Biomedical subjects
Publications and source records attributed to V L Fornasier.
The roentgenographic scintographic and histologic features of an "ivory vertebra" are characteristic of monostotic Paget's disease. This case and condition are of special interest because Paget's disease is quite unusual in persons aged 30 or younger.
Chronic arthritis was the only symptom that led to the detection of increased iron stores in four patients. In these persons, the serum iron was ordered at the time of initial examination, and ranged from 212 to 237 microgram/dl with a transferrin saturation of 83% to 100%. Liver biopsy specimens showed hepatocyte iron deposition in each person, with definite cirrhosis in only one patient. These cases illustrate that a chronic arthropathy may be the first clinical manifestation of iron overload, and can lead to discovery of the disease in patients and their family members. Treatment may then be initiated before extensive tissue damage has occurred.
Iliac crest bone biopsy specimens from 34 patients were examined with the electron microscope. Although the biopsy examinations were undertaken because of suspected metabolic or hematopoietic disease, neither clinically nor by light microscope was any evidence of disease identified. The layer of bone matrix between the osteoblast and the mineralized bone, usually referred to as "osteoid," is found not to be a homogeneous mass but to show a constant sequence of maturation and organization of collagen fibrils and mucopolysaccharides. This pattern was found to be modified in a situation of rapid bone formation such as normal fetal bone or in disease states such as Paget's disease of bone. These observations are of paramount importance in the evaluation of metabolic diseases of bone and in the identification of bone formation by mesenchymal neoplasms.
A review of 839 necropsies revealed 415 cases of malignant neoplasm, 63 of which were found to have evidence of metastatic spread to the sternum. Nineteen of these metastases resulted in pathological sternal fractures. Fine detail radiography proved a quick and accurate technique for detecting these lesions post mortem. The characteristics of pathological sternal fractures were compared with traumatic sternal fractures with respect to deformity and healing. Pathological fractures of the sternum demonstrate a tendency to greater deformity and slower healing than traumatic sternal fractures.
Periosteal chondroma is an uncommon benign cartilagenous lesion, and its importance lies primarily in its characteristic radiographic and pathologic appearance which should be of assistance in the differential diagnosis of eccentric lesions of bones. The pathologist must be aware of this tumour because at a histologic level, it may closely resemble a more ominous cartilagenous lesion. He can exclude this lesion in a differential diagnosis of a primary cartilagenous bone neoplasm by familiarity with the clinical and radiological appearance of the lesion. In all cases reported so far, treatment has been that of wide local excision. There are no recorded cases of metastases in follow-up periods ranging up to 8 years after surgery. In those cases where local recurrences were reported, inadequate initial excision is the admitted cause, and subsequent re-excision led to complete eradication of the residual tumour.
Detailed histological evaluation of 72 femoral heads in terms of bone density, cartilagenous integrity and number of stress fractures in 3 different clinical groups of patients suggest that femoral trabecular fatigue fractures are largely determined by the degree of osteoporosis in all clinical states. The state of the hyaline cartilage also contibutes to the development of these fractures but only when the cartilage is degenerated to a severe degree as seen in rheumatoid arthritis. Both bone density and cartilage viability may be determining factors in the pathogenesis of trabecular stress fractures in rheumatoid hips.
A study of the cement prosthesis interface has been carried out on the femoral component of 5 total hip relacements which had been in place between 7 weeks and 5 years. In every case a thin layer of connective tissue at varying stages of organization was present between the prosthesis and the cement. This suggests that the prosthesis is not rigidly fixed to the cement and is capable of micromovement. The gap presumably comes about by a combination of factors which include thermal expansion of the femoral stem, shrinkage of the cement and organization of the film of blood or tissue fluid present on the stem at the time of implantation. This information must be used when construction mathematical models of joint replacements, but its clinical significance is not yet fully clear.
Review of 643 autopsies revealed 374 cases of malignant neoplasms, of which 140 were found to have evidence of disease metastatic to the vertebral bodies of the thoracolumbar spine. A comparison is made of the proportion of cases detected by clinical radiographs antemortem vs. the cases of metastatic tumor of the spine detectable by radiographs of slabs of the spine and by histologic examination. A high degree of correlation was found between metastases detected by fine-detail radiography and those detected by microscopic examination. Thus, the incidence of neoplastic metastases to the thoracic and lumbar vertebral bodies is presented, and the reliability of fine-detail radiography is assessing the presence of neoplastic metastases at autopsy is indicated.
The technique of fine detail radiography is presented with a discussion of its value to the pathologist. The current availability of safe equipment for fine detail radiography makes this technique highly useful in the examination of calcified tissues as well as a wide variety of soft tissues.
Abnormalities of the embryonic development of the aortic arch system and the great vessels produce a multiplicity of anomalies. This discussion deals with an unusual combination of congenital abnormalities of the aortic arch system found at necropsy in a 71 year old woman. The condition had not produced any clinical signs or symptoms and was totally unsuspected.
A scanning electron microscopic study of six cases of pyrophosphate arthropathy has been conducted. In the majority of cases the crystals were rectangular. In some cases giant crystals were present. In one case, the crystals were pyramidal. It is concluded that many geometrically different forms of calcium pyrophosphate crystal exist and that the scanning electron microscope is a useful tool in the differentiation of pyrophosphate arthropathy from other forms of crystal synovitis.
This study was conducted to evaluate the theory that increased rigidity in the subchondral cancellous bone and trabecular stress fractures are responsible for the development of osteoarthritis. Histological sections of the entire femoral head were examined in 80 normals, 50 cases with early degenerative changes, and 50 cases with advanced osteoarthritis. It was found that trabecular stress fractures occur normally and show no greater incidence in early osteoarthritis. Increase in thickness of the trabeculae not associated with fractures is seen, but only after considerable cartilage disruption. It is concluded that trabecular stress fractures are not of importance in the development of osteoarthritis.
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A recently recognized complication of intertrochanteric fracture is a subcapital fracture occurring at the tip of the blade of an intertrochanteric fracture fixation blade plate. Histological examination reveals that this is not a fatigue fracture but is the result of stress concentration effects of a stiff metalic device. This fracture may be prevented by using a blade plate with a long blade which is well seated in the head, and by removing the metallic device as soon as it is safe to do so. Ultimate prevention lies in using a more compatible material for the internal fixation of fractures.
In a review of subcapital fractures due to metastases in the femoral neck it was found that in the majority of cases pain in the region of the hip developed a few days prior to fracture. While the majority of subcapital fractures are sustained as the result of a single incident of trauma, in cases with metastases trabecular stress fractures occur in increasing numbers until finally femoral neck fracture occurs. It would seem that once a critical number of trabecular stress fractures has been reached the patient develops pain. Immediate radiologic examination should be performed, and if there is evidence of bone destruction approaching 50% of the cortex, prophylactic hip pinning is strongly indicated.
The material from a case of Tietze's disease has been examined histologically. A review of the literature on the pathology of this lesion correlated with the findings from this case indicates that there is a pathological lesion in the costal cartilage in this disease. This consists of an increased vascularity and degenerative changes with patchy loss of ground substance leading to a fibrillar appearance. Cleft formation may occur with mucoid debris which may undergo calcification. Hypertrophic changes may be present at the periphery. The aetiology still remains obscure.
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