Biomedical subjects
Publications and source records attributed to G Niwayama.
A case is presented of a 32-year-old black female who died from adult respiratory distress syndrome with disseminated intravascular coagulopathy. At autopsy she was found to have typical multiple endocrine neoplasia IIA, a combination of medullary carcinoma of the thyroid, bilateral adrenal pheochromocytoma and nodular hyperplasia of the parathyroid.
The autopsy is performed with multiple purposes. The first purpose of the autopsy is a service for clinicians. The dissection technic should be determined to present the best clinical-pathological correlation of the lesions. Imprint (touch preparation) from the organ is most useful to make initial pathological diagnoses during autopsy examination. This preparation provides not only oncologic data (tumor identification), but also the presence of infections. Numerous photographs illustrate both the gross pathological lesions and infections of the hepato-biliary system.
The autopsy is performed with multiple purposes. It is felt that the first purpose of the autopsy is a service for clinicians. Dissection technic should be determined to present the best clinical pathological correlation of the lesions. Touch preparation (imprint) from the organs is most useful to establish initial pathological diagnoses during autopsy examination. This provides not only oncologic data (identification of tumors), but also the presence of infectious complications such as opportunistic organisms. Multiple photographs illustrate both the gross pathological lesions and infections, demonstrated by the imprints of the respiratory system.
The autopsy is performed with multiple purposes such as medical education, searching direct cause of the death and researches. The first purpose of the autopsy is, however, a service for clinicians. The dissection technic should be determined to present the best clinical-pathological correlation of the lesions. In addition to the careful evaluation of the gross lesions of the pancreas, Smears (Imprints) of the lesions are most useful to make initial pathological diagnoses during autopsy examination. Multiple photographs illustrate both the gross pathological lesions and cytological data of the pancreas.
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Adhesive arachnoiditis, a meningioma and a schwannoma were found at autopsy in a 56 year old man who had undergone Thorotrast myelography 33 years previously. Thorotrast was demonstrated in tissue sections by transmission and scanning electron microscopy, radioautography, and x-ray spectrometry.
Cartilaginous (Schmorl's) nodes are related to prolapses of intervertebral disk material into the vertebral body. These nodes can be produced by any process which weakens either the cartilaginous plate covering the superior and inferior surfaces of the vertebral body or the subchondral trabeculae of the vertebra. Such processes include juvenile kyphosis, trauma, metabolic and neoplastic disorders, and degenerative disk disease. Radiographic abnormalities include indentations of vertebral outline and radiolucencies within the vertebral body with varying degrees of sclerosis. These can be readily differentiated from other vertebral alterations such as "butterfly", "fish", and "H" vertebrae.
A comprehensive anatomic, pathologic and radiographic study of the adult hip was undertaken to define bony landmarks which, when altered, are reliable indicators of disease. Methodology included radiography of cadaveric specimens and analysis of over 300 anteroposterior (AP) radiographs of "normal" adult hips. This information was applied to clinical situations with the following conclusions: (a) The diagnosis of protrusio acetabuli is warranted if the acetabular line projects medial to the ilioischial line by 3 mm or more in men and by 6 mm or more in women. (b) In acetabular trauma, an AP and two oblique radiographs (30 degrees anterior oblique and 30--45 degrees posterior oblique) are required for complete evaluation. (c) Characteristic alterations in the joint space allow accurate diagnosis of disease.
A comprehensive anatomic, pathologic, and radiographic study was undertaken to define reliable soft-tissue landmarks about the hip. Methodology included an analysis of 300 "normal" adult hip radiographs, tissue maceration, cadaveric intra-articular injection studies and review of selected clinical cases. Results, when applied to clinical situations, indicate: (a) The iliopsoas and "capsular" fat planes are poor indicators of small to moderate amounts of intra-articular fluid in the adult. (b) The "capsular" fat plane is not associated with the joint capsule, but in fact is a fat plane between two muscle bundles anterior to the articulation. (c) Distinct soft-tissue planes are available for dissemination of fluid from the hip joint. These include the iliopsoas bursa, which may distend in association with articular disease, and the fat plane of the obturator externus muscle.
