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[Osteoporotic changes in rheumatoid arthritis--longitudinal bone mass study and effect of 1 alpha-hydroxyvitamin D3].

Serial measurements of bone mass were carried out by single photon absorptiometry and/or X-ray microdensitometry of the second metacarpus in 29 rheumatoid arthritis patients not treated by corticosteroids. The effect of 1 alpha-hydroxyvitamin D3 on rheumatoid arthritis was also investigated by longitudinal bone mass study. In premenopausal females and also males, the rate of radial diaphyseal bone loss was less than 1%/year and bone loss was seen only in the periarticular region of affected joints. On the other hand, bone loss was much more rapid in both the periarticular and diaphyseal regions in postmenopausal patients. 1 alpha-hydroxyvitamin D3 administration for more than 1 year produced no significant change of blood biochemical examination and Lansbury's index, but resulted in a significant attenuation of bone loss rate.

Absorptiometry, Photon↗

Robinow syndrome: report of one case.

We report a 2-month-old infant with Robinow syndrome. Clinical manifestations included short stature, characteristic facies, mesomelic brachymelia, brachydactyly, camptodactyly, duplication of thumbs, hypoplasia of clitoris, and deformed pronated foot. A cytogenetic study revealed a normal female karyotype. Chest radiography showed rib anomalies, a vertebral anomaly in T8, narrowing of interpedicular distances and flaring with slight thickening of the bone cortex in the bilateral humeral bone. Hand and foot radiography showed generalized shortening include unequal size of metacarpal, metatarsal and phalangeal bones. In our case, sporadic or autosomal recessive inheritance was most likely. The literature is reviewed.

Abnormalities, Multiple↗

Bone age determination in children with Legg-Calvé-Perthes disease: a comparison of two methods.

In 100 children (17 girls, 83 boys) with Legg-Calvé-Perthes disease, the average chronological age, pelvis bone age, and hand-wrist bone age were significantly different for the girls (8.2, 6.9, and 7.0 years, respectively; p < 0.05) and the boys (8.2, 7.4, and 5.9 years, respectively; p < 0.05). For the girls, the chronological age was greater than the pelvis bone age and the hand-wrist bone age (p < 0.05); there was no difference between the pelvis and hand-wrist bone age. For the boys, the chronological age was greater than the pelvis bone age and the hand-wrist bone age (p < 0.05); the pelvis bone age was greater than the hand-wrist bone age and less than the chronological age (p < 0.05). The acromelic growth in Legg-Calvé-Perthes disease may explain why the more proximal pelvis bone age in boys was less delayed than that of the more distal hand-wrist.

Age Determination by Skeleton↗

Giant-cell-bearing lesions of bone of the hands.

Giant cell tumors, giant-cell reparative granulomas, and aneurysmal bone cysts may produce rarefying defects in the bones of the hand. The radiologic features of the three lesions overlap so much that the distinction must be made on the basis of pathologic study. Experience at the Mayo Clinic and reports in the literature suggest that, when small bones are involved, giant cell tumors are more likely to be multicentric and to recur; two thirds of the giant cell tumors of small bones, 39 per cent of the giant cell reparative granulomas, and 33 per cent of the aneurysmal bone cysts recurred. This difference in recurrence makes it seem important to distinguish these three benign lesions.

Bone Cysts↗

Evolution of the human hand: approaches to acquiring, analysing and interpreting the anatomical evidence.

The discovery of fossil hand bones from an early human ancestor at Olduvai Gorge in 1960, at the same level as primitive stone tools, generated a debate about the role of tools in the evolution of the human hand that has raged to the present day. Could the Olduvai hand have made the tools? Did the human hand evolve as an adaptation to tool making and tool use? The debate has been fueled by anatomical studies comparing living and fossil human and nonhuman primate hands, and by experimental observations. These have assessed the relative abilities of apes and humans to manufacture the Oldowan tools, but consensus has been hampered by disagreements about how to translate experimental data from living species into quantitative models for predicting the performance of fossil hands. Such models are now beginning to take shape as new techniques are applied to the capture, management and analysis of data on kinetic and kinematic variables ranging from hand joint structure, muscle mechanics, and the distribution and density of bone to joint movements and muscle recruitment during manipulative behaviour. The systematic comparative studies are highlighting a functional complex of features in the human hand facilitating a distinctive repertoire of grips that are apparently more effective for stone tool making than grips characterising various nonhuman primate species. The new techniques are identifying skeletal variables whose form may provide clues to the potential of fossil hominid hands for one-handed firm precision grips and fine precision manoeuvering movements, both of which are essential for habitual and effective tool making and tool use.

Animals↗

Chondrosarcoma of the bones of the hand.

