Modern trends in joints investigation are presented, particularly the tribological aspects of natural and artificial joints. The extent of the achievements in this field at the turn of the 21st century is discussed. This period is distinguished by the discovery of liquid-crystalline and quasi-electret states in synovial liquids; ascertainment by AFM of new boundary lubrication mechanisms in joints, which are realized at the nanolevel; development of methods for in vitro study of friction in joints using electromagnetic fields able to simulate the natural articular biofield. A relationship is shown between biotribology and the chief directions in contemporary orthopedics including: intraarticular chondroprotection exercised via local therapeutic methods based on tribological monitoring of pharmaceutic substances; injection of drugs based on blood serum; development of a new generation of articular endoprostheses able to simulate the biophysical properties of synovial joints. It is shown that progress in modern biotribology has provided scientific substantiation of orthopedic treatment procedures.

Hypoglycemia is a frequent and severe cause of coma, especially of diabetic patients. Prognosis is related to irreversible neuronal lesions and the most important predictive factors are the severity and duration of hypoglycemia. Cerebral cortex, hippocampus and basal ganglia are the most vulnerable sites. We report a case of hypoglycemic coma with cortical and basal ganglia hyper-intensities on diffusion weighted MRI suggesting cerebral complication, also we focused on the interest of Diffusion weighted MRI sequences in this issue through a literature review.

A 55-year-old woman admitted to our emergency department with three days history of abdominal pain, fever and vomiting. She was a known diabetic patient for last 25 years. On admission, she had fever (390C), heart rate of 100BPM and a, normal blood pressure and respiratory rate. The physical examination revealed an ill-looking patient with distended abdomen. There was extremely tender right renal angle with a diffusely tender right loin. The laboratory support showed leukocytosis, creatinine 2.06mg/dl and random serum glucose 512mg/dl. Urinalysis revealed numerous pus cell an RBC but ketonuria was absent. The cultures from the blood and urine sample showed Escherichia coli organism. Abdomen CT showed gas into the renal parenchyma and into the perirenal space on the right (Figures 1,2). The patient was diagnosed Emphysematous Pyelonephritis and successfully treated with antibiotic and supportive therapy. EPN is a uniformly fatal illness, if left untreated [1]. Treatment should be aggressive, starts with vigorous fluid resuscitation, antibiotic therapy, and control of blood sugar and electrolytes [2,3]. Before the advent of interventional radiology, early surgery and nephrectomy was a mandatory procedure.

An 78 year old woman with Chronic Obstructive Pulmonary Disease (COPD) post tobacco (30 packs annualy) and Cardiac Arrhythmia was admitted to our hospital. It was noted a medical history of laparotomy sub costal for for cholecystectomy 20 years ago. She present with worsening of respiratory symptoms such as dyspnoea of rest for more than one week. Physical examination showed the patient was afebrile with acute respiratory distress (oxygen saturation at 87%) associated with confusion (Glasgow score : 10) and a high blood pressure situation (200/100 mm Hg) accompagnied by tachycardia (heart rate approximately 125 BPM) and abdominal distension comes with vomiting alimentary. Laboratory investigations indicated : respiratory acidosis (pH: 7.07) with hypercapnia at 91 mm Hg, a PaO2 at 135 mm Hg and alcaline reserve at 36 mmol/l. The rest of biological examinations did not show any other specific abnormalities.

A 75-year-old woman presented with a six-months history of recurrent painful lumps on the palmar aspect of different fingers on both hands (Figure 1). They resolved spontaneous in few days. Patient didn’t remember any local trauma. She was anticoagulated with vitamin K-antagonists because of previous pulmonary embolism and prosthetic mechanical mitral valve. She had no neoplasms, infections or systemic diseases in her medical history. Physical examination revealed bluish nodules on the volar side of the proximal interphalangeal joints of the index and middle f ingers (Figure 2). They were painful,of hard fibrous consistency, subcutaneous and 3-5 mm in size. Laboratory tests were normal. The clinical picture was not typical for paroxysmal finger haematomas, infective endocarditis(Osler’s nodes, Janeway lesions) or vasculitis. A diagnosis of recurrent spontaneous thrombosis of palmar digital veins was confirmed by echography. An antiphospholipid syndrome was rouled out and ibuprofen was locally applied. Mondor’s Disease was first described in 1939 and it is a rare condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall. It sometimes occurs on the penis or on the fingers. The diagnosis is made by the typical clinical aspect. Radiological or Histological examinations are usually not necessary. Mondor’s Phlebitis is a self-limiting and generally benign disease. The specific aetiology remains uncertain. Trivial local traumas (for example handwork) are presumed. Surgery, infection, malignancy or hypercoagulable state are responsible for the disease only in rare cases.