scholarly journals Can large doses of glucocorticoids lead to Perthes? a case report and review of the literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guoming Chen ◽  
Tengyu Chen ◽  
Peng Zhang ◽  
Zhaoping Zhang ◽  
Ruilan Huang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Systemic Disease ◽  
Perthes Disease ◽  
High Dose ◽  
Imaging Data ◽  
Ischemic Necrosis ◽  
Case Presentation ◽  
X Ray ◽  
Examination Finding

Abstract Background Perthes disease (Legg-Calvé-Perthes, LCP) is a self-limited and non-systemic disease occurring in the femoral heads of children, which is mainly manifested as an ischemic necrosis of the femoral head epiphysis, leading to subchondral ossification injury of the femoral head. Case presentation Here we report a case of 11-year-old child with long-term use of high-dose glucocorticoids. With MRI examination finding the epiphyseal necrosis of right humeral head, femur and tibia, and X-ray examination finding bilateral femoral head necrosis, the child was diagnosed as Perthes disease based on his clinical and imaging data. Conclusions Long-term and high-dose glucocorticoids may be one of the causes of Perthes disease.

scholarly journals Legg-Calve-Perthes Disease: A Rare Cause of Bilateral Avascular Necrosis of the Hip Joints

2013 ◽  
Vol 4 (1) ◽  
pp. 40-41
Author(s):  
Quazi Tarikul Islam ◽  
Mahmudur Rahman Siddiqui ◽  
Ekramul Mustafa ◽  
Ahmed Hossain ◽  
Md Yousuf Ur Rahman ◽  
...  
Keyword(s):  
Femoral Head ◽  
Early Detection ◽  
Avascular Necrosis ◽  
Typical Case ◽  
Perthes Disease ◽  
Clinical Correlation ◽  
Hip Joints ◽  
X Ray ◽  
Relieve Pain

Perthes' disease is a disorder of the hip joint in children. Femoral head became softens, flattened or deformed because of the lack of blood supply of unknown cause. It is a very rare cause of bilateral avascular necrosis of the head of the femur, which can easily diagnosed by clinical correlation with the X-ray pelvis findings. Here we present a typical case of Perthes disease, who was finally diagnosed after a long periods of time. In Perthes disease early detection is very important to preserve, restore the femoral head, relieve pain and prevent long term osteoarthritis. DOI: http://dx.doi.org/10.3329/akmmcj.v4i1.13684 AKMMC J 2013: 4(1): 40-41  

The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

2021 ◽  
Vol 103-B (12) ◽  
pp. 1815-1820
Author(s):  
Stefan Huhnstock ◽  
Ola Wiig ◽  
Else Merckoll ◽  
Svein Svenningsen ◽  
Terje Terjesen
Keyword(s):  
Femoral Head ◽  
Skeletal Maturity ◽  
Strong Predictor ◽  
Perthes Disease ◽  
Radiological Outcome ◽  
Long Term Follow Up ◽  
The Mean ◽  
Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

scholarly journals Virtual Model for Legg-Clavé-Perthes: Preliminary Work to Develop a Minimally Invasive Preclinical Model

2019 ◽  
Author(s):  
Bethany Juhnke ◽  
Susan A. Novotny ◽  
Jennifer C. Laine ◽  
Ferenc Toth ◽  
Arthur Erdman
Keyword(s):  
Blood Flow ◽  
Femoral Head ◽  
Minimally Invasive ◽  
Perthes Disease ◽  
Preclinical Model ◽  
Virtual Model ◽  
Preclinical Models ◽  
Long Term Outcomes ◽  
New Methods

Legg-Calvé-Perthes disease (LCPD) is a painful pediatric hip condition caused by an idiopathic disruption of blood flow to the femoral head. The bone subsequently becomes necrotic and fragile. This can result in significant femoral head deformity, leading to pain and early degeneration of the hip. Severity of avascular involvement of the femoral head correlates with long-term outcomes, including hip arthritis and replacement. Preclinical models present extreme cases of the disease and do not represent the spectrum of LCPD seen clinically. A virtual model was developed to explore advancing the preclinical model through new methods of visualizing the data. Overall, three opportunities to advance the preclinical model and our understanding of LCPD are presented.