Nineteen chondrosarcomas are reported arising in proximal phalanges or metacarpal bones of the hand mainly in elderly patients, predominantly women. The usual clinical presentation was of a progressively painful large tumour, often arising in a dormant lesion near the metacarpo-phalangeal joint. Radiologically most showed some bone expansion with a poorly defined area of destruction and a considerable soft-tissue swelling. Histologically, malignancy was usually obvious, but confusion might arise from the inclusion of bland areas of chondromatous tissue that probably represented the original lesion. Four tumours, initially curetted and grafted, recurred locally and necessitated amputation of the digit or ray. Amputation was the primary treatment for fourteen other tumours and was curative except in one patient who eventually needed amputation through the forearm for a large second recurrence. One tumour was satisfactorily controlled by excision of the affected phalanx. None of these nineteen tumours is known to have metastasised. Correct treatment implies a carefully considered balance between conservation of function and complete removal of all tumour tissue.

Adult↗

Bone minerals in beta-thalassemia minor.

Homozygous beta-thalassemia is a severe hereditary disorder associated with osteopenia. Recently it was suggested that thalassemia minor may be a risk factor for osteoporosis. The purpose of the present study was to investigate this suggestion. Bone mineral status was assessed in 22 premenopausal women and 21 men with beta-thalassemia minor. In vivo neutron activation analysis was applied to measure hand-bone phosphorus (HBP), single-photon absorptiometry to measure forearm bone mineral content (BMC), and dual-energy X-ray absorptiometry to measure spinal bone mineral density (BMD). Comparison of the HBP, BMC, and BMD values with those of sex- and age-matched healthy subjects without the beta-thalassemia trait failed to indicate a statistically significant difference for either sex group. Concerning the biochemical markers of bone metabolism that were studied (serum calcium, phosphate, alkaline phosphatase, osteocalcin, and parathyroid hormone, and 3-h fasting urine calcium-to-urine creatinine ratio) no difference was observed between the study subjects and matched controls. In conclusion, the present study showed that subjects with beta-thalassemia minor are not at risk for osteoporosis.

Absorptiometry, Photon↗

Tumor resection and antibodies to parathyroid hormone-related protein cause similar changes on bone histomorphometry in hypercalcemia of cancer.

Bone resorption is increased in both humoral hypercalcemia of malignancy (HHM) and primary hyperparathyroidism. On the other hand, bone formation parameters are increased in primary hyperparathyroidism and decreased in HHM. Recently, a PTH-related protein (PTHrP) has been shown to be responsible for the hypercalcemia in the syndrome of HHM. In the present study we evaluated the effects of a neutralizing antiserum to PTHrP on bone histomorphometric parameters in hypercalcemic athymic mice bearing a human squamous cell lung cancer. These effects were compared to those of tumor resection. Similar to the effects of tumor resection, the antiserum to PTHrP resulted in a decrease in serum Ca levels, a decrease in bone resorption, and an increase in bone formation parameters. The studies, therefore, indicate that PTHrP is the major factor responsible for all of the features, including the decreased bone formation seen in HHM.

Animals↗

[Effect of ethnic affiliation and the high altitude factor on the tubular bones of the hand in children from Dagestan (x-ray osteologic study)].

Dimentions of tubular bones were compared concerning ethnic and climatic-geographical peculiarities of populations (under the conditions of ethnic homogenity of the groups). The data obtained demonstrated that Avarian people living at the altitude of 2,000 m differ from Avarian people living at the altitude of 1,000--1,100 m and from Kumyk people living at the foothills (500--600 m) in faster growth of the tubular bones of the hand and in their larger dimentions. Activation in bone growth of the Avarian people living high in the mountains results in "discoordination" of increment values of separate dimentions and in decrease of the correlation level.

Adolescent↗

Bone marrow hypoplasia in anorexia nervosa: a case report.

If hematological abnormalities appear to be a common feature of severe anorexia nervosa, on the other hand bone marrow hypoplasia seems to be comparatively rare. We recently encountered a patient with anorexia nervosa who demonstrated a hypoplastic bone marrow associated with gelatinous transformation. These abnormalities were rapidly reversible with intensive nutritional rehabilitation. Bone marrow hypoplasia and gelatinous transformation are discussed in relation to current concepts of the role of nutrition in hematopoiesis in humans.

Adult↗

Hand metastasis from renal cell carcinoma with no bone involvement.

Hand metastases account for 0.1% of all metastases and most of them involve primarily the bones. A case of a metastasis from renal cell carcinoma to the distal segment of the little finger with no bone involvement is described. In view of the fact that the kidneys are the origin of only 10% of hand metastases, such a case is extremely rare.

Carcinoma, Renal Cell↗

Primary bone tumours of the hand and wrist.

Primary bone tumours are rare in the hand and wrist. This 34-year survey of the Leeds Regional Bone Tumour Registry reveals 80 such tumours, representing 3.9% of the total number of bone tumours in the registry. The large majority of these tumours were benign (86%), and were found predominantly in younger patients. Malignant lesions were found more frequently in older patients. 61% of tumours were found in the metacarpals and proximal phalanges. Two-thirds of patients (67.5%) presented with features of swelling, either with or without pain. We conclude that the information gathered from Bone Tumour Registries is of value in describing tumour characteristics, where such information could not be gathered by personal experience alone.

