Presentation is loading. Please wait.

Presentation is loading. Please wait.

Clinicopathological seminar. Pain in left groin – duration 2 years – activity related on initiation – morning stiffness lately – no rest or at night pain.

Similar presentations


Presentation on theme: "Clinicopathological seminar. Pain in left groin – duration 2 years – activity related on initiation – morning stiffness lately – no rest or at night pain."— Presentation transcript:

1 Clinicopathological seminar

2 Pain in left groin – duration 2 years – activity related on initiation – morning stiffness lately – no rest or at night pain – last 2 months get worse – analgesics No treatment in childhood Clinical case 5/12 – female 54 y

3 On examination – palpation tenderness in groin area – palpation tenderness over the greater trochanter – restricted ROM flexion ° internal rotation 0 external rotation 0-10 ° abduction 0-20 ° adduction 0-20 ° Clinical case 5/12 – female 54 y

4 laboratory examination – ESR 12/20, Hb 136 g/l, Ery /μl, Hct 0,38, Leu 8600/μl – Na 141 mmol/l, K 4,4 mmol/l, Cl 120 mmol/l, bili 9,9 mmol/l, AST 0,20 μkat/l, ALT 0,22 μkat/l, urea 5,4 mmol/l, creatinin 85 μmol/l, CRP 7,4 mg/l – urine analysis negative Clinical case 5/12 – female 54 y

5 laboratory examination – ESR 12/20, Hb 136 g/l, Ery /μl, Hct 0,38, Leu 8600/μl – Na 141 mmol/l, K 4,4 mmol/l, Cl 120 mmol/l, bili 9,9 mmol/l, AST 0,20 μkat/l, ALT 0,22 μkat/l, urea 5,4 mmol/l, creatinin 85 μmol/l, CRP 7,4 mg/l – urine analysis negative Clinical case 5/12 – female 54 y

6 X-ray pelvis and hip joints – flattening of the femoral head Rt – acetabular subchondral sclerosis bilat. – narrowing of joint space bilaterally – marginal osteophytes acetabulum bilaterally – cysts in head and acetabulum Rt – findings worse in Rt Clinical case 5/12 – female 54 y

7 What is this disease? What will be the conservative therapy? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? Clinical case 5/12 – female 54 y

8 What is this disease? – coxarthrosis grade III. What will be the conservative therapy? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? Clinical case 5/12 – female 54 y

9 What is this disease? What will be the conservative therapy? – regime measures – pharmacotherapy – physiotherapy What pharmacotherapy is appropriate? What surgical treatment is possibly coming? Clinical case 5/12 – female 54 y

10 What is this disease? What will be the conservative therapy? What pharmacotherapy is appropriate? – anti-inflammatory drugs – analgesics – chondroprotectives What surgical treatment is possibly coming? Clinical case 5/12 – female 54 y

11 What is this disease? What will be the conservative therapy? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? – osteotomies – hip replacement Clinical case 5/12 – female 54 y

12 degenerative disorders of joints – pathophysiology – morphological changes Clinical case 5/12 – female 54 y

13 three days subfebrile swelling, redness and pain in the lower leg today can no longer stand on Rt leg 10 years ago treated for infected fracture of Rt leg Clinical case 8/12 – male 45 y

14 body temperature – 38,9 °C (102°F) on lower extremity Rt – swelling and redness – palpable tenderness – no failure of blood supply and innervation of peripheral limb Clinical case 8/12 – male 45 y

15 laboratory examination – ESR 68/90, Hb 146, Ery /μl, Hct 0,42, Leu 12600/μl – Na 143 mmol/l, K 4,2 mmol/l, Cl 117 mmol/l, bilirubin 12,9 mmol/l, AST 0,30 μkat/l, ALT 0,42 μkat/l, urea 6,4 mmol/l, creatinin 75 μmol/l, CRP 268 mg/l – urine analysis negative Clinical case 8/12 – male 45 y

16 laboratory examination – ESR 68/90, Hb 146, Ery /μl, Hct 0,42, Leu 12600/μl – Na 143 mmol/l, K 4,2 mmol/l, Cl 117 mmol/l, bilirubin 12,9 mmol/l, AST 0,30 μkat/l, ALT 0,42 μkat/l, urea 6,4 mmol/l, creatinin 75 μmol/l, CRP 268 mg/l – urine analysis negative Clinical case 8/12 – male 45 y

