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Unknown syndrome: ischiadic hypoplasia, renal dysfunction, immunodeficiency, and a pattern of minor congenital anomalies.

We report a 6 year old male with a pattern of malformations and anomalies including intrauterine growth retardation, microcephaly, psychomotor retardation, a pattern of craniofacial anomalies (flat face, hypertelorism, epicanthic folds, strabismus, short nose, low set ears), hypospadias and cryptorchidism, bilateral partial cutaneous syndactyly between fingers 2 to 5 and toes 2 to 4, postaxial polydactyly of the fingers and toes, severe conductive hearing loss, hypoplasia of the ischiadic bones, complex renal dysfunction, hypogammaglobulinaemia with proneness to bacterial infections of the upper and lower respiratory tract, and recurrent pseudomembranous enterocolitis. The parents are cousins of Turkish origin.

Abnormalities, Multiple↗

Necrotising fasciitis of the leg as a complication of ischiorectal abscess.

This case report describes the rare complication of necrotising fasciitis of the right thigh and calf after drainage of an ischiorectal abscess. The important early symptoms and signs of this life threatening infection, and the need for urgent treatment with aggressive surgical debridement and broad spectrum antibiotics, are emphasised in order to facilitate early recognition and prompt initiation of the appropriate therapy in future cases.

Abscess↗

Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbalgia and ischialgia.

A comparison was made between 50 patients treated with acupuncture and 50 patients treated with transcutaneous electric stimulation. All patients suffered from chronic sacrolumbalgia or ischialgia of more than six months' duration. Two to 10 treatments were given at weekly sessions, the mean being 5 in both groups. Stimulation points were selected by the same principle in both groups: one point along the course of the nerve trunk affected, and one point at a dermatome proximal to the affected segment. The stimulation was given bilaterally. Needles were inserted as deep as the muscular layer and twirled at 5 min intervals. In the electric stimulation square-wave impulses of 1.0 msec duration and 50 Hz frequency were used. The electrodes were 0.9 cm in diameter. Each acupuncture and electric stimulation was of 20 min duration. Pain relief was complete or moderate in the acupuncture group in 58% of the cases, and in 46% in the electric stimulation group. After 2 months 30 patients in the acupuncture group and 23 patients in the electric stimulation group still reported satisfactory relief of pain. After 6 months 15 patients in the acupuncture group and 10 patients in the electric stimulation group still reported satisfactory relief of pain.

Acupuncture Therapy↗

Computed tomography of the osseous pelvis.

Computed tomography (CT) was used for study of the osseous pelvis in 43 patients with definitive pathological or clinical follow-up. CT accurately characterized and determined extent of bone and soft-tissue involvement; neoplasms and other disease processes, such as sacroiliac joint disease, were well localized. In cases of trauma, CT was able to identify, localize, and characterize fracture fragments and bone or joint displacement. CT was judged "useful" or "definitive" in 80% of all lesions and 96% of neoplasms studied.

Adolescent↗

The normal and pathologic ischiorectal fossa at CT and MR imaging.

A wide spectrum of disease processes involve the ischiorectal fossa, including congenital and developmental lesions; inflammatory, traumatic, and hemorrhagic conditions; primary tumors; and pathologic processes outside the ischiorectal fossa with secondary involvement. Both computed tomography (CT) and magnetic resonance (MR) imaging are useful in the definitive diagnosis of these pathologic conditions, with MR imaging being the modality of choice because of its superior contrast resolution and multiplanar capability. In Gartner duct cyst, both CT and MR imaging demonstrate a well-defined, round mass; in tailgut cyst, CT demonstrates a well-defined retrorectal mass with a solid or cystic appearance. MR imaging in particular plays a major role in the assessment of fistula in ano, infection, and hematoma. Lipoma and pelvic plexiform neurofibroma typically have low attenuation and high signal intensity at CT and MR imaging, respectively. Recurrent rectal tumor appears at both modalities as an irregular soft-tissue mass with or without central necrosis in the presacral space, perineum, or pelvic sidewall. Familiarity with the imaging features and differential diagnoses of various ischiorectal pathologic processes will facilitate prompt, accurate diagnosis and treatment.

Adult↗

Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples.

PURPOSE: To determine the utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples in cases of suspected osteomyelitis. MATERIALS AND METHODS: Twenty-five patients with suspected osteomyelitis were prospectively studied over a 1-year period. With usual trephine techniques under radiologic guidance, core and aspiration biopsy samples were obtained in each patient for both histologic and microbiologic analyses. RESULTS: Sixteen biopsy specimens demonstrated histologic evidence of osteomyelitis. Of these, eight were also culture positive. Seven of the eight culture-negative, histologically positive cases were interpreted as chronic osteomyelitis. In no patient were cultures positive and histologic findings negative. Three of 19 patients with proved osteomyelitis had negative histologic and microbiologic findings. The sensitivity of culture in the diagnosis of osteomyelitis in our study was 42%; the sensitivity of both culture and histologic findings was 84%. CONCLUSION: Although the volume of a biopsy specimen is a major determinant of culture yield, a portion of a percutaneous biopsy sample should be histologically evaluated for possible osteomyelitis.

Acute Disease↗

Skeletal findings in human neutrolethyrism. Is there a human osteolathyrism?

In a review of the roentgenological files of 22 patients suffering from spastic paraplegia due to neurolathyrism, 3 patients were found to present abnormal skeletal findings. 2 patients showed absence of union of the secondary ossification centres of the iliac crests, the ischial tuberosities and the vertebral bodies. Their age at the time of ingestion of poisonous Lathyrus sativus plants was 19 and 20 years. The 3rd patient had bowing and thickening of his right femoral shaft. He was 22 years old at the time of poisoning. These findings which are similar to those found in experimental osteolathyrism have never been described in clinical neurolathyrism. They are of a nature to throw some doubt on the correctness of the currently prevailing concept of sharp distinction between these two pathological entities.

Bone Diseases↗

Anatomy of the bony pelvis in parapithecid primates.

Four partial innominate bones, attributed to the parapithecid primates Parapithecus grangeri and Apidium phiomense, have recently been recovered from Oligocene deposits in the Fayum of Egypt. These fossils provide the first documentation of pelvic morphology for early anthropoids. In pelvic anatomy, parapithecids show definite similarities to higher primates rather than to prosimians, but cannot be clearly allied with any one extant group. Functionally, the fossils indicate quadrupedal or leaping habits rather than suspensory or bipedal behaviors.

Acetabulum↗

Ureterosciatic hernia. A rare cause of pyonephrosis.

A female patient presented as an emergency case with pyonephrosis and septicemia as a result of ureterosciatic hernia. Septicemia was treated successfully by immediate percutaneous nephrostomy tubing. After complete disappearance of symptoms, the hernia was closed operatively. Topographic anatomy of ureterosciatic hernia is presented.

Aged↗