Long-term x-ray follow-up of osteonecrosis of the femoral head after renal transplantation

1998 ◽  
Vol 30 (7) ◽  
pp. 3036-3038 ◽  
Author(s):  
T Kubo ◽  
N Yoshimura ◽  
T Oka ◽  
K Shibatani ◽  
M Fujioka ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Femoral Head ◽  
X Ray

scholarly journals REHABILITASI MEDIK PADA PENYAKIT LEGG-CALVÉ-PERTHES

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
René R. Pradnasurya ◽  
Engeline Angliadi
Keyword(s):  
Femoral Head ◽  
Physical Examination ◽  
Avascular Necrosis ◽  
Clinical Symptoms ◽  
Knee Extensor ◽  
Perthes Disease ◽  
X Ray ◽  
Muscle Strengthening ◽  
Infra Red ◽  
The Right

Abstract: In Legg-Calvé-Perthes disease there is an avascular necrosis condition of the femoral head with a clinical onset between the ages of 2-12 years old.  The etiology of this disease remains unknown. Its variable clinical symptoms and disease progression depend on the severity of the disease. The principle of therapy is hip containment. Rehabilitation programs play an important role to revert or to maximize the function and activities of daily living. We reported a case of a 9-year-old girl with complains of limpness, asymmetric lower extremities, weakness of the right lower extremity, pain around the right knee, with a history of trauma on the right hip 5 months ago. Physical examination revealed weakness of the right hip flexor and knee extensor with limitation of the right hip’s range of motions. The X-ray taken showed an avascular necrosis appearance at the right femoral head. Conclusion: This case was diagnosed as Legg-Calvé-Perthes disease based on anamnesis, physical examination, and the X-ray result. The rehabilitation management for this case was heat modality with infra red to prepare the muscle condition for exercises, muscle strengthening and range of motion exercises to prevent contracture, as well as medical education with psychological support.  Scottish Rite orthosis was planned to position the hip in abduction while limiting the hip adduction. Keywords: Legg-Calvé-Perthes, avascular necrosis, comprehensive rehabilitation.   Abstrak: Pada penyakit Legg-Calvé-Perthes terjadi kondisi nekrosis avaskular kaput femur dengan usia awitan paling sering antara usia 2-12 tahun. Etiologi penyakit ini masih belum diketahui, dengan perjalanan dan gambaran klinis yang bervariasi tergantung dari tingkat keparahan penyakit. Prinsip terapi penyakit ini ialah hip containment. Program rehabilitasi diberikan secara komprehensif baik dari fisioterapi, terapi okupasi, ortotik-prostetik, psikologi, serta sosial medik yang sangat berperan dalam mengembalikan atau memaksimalkan fungsi dan aktivitas kehidupan sehari-hari. Kami melaporkan kasus seorang anak perempuan usia 9 tahun dengan keluhan berjalan pincang, asimetris antara tungkai kanan dan kiri, kelemahan tungkai kanan, nyeri sekitar lutut kanan, dengan riwayat trauma panggul kanan 5 bulan lalu. Pada pemeriksaan fisik ditemukan kelemahan otot fleksor panggul dan ekstensor lutut kanan serta keterbatasan lingkup gerak sendi panggul kanan. Pada pemeriksaan radiologik terlihat gambaran nekrosis avaskular kaput femur kanan. Simpulan: Pada kasus ini, diagnosis penyakit Legg-Calvé-Perthes ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan radiologik. Penanganan rehabilitasi yang diberikan ialah modalitas panas berupa sinar infra red untuk mempersiapkan kondisi otot sebelum latihan, latihan penguatan otot dan lingkup gerak sendi untuk mencegah kontraktur, serta edukasi baik dari sisi medik maupun psikologik. Juga direncanakan pemberian Scottish Rite orthosis untuk membuat posisi panggul menjadi abduksi dengan membatasi gerakan adduksi. Kata kunci: Legg-Calvé-Perthes, nekrosis avaskular, rehabilitasi komprehensif.