An anatomic-pathologic-radiographic study of the proximal tibiofibular joint was undertaken. This synovial articulation between the proximal tibia and fibula may communicate with the knee joint in 10% of adults. Radiography of the normal proximal tibiofibular articulation outlines a consistent relationship between the proximal portions of the tibia and fibula. Disruption of this normal relationship is indicative of anterolateral or posteromedial subluxation or dislocation. Articular disorders of this joint include reheumatoid arthritis and septic arthritis. In the latter, initial alterations of the knee joint may subsequently extend to involve the proximal tibiofibular joint, illustrating the potential communication between these two articulations.
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The roentgen appearance and pathogenesis of carpal instability are described in an evaluation of patients and cadavers with rheumatoid arthritis and calcium pyrophosphate deposition disease. Dorsiflexion (16%) and palmar flexion (8%) instability occurs in rheumatoid arthritis, particularly in patients with moderate to advanced disease. Navicular-lunate dissociation frequently accompanies dorsiflexion instability and results from involvement of the interosseous ligament between the two bones by rheumatoid pannus. Carpal instability and navicular-lunate dissociation also accompany pyrophosphate arthropathy, resulting from calcific deposition and cystic degeneration of ligamentous structures.
Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD) (pseudogout) are outlined in an investigation of 85 patients with definite or probable disease and available cadaveric and human surgical material. Pyrophosphate arthropathy produced distinctive roentgenographic abnormalities with were most frequent in the knee, wrist and metacarpophalangeal joints. Although the alterations superficially resembled osteoarthritis, they were frequently more severe and progressive with extensive fragmentation of bone, causing intra-articular osseous bodies. Pyrophosphate arthropathy occurred in unusual locations, such as the radiocarpal compartment of the wrist, elbow, and patellofemoral compartment of the knee. These characteristics allow the radiologist to suggest a probable diagnosis of CPPD even in the absence of articular calcification.
The sesamoids generally appear as small ovoid bones adjacent to articulations or at sites where tendons are angled about osseous surfaces. At either location they participate in joint afflictions, the pattern of abnormality being remarkably constant and predictable. Sesamoids may demonstrate osseous erosion in rheumatoid arthritis, bony proliferation or "whiskering" in rheumatoid variants, joint space narrowing and bony ankylosis in septic arthritis, and eburnation and osteophyte formation in osteoarthritis and diffuse idiopathic skeletal hyperostosis. These changes become particularly important when they occur in the absence of significant adjacent articular disease. In these instances, recognition of sesamoid abnormalities allows accurate radiographic diagnosis.
Two patients with scleroderma demonstrated intra-articular calcification, which is rarely observed in this disease. The authors suggest that intra-articular calcification and erosion of adjacent cartilage and bone are related.
The calcaneus of normal control patients, and those with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and Reiter syndrome was studied. Pathological abnormalities of the plantar aponeurosis, Achilles tendon, and retrocalcaneal bursa account for the radiographic alterations. In normal individuals, lateral radiographs show the thickness of the Achilles tendon to be not greater than 8 mm; the retrocalcaneal bursa creates a radiolucency which extends at least 2 mm below the superior surface of the calcaneus. In patients with any of these 4 articular disorders, Achilles tendinitis produces thickening of the tendon, and retrocalcaneal bursitis obliterates the normal radiolucency.
Degenerative disease of the sacroiliac joint is common in middle-aged and elderly patients. Its radiographic features simulate those of ankylosing spondylitis. Interosseous space narrowing, subchondral sclerosis, and osteophytosis are apparent. Although intraarticular bony ankylosis is generally absent, anterior paraarticular bridging osteophytes resemble true osseous fusion of the joint cavity on frontal radiographs. Focal sclerosis in degenerative disease is most common on the superior and inferior margins of the articular cavity and can usually be differentiated from that accompanying ankylosing spondylitis and osteitis condensans ilii.
A comprehensive study of femoral heads of patients and cadavers with osteoarthritis, rheumatoid arthritis, osteonecrosis, and calcium pyrophosphate dihydrate deposition disease allows insight into the radiographic and pathologic appearance of subchondral radiolucencies in these disorders. The term geode, rather than cyst or pseudocyst, may be a more appropriate decription of these lesions. In osteoarthritis, goedes occur on the pressure segment of the femoral head in association with loss of articular space; in rheumatoid arthritis, they are initially noted at the chondro-osseous junction and subsequently involve the entire femoral head. In osteonecrosis, geodes appear in the necrotic segment of the femoral head. In calcium pyrophosphate deposition disease, geodes resemble those in osteoarthritis but are larger, more numerous, and more widespread.