients. While on T2-weighted images, it was hyperintense in 10, isointense in nine, and hypointense in two patients.
Conclusion:
Large joint monoarticular tuberculous arthritis can present variably. Large erosions with rim enhancement, the signal intensity of synovium on T1 weighted and T2 weighted, uniformity of synovial thickening, and enhancement pattern of abscesses can help make a diagnosis.
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