Membrane Microparticles from Patients with Steroid-Induced Avascular Necrosis of Femoral Head Increase the Expression of Fas in Endothelial Cells In Vitro.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3903-3903
Author(s):  
Xi-sheng Weng ◽  
Zhi-hong Wu ◽  
Yi Wei ◽  
Gui-xing Qiu
Keyword(s):  
Endothelial Cells ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Umbilical Vein ◽  
Cell Types ◽  
High Dose ◽  
Necrosis Of Femoral Head ◽  
Membrane Microparticles

Abstract High-dose or long-term usage of steroid have been suggested to be at great risk of developing avascular necrosis of femoral head (ANFH). A theory proposed to decipher the mechanism behind the development of steroid-induced ANFH involves vascular compromise and cell death. Membrane microparticles (MMPs) are fragments shed from plasma membrane blebs of virtually all cell types when submitted to a number of stress conditions, including apoptosis. It has been reported that high-dose dexamethasone cause dysfunction and apoptosis of endothelial cells; and MMPs isolated from the plasma of patients with myocardial infarction of preclampsia were found to cause damage in isolated arteries in vitro. We hypothesize that MMPs generated after high-dose or long-term administration of steroid facilitates the apoptosis of endothelial cells initiated by steroid, which contributes to the development of ANFH. MMPs were isolated from the blood of 4 healthy individuals, and 5 patients demonstrated to have ANFH by magnetic resonance imaging (MRI) and X-ray. The mean duration and accumulated dose of steroid administration were 8 months and 2000 mg respectively. The 3rd generation of human umbilical vein endothelial cells (HUVEC) was exposed to MMPs (corresponding to 0.2-fold circulating plasma level) prepared above. After 48 hours, part of cells was lysed to make total cell lysate. And the rest were used to prepare mRNA. The expression level of Fas was detected with reverse-transcript PCR and Western Blot. Our results shown that treatment of HUVEC with MMPs from ANFH patient’s blood significantly increases the transcription and expression of Fas, indicating that MMPs derived from patients with steroid-induced ANFH exacerbates high-dose steroid-induced apoptosis of endothelial cells by enhancing the expression of Fas.

Dysplasia Epiphysealis Capitis Femoris: Two Long-Term Observations

1995 ◽  
Vol 5 (2) ◽  
pp. 63-68
Author(s):  
B. Moretti ◽  
V. Patella ◽  
G. Mastrorillo ◽  
V. Pesce ◽  
G.LO Bianco ◽  
...  
Keyword(s):  
Femoral Head ◽  
Early Diagnosis ◽  
Clinical Signs ◽  
Perthes Disease ◽  
Radiological Findings

Two patients with Meyer's dysplasia epiphysealis capitis femoris were followed, and the clinical and radiological findings are described. The importance of early diagnosis is underlined, and of differentiating Meyer's disease from Perthes disease, particularly in children under the age of four years, who present no true clinical signs. The utility of monitoring ossification of the femoral head is illustrated.

scholarly journals Avascular Necrosis of Femoral Head in the Republic of Bashkortostan: a Clinical and Epidemiological Study

2020 ◽  
Vol 10 (2) ◽  
pp. 100-107
Author(s):  
R. N. Mustafin
Keyword(s):  
Risk Factors ◽  
Cerebral Ischemia ◽  
Femoral Head ◽  
Incidence Rate ◽  
Avascular Necrosis ◽  
Complex Disease ◽  
Protective Role ◽  
Chronic Cerebral Ischemia ◽  
X Ray

