FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression.

A man with newly diagnosed AIDS presented with months of back pain and fever. Computed tomography (CT) results demonstrated aortitis with periaortic tissue thickening. DNA amplification of biopsy tissue revealed Bartonella quintana, and Bartonella serologies were subsequently noted to be positive. The patient improved with prolonged doxycycline and rifabutin treatment. This case illustrates how molecular techniques are increasingly important in diagnosing Bartonella infections. CASE REPORTA 48-year-old heterosexual African male with type II diabetes presented to an emergency room (ER) with several months of abdominal pain, back pain, polydipsia, loss of 30 pounds of body weight, and subjective fevers. He was febrile (38.6°C) and tachycardic, with a glucose level of 298 mg/dl. He was given intravenous fluids and metformin and discharged from the ER. Subsequently, his HIV-1 test returned a positive result; his CD4 ϩ T cell count was 68 cells/mm 3 (7%), and his HIV-1 RNA level was 537,519 copies/ ml. He was empirically started on antiretroviral therapy and prophylactic trimethoprim-sulfamethoxazole. Four weeks later, the patient described persistent abdominal and back pain, fever, and chills. The mid-thoracic back pain was sharp, constant, and relieved by leaning forward.The patient worked as a taxi driver, lived alone in an apartment, and had no pets. He grew up in Ethiopia and moved to the United States in 1991. He reported being heterosexual and denied contact with commercial sex workers or having surgeries or tattoos. He reported no alcohol, tobacco, or illicit drug use. He had last traveled to Ethiopia in 2006, stayed in rural areas with goats, sheep, cows, dogs, and cats, and consumed only store-bought milk and meat.On examination, the patient had no thrush or lymphadenopathy. His abdomen was soft and mildly tender in response to palpation throughout, without rebound. There was no tenderness in response to palpation along the spine. He had no cutaneous lesions. His laboratory results were notable for a white blood cell count of 2.9 ϫ 10 3 /l, with 38% polymorphonuclear cells, 36% lymphocytes, 8% monocytes, 15% eosinophils, and a hemoglobin level of 8.9 g/dl. His liver function test results were normal.Single-phase phase-contrast-enhanced CT results demonstrated abnormal circumferential soft tissue thickening involving the lower abdominal aorta, with additional periaortic soft tissue, inseparable from the aortic wall. Heterogeneous enhancement within the soft tissue suggested active inflammation. A subsequent multiphase CT angiography (CTA) procedure confirmed aortic wall thickening, extending from the superior mesenteric artery to the proximal left common iliac artery (Fig. 1A). Additionally, a wedge-shaped hypodense region in the posterior left kidney was suspicious for a small infarct.The patient was hospitalized for further evaluation. Routine bacterial, mycobacterial, and fungal blood culture results were negative, as were those of Coccidioides complement fixation and immunodiffusion assays, Cryptococcus ...

Proximal symphalangism (SYM1) is an autosomal-dominant developmental disorder of joint fusion. This disorder is best known from famous historical descriptions of two large kindred: Cushing's description in 1916 of the "straight-fingered" Brown family of Virginia and Drinkwater's description in 1917 of the British Talbot family of noble blood, descended from the English war hero John Talbot, the first Earl of Shrewsbury (1388-1453). Recent genetic studies link this phenotype to expression of abnormal genes at future joint sites: too little expression of NOG, a growth antagonist, or overexpression of GDF5, a growth agonist, results in cartilage overgrowth and bony fusion. This review unites in depth the first historical accounts of SYM1 with a clinical description and reviews the current understanding of the molecular mechanism underlying what is likely the oldest dominant trait ever studied.

The purpose of this review is to discuss the rationale and indications for transvaginal ultrasound-guided biopsy. Transvaginal ultrasound-guided biopsy can be a helpful tool for diagnosis and treatment planning in the evaluation of pelvic masses, particularly when the anatomy precludes a transabdominal or posterior transgluteal percutaneous biopsy approach. A step-by-step summary of the technique with preprocedure and postprocedure considerations is included.

Liposarcoma is a soft-tissue sarcoma typically seen in adults. It is extremely rare in children. It most often occurs in the extremities or in the retroperitoneum. We present a very rare case of an anterior mediastinal liposarcoma of the pleomorphic subtype in a 17-year-old girl, along with radiological and pathological correlation. The location, patient age and histological subtype are exceedingly uncommon for this tumor.

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