[What is your diagnosis? Garrè's sclerosing osteomyelitis].
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Biomedical subjects
Publications and source records attributed to H Ott.
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Axial and appendicular osteoporosis are common features of Turner's syndrome. The histology of this osteoporosis is similar in some respects to postmenopausal osteoporosis. Therefore, we treated a woman with Turner's syndrome who developed a vertebral wedge fracture, despite estrogen substitution since adolescence, with bone stimulating drugs. Absence of a beneficial effect on bone biological indices or bone mineral density, could be explained by other pathogenetic factors like a direct result of the chromosomal abnormality or other hormonal deficiencies.
Gold salts are still a first choice for treatment of rheumatoid arthritis. Although adverse reactions are relatively frequent, hepatic abnormalities are rare. They consist largely of reversible cholestasis, and, exceptionally, the evolution can prove rapidly fatal due to extensive hepatic necrosis. We present an additional case of this kind which occurred after a total dose of 450 mg intramuscular Aurothiopropanol over 6 weeks. The pathogenetic mechanism is complex, toxic and/or immuno-allergic. Nevertheless, regular hepatic enzyme testing is not recommended.
The tonotopic map of the cochlea in the gerbil Pachyuromys duprasi was analysed by local iontophoretic HRP-application into physiologically defined regions of the cochlear nucleus and mapping of subsequent HRP transport patterns in cochlear spiral ganglion cells. Furthermore the spiral ganglion cell density along the cochlear duct was determined. The cochlear tonotopic map was established in the frequency range between 0.6 and 17.5 kHz. These frequencies corresponded to locations between 86 and 3% basilar membrane length (0% = cochlear base). It was found that the slope of the place-frequency map varied with frequency, the maximum slope being found between 1 and 4 kHz. This frequency range corresponds to the frequency range of highest auditory sensitivity as determined from cochlear microphonic recordings (Plassmann et al., 1987). The density of spiral ganglion cells also varied along the cochlear duct. A pronounced maximum (1927 cells/mm) was located at around 70% basilar membrane length, compared to values of 800 cell per mm near the cochlear apex and base. This region of high ganglion cell density also corresponds to the frequency range of highest auditory sensitivity.
In search of a biocompatible implant for the correction of small deficiencies within the dermal corium as in wrinkles and acne scars, polymethylmethacrylate (PMMA) microspheres, 10 to 63 microns in diameter, were dispersed in Tween 80 medium and injected intradermally and subdermally into the abdominal skin of rats. Histological examination of specimens for up to 7 months revealed a modest tissue reaction, forming a delicate fibrous capsule around each individual microsphere within 4 months. Foreign body giant cells were seen rarely (in up to 1.5% of all cells). No break-down, corrosion, or phagocytosis of the spheres was observed at 7 months. The Tween 80 dispersion medium did not produce any histologically detectable reaction. Because PMMA products (Paladon, Palacos) have been used in medicine for almost 50 years without causing biological degradation or cancer, the material may be applied safely in the form of microspheres (Arteplast) in corium and subcutis of human patients with wrinkles or acne scars.
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The radial tubercle is rarely the site of enthesopathy. When it occurs, symptoms and radiological images are usually typical enough for unequivocal diagnosis. We report the case of a man with atypical pain and X-rays modifications of the radial tubercle. Correct diagnosis was established by histological analysis. Better knowledge of this pathology should prevent unnecessary excision.
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Bone scintigraphy is largely used for diagnosis and surveillance of osteoarticular diseases. Interpretation of fortuitous increased isotope accumulation elsewhere on the skeleton may be difficult. We report a man with a peripheral seronegative inflammatory arthropathy, whose bone scintigraphy disclosed stippled ribs and vertebral increased isotope uptake, corresponding to rib enthesopathy and vertebral hyperostosis. Better knowledge of these unusual pictures should prevent further unnecessary investigations.
A parasitic origin of rheumatological manifestations is only suspected if the patient returns from an endemic area of the world. We report a young girl who developed without travelling, an isolated hip arthropathy simultaneously with a Toxocara infestation. Pathogenesis is discussed.
The influence of tenoxicam on renal function was studied prospectively in two different populations. Group I (n = 10) was classified as "high renal risk" patients and received 20 mg of tenoxicam per day for five days. Glomerular filtration rate measured with Cr51 EDTA decreased significantly by 13 +/- 3.6% (p less than 0.01). Group II (n = 56) were outpatients from the rheumatology clinic and received 20 mg tenoxicam per day for one to five years. Plasma creatinine did not change significantly, except in one patient who had some degree of renal impairment before therapy. Tenoxicam carries no greater renal risks than other non-steroidal antiinflammatory drugs when administered to a non-"high renal risk" population. On the other hand, simple renal function monitoring should be carried out in high risk patients.
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A woman with overlapping features of rheumatoid arthritis and systemic lupus erythematosus presented with multiple small asymptomatic calcifications of the spleen. The absence of any other origin suggests that these calcifications are directly related to the connective tissue disease.
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Since plethysmography was introduced as the earliest screening method of peripheral veins there was a constant improvement of apparatus and methods. Presently the color-coded Duplex sonography gives results more detailed than any other screening test and is comparable with the accuracy of phlebography. Nevertheless, since the introduction by Mahler of the "climbing pulse rate" as the best known clinical sign of thrombosis a fundamental problem still waits for the solution: diagnosis of the very beginning of thrombosis. Only when the initial symptoms of the disease are correctly interpreted the best suitable diagnostic methods can be carried out stepwise. A wrong interpretation of the patient's complaints still causes serious retardations of the induction of an adequate therapy.
Spina bifida is a congenital malformation which occurs during the first weeks after conception. The association with intraspinal tumours, usually lipomas, is well known. During evaluation of back pain, we observed a case of occult spina bifida associated with extra- and intradural lipoma. Simultaneously the patient exhibited cutaneous, orthopedic and neurological signs. The clinical symptoms of lipoma are due to compression and elongation of the spinal cord causing tethered cord syndrome. The onset of neurological symptoms usually occurs in childhood. Late occurrences in adults are often associated with sphincter problems. CT scan and, in particular, magnetic resonance imaging (MRI) provide good visualization of intraspinal lipoma. Treatment is surgical.