Quantitative sacroiliac scintigraphy (QSS) was performed on 34 patients suspected of having ankylosing spondylitis (AS) with low back pain and stiffness of recent onset, by utilizing three technical features not previously described: fractional scintigraphy of the sacroiliac (SI) joints, background subtraction, and drug washout. Imaging was performed with a 14O-keV, high-resolution collimator, and the data were recorded and processed with an Ohio Nuclear 150 System, 3 hours after administration of 17 mCi of 99m Tc ethane-1-hydroxy-1, 1-diphosphonate (EHDP) per 70 kg of body weight. The SI index determined by QSS was compared with diagnostic tissue-typing for HLA-B27 and standard radiography of the SI joints to assess the potential of QSS to discriminate inflammatory sacroiliitis from nonspecific low back strain. Twenty-three
The periarticular uptake of 99mtechnetium‐labeled diphosphonate (99mTcDP) was compared in 12 patients hospitalized for psoriasis and in 12 hospitalized for other dermatoses not associated with arthropathy. The 12 patients with psoriasis had recent onset disease of less than 5 years duration; neither group had historical or clinical evidence of arthritis. All psoriatics had markedly abnormal scans with symmetrically increased periarticular uptake about the imaged joints. None of the controls had similar findings. In 4 patients scanned with 99mtechnetium‐pertechnetate within 24 hours of their 99mTcDP scan, no evidence of inflammatory synovitis was found. Three of these patients were serially imaged with 99mTcDP at intervals of 2 weeks to 3 months after their initial study, when obvious clinical improvement in their psoriasis was apparent. Improvement in the radionuclide joint images was demonstrated in some of the patients, but none reverted to normal during the study period. In light of recent evidence for the preferential binding of 99mTcDP to immature collagen, it is suggested that psoriasis may represent a generalized, but uncharacterized, collagen disorder present in bone as well as skin, linking the cutaneous disease with the potential for arthropathy.
We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. The clinical findings of sciatic neuropathy, external rotation of the ipsilateral foot in the position of comfort, and a therapeutic response to local anesthetic injection into the pyriformis muscle are diagnostic of the syndrome. Nerve conduction studies should be performed to aid in the differentiation between a common peroneal and sciatic neuropathy. The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.
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