17 X-ray of Rt leg – deformed bone – bony sequestra cannot be excluded – appropriate use of CT Clinical case 8/12 – male 45 y

18 angiography – aa. tibialis anterior et posterior visible to the periphery Clinical case 8/12 – male 45 y

19 What is this disease? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? Clinical case 5/12 – male 45 y

20 What is this disease? – osteomyelitis What pharmacotherapy is appropriate? What surgical treatment is possibly coming? Clinical case 5/12 – male 45 y

21 What is this disease? What pharmacotherapy is appropriate? – analgesics, antipyretics – antibiotics (what?) What surgical treatment is possibly coming? Clinical case 5/12 – male 45 y

22 What is this disease? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? – surgical revision of bone cavity – removal of necrotic and infected tissue – defect coverage with well-perfused tissues Clinical case 5/12 – male 45 y

23 osteomyelitis – acute and chronic – non specific and granulomatous infections Clinical case 8/12 – male 45 y

24 thigh pain – duration 3 months – get worse – in morning on initiation, permanently now – initially alleviated by aspirine Clinical case (11/12) – female 46 y

25 lower extremity Lt – no palpation thigh pain – no swelling and palpable mass – ROM hip and knee without restriction – during hip abduction feel tension in the abductors muscles – no failure of blood supply and innervation of peripheral limb Clinical case (11/12) – female 46 y

26 X-ray of proximal femur – thickening of medial cortex – appropriate use of CT Clinical case (11/12) – female 46 y

27 CT of proximal femur – well-formed bone tissue – nidus not seen, but probably it is the osteoid osteoma Clinical case (11/12) – female 46 y

28 What is this disease? What next treatment is possibly coming (conservative, surgical)? What is the prognosis of patient? Clinical case (11/12) – female 46 y

29 What is this disease? – osteoid osteoma – benign tumour What next treatment is possibly coming (conservative, surgical)? What is the prognosis of patient? Clinical case (11/12) – female 46 y

30 What is this disease? What next treatment is possibly coming (conservative, surgical)? – always surgical – growing of tumour, progression of the symptoms What is the prognosis of patient? Clinical case (11/12) – female 46 y

31 What is this disease? What next treatment is possibly coming (conservative, surgical)? What is the prognosis of patient? – prognosis is very good after surgical removal of the nidus Clinical case (11/12) – female 46 y

32 bone tumours – primary – metastases Clinical case (11/12) – female 46 y

33 fall – she had a dizziness – circumstances does´nt remember – then can no longer stand on Rt leg pain in Rt groin area Clinical case 6/12 – female 80 y

34 head – haematoma on her forehead lower extremity Rt – shortening 2 cm – pain in Rt groin area – signif. painfull restriction of ROM – no failure of blood supply and innervation of peripheral limb Clinical case 6/12 – female 80 y

35 X-ray pelvis and hip joints – interruption of the femoral neck Rt – distal fragment displaced proximally Clinical case 6/12 – female 80 y

36 What is this disease? Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? The patient is at risk for life? If so, what? Clinical case 6/12 – female 80 y

37 What is this disease? – fracture of the femoral neck Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? The patient is at risk for life? If so, what? Clinical case 6/12 – female 80 y

38 What is this disease? Is necessary rule out coincidence disease or stroke? What? – stroke – subdural haematoma Next management (exam, Tx)? The patient is at risk for life? If so, what? Clinical case 6/12 – female 80 y

39 What is this disease? Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? – standard preOP exam + neurological exam – surgery (hemiarthroplasty) The patient is at risk for life? If so, what? Clinical case 6/12 – female 80 y

40 What is this disease? Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? The patient is at risk for life? If so, what? – risk of bleeding complications (CNS) – risk of immobilization Clinical case 6/12 – female 80 y

41 osteoporosis – pathophysiology – morphological changes Clinical case 6/12 – female 80 y


Download ppt "Clinicopathological seminar. Pain in left groin – duration 2 years – activity related on initiation – morning stiffness lately – no rest or at night pain."

Similar presentations


Ads by Google