Introduction. Avascular necrosis of the femoral head (AVNFH) is a relatively rare complex disease that occurs in people of working age and leads to disability due to irreversible changes in the aff ected hip joint. Aetiology of the disease has not been reliably established so far.Materials and methods. Among a total of 42,877 residents of Ufa surveyed, 71 were diagnosed with AVNFH. Patients granted an informed consent to conduct the survey, access the outpatient history of concomitant pathology, perform hip X-ray and laboratory blood tests.Results and discussion. Th e AVNFH incidence rate was 166 per 100,000 people, with the men to women ratio 1:1.5 and average age of manifestation 50 years. Secondary necrosis was established in 14, and bilateral lesion — in 42 % of cases. A family with hereditary AVNFH (mother, daughter and grandmother) was observed. A significantly higher incidence rate was observed with children in mononational families, which suggests a protective role of crossbreeding against this pathology. In 31 % of patients, the disease manifested atypically resembling lumbago with sciatica, which entailed a late AVNFH diagnosis. Smoking and long-term contact with chemicals were identified as the risk factors, and hypertension, chronic cerebral ischemia, anaemia, hypercholesterolemia and chronic inflammation — as associated disorders. A radiological profi le of the disease is described.Conclusion. Th e study allowed a precise estimation of the AVNFH incidence rate as 1 per 600 people. Idiopathic AVNFH occurred in 86 % of cases, with smoking and professional long-term contact with chemical agents as associated risk factors. Pedigree studies exposed a low incident rate in ethnically mixed families. AVNFH was shown comorbid with the hypertensive disease in 56 and chronic cerebral ischemia — in 42 % of patients. Atypical lumbago-sciatica-like symptoms in 1/3 of AVNFH cases warrant the need to conduct hip X-ray and MRI in this category of patients.

scholarly journals Multi-epoch X-ray imaging of globular cluster M62 with Chandra

2020 ◽  
Vol 498 (1) ◽  
pp. 292-303
Author(s):  
Kwangmin Oh ◽  
C Y Hui ◽  
K L Li ◽  
A K H Kong
Keyword(s):  
Globular Cluster ◽  
Globular Clusters ◽  
Imaging Data ◽  
Short Term ◽  
Observation Window ◽  
X Ray ◽  
Compact Binaries ◽  
X Ray Imaging ◽  
Low Mass

ABSTRACT Using archival spectral-imaging data with a total exposure of ∼144 ks obtained by Chandra, 43 X-ray sources are detected within the half-light radius of globular cluster M62 (NGC 6266). Based on the X-ray colour–luminosity diagram or the positional coincidences with known sources, we have classified these sources into different groups of compact binaries including cataclysmic variable (CV), quiescent low-mass X-ray binary (qLMXB), millisecond pulsar, and black hole (BH). Candidates of the X-ray counterparts of 12 CVs, 4 qLMXBs, 2 MSPs, and 1 BH are identified in our analysis. The data used in our analysis consist of two frames separated by 12 yr, which enable us to search for the long-term variability as well as the short-term X-ray flux variability within each observation window. Evidence for the short-term variability and long-term variability have been found in 7 and 12 sources, respectively. For a number of bright sources with X-ray luminosities Lx ≳ 1032 erg s−1, we have characterized their spectral properties in further details. By comparing the X-ray population in M62 with those in several other prototypical globular clusters, we found the proportion of bright sources is larger in M62 that can possibly be a result of their active dynamical formation processes.

THE RADIOLOGICAL APPEARANCE OF RECURRENT PHALANGEAL SARCOIDOSIS

Hand Surgery ◽  
2002 ◽  
Vol 07 (02) ◽  
pp. 187-189 ◽  
Author(s):  
John L. Kelly ◽  
Michael O'Shaughnessy ◽  
Thomas P. F. O'Connor
Keyword(s):  
Clinical Presentation ◽  
Systemic Disease ◽  
Steroid Treatment ◽  
High Dose ◽  
Long Term Follow Up ◽  
Radiological Pattern ◽  
New Evidence ◽  
Severe Systemic Disease

Sarcoidosis of the phalanx is rare and is usually associated with severe systemic disease. We present a patient with recurrent phalangeal sarcoidosis and new evidence of a changing radiological pattern. The clinical presentation and outcome is discussed. High dose steroid treatment and careful long-term follow-up is recommended.

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