Adolescent↗

Dual-photon bone densitometry in normal Australian women: a cross-sectional study.

Osteoporosis is a major health problem in Australia, as it is in most Western societies. Bone mineral density in the spine and femoral neck are accurate indicators of osteopenia and thus useful indicators of the risk of a fracture. Dual-photon absorptiometry is a non-invasive technique that allows the accurate quantitation of bone mineral density in the lumbar vertebrae and proximal femur with a low radiation exposure. The increasing availability of this technique dictates the requirement for "normal" ranges and quality control. We report here lumbar vertebral and proximal femur bone mineral density as measured by dual-photon absorptiometry in 179 normal Australian women. Forearm bone mineral content in these subjects, as measured by single-photon absorptiometry, is also presented. There was a relative stability of lumbar bone mineral density and forearm bone mineral content before the menopause, after which there was an age-related decline. On the other hand, bone mineral density at all three sites in the proximal femur showed an age-related decline throughout adult life. Intraoperator variability in calculated bone mineral density did not exceed 2.3%. The requirement for correct positioning of the patient is illustrated. The data allow statistical analysis and the development of normal ranges. They provide an Australian base against which individual patient values can now be compared.

Adult↗

[Fresh fractures! Classification, management, results and problems: the wrist joint].

Carpal bone fractures are rare, with an incidence of 13% compared to that of fractures and luxations of the hand bones. Generally they are intraarticular fractures. Fracture of the scaphoid bone occurs most frequently, with an incidence of 75%. The greater number of fractures is found in the middle-third of the wrist bordering on the os lunatum. They are usually treated conservatively by splinting with a cast. Surgery is indicated only when the fracture is open, instable, dislocated or combined with carpal instabilities.

Carpal Bones↗

Production of T lymphocyte colony-forming units from precursors in human long-term bone marrow cultures.

T cell differentiation in human marrow was studied in Dexter type long-term bone marrow cultures. In these cultures, T lymphocyte colony-forming units (TL-CFU), E rosette-forming cells (E+), and T3+, T4+, and T8+ cells (assayed by indirect immunofluorescence) were found to be present for at least 7 weeks. It was investigated whether the existence of T cells in long-term culture resulted from the persistence of inoculated T lymphocytes or from the production by immature progenitors. No significant numbers of E+, T3+, T4+, or T8+ cells were detected in cultures that were established from E+ lymphocyte-depleted bone marrow, indicating little or no production of T lymphocytes from E-negative precursors. On the other hand, bone marrow cells purged of E+ lymphocytes did not contain TL-CFU, but appeared to regain high numbers of TL-CFU during Dexter culture; this suggested that an earlier step in T cell differentiation may take place in this culture system. The generation of TL-CFU in the E-negative long-term marrow cultures only occurred when an adherent stroma layer had been established in the culture flask; it did not require added mitogens or detectable interleukin 2 in the culture medium. TL-CFU in fresh marrow (TL-CFU II) are mature (E+, T3+) T cells and are capable of producing helper (T4+) and suppressor/cytotoxic (T8+) phenotype cells in colonies. The TL-CFU newly formed in E-depleted Dexter cultures (TL-CFU I) are distinct from this population, as they are E-negative and give rise to colonies of the helper type only. T3 cell depletion of the marrow inoculum prior to culture did not prevent the appearance of TL-CFU I in long-term culture; this suggests that TL-CFU I are derived from an E- and T3- precursor (pre-TL-CFU).

Bone Marrow Cells↗

Radiographic appearance of sesamoid bones in the hands and feet of Malawian subjects.

Our aim was to determine the prevalence of sesamoid bones in adult black Malawians from radiographs of the hands and feet. A total of 255 radiographs from 85 men and 45 women aged 16-66 years were used: 126 of the hands and 129 of the feet. All the hand films revealed one sesamoid bone at the interphalangeal joint and two at the metacarpophalangeal joint of the thumb. All the foot films showed two sesamoid bones at the metatarsophalangeal joint of the big toe. Occasional sesamoid bones were found at the metacarpophalangeal and metatarsophalangeal joints of the index finger and the small toe, respectively. Only 4.8% of the hands had sesamoid bones at the metacarpophalangeal joint of the index finger, compared with reported percentages of between 35% and 64.2% in Caucasians. The present study also records, probably for the first time in Africans, an incidence of 10.8% of sesamoid bones occurring at the metatarsophalangeal joint of the small toe, which again is at variance with the reported range of 5.5-10% in Caucasians. This study provides anatomical data that will help in the diagnosis and management of disorders of sesamoid bones which are often overlooked in Africans.

Adolescent↗