PubMed · 10829161
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A E Gross. 2000. The difficult socket.. https://pubmed.ncbi.nlm.nih.gov/10829161/
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HISTORY AND CLINICAL FINDINGS: A 63-year-old man was admitted to a surgery department with fracture of the acetabulum and luxation of the hip joint. Eight days after intracondylar nail-extension during subcutaneous heparin prophylaxis he developed a dramatic deterioration of his condition with severe abdominal pain and fever and was admitted to our hospital. INVESTIGATIONS: White cell count was 12,000/microliter, C-reactive protein 7.90 mg/dl. CT-scan, abdominal ultrasound, mesenteric angiography and exploratory laparotomy revealed no pathological findings. At day 13 abdominal ultrasound showed adrenal haemorrhages on the right. Together with a drop in platelet count below 50,000/microliter, adrenal haemorrhage caused by heparin-induced thrombocytopenia (type II; immunological [HIT II]) was suggested. THERAPY: After discontinuation of heparin and starting therapy with recombinant hirudin and hydrocortisone, a dramatic clinical recovery followed within 24 hours. One year after the initial diagnosis the patient is in a good condition. CONCLUSION: When abdominal pain, hypotension and fever occurs with a drop in platelet count during heparin therapy HIT II should be considered. An early diagnosis is essential for treatment of this life-threatening complication at an early stage.
INTRODUCTION: MR arthrography by direct joint puncture and instillation of contrast medium is a minimally-invasive diagnostic technique in patients with suspected acetabular labral tear. The joint is distended, and the intraarticular structures are well separated. MATERIAL AND METHODS: 31 patients with chronic hip joint pain underwent MR arthrography by direct joint puncture and instillation of diluted gadolinium to evaluate the glenoid labrum. RESULTS: The glenoid labrum was seen in all patients. Labral tear was found in ten patients. Two of these underwent arthroscopy, and the tears were verified. We also found other causes of hip pain. One patient with villonodular synovitis at MR arthrography was verified at arthroscopy. INTERPRETATION: MR arthrography is a promising diagnostic technique for evaluating the acetabular labrum.