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Paleopathology of the Copper Age mummy from the Val senales glacier.

The unique conditions of preservation of the Copper age mummy found in the Val Senales glacier permit to analyze the general state of health of a man of the late European prehistory. Investigations conducted within the organizational framework of an International Research Project revealed the presence of a series of alterations, that, in a broad sense, can be considered of paleopathological interest. These can be classified as: 1) post mortem lesions, including scalp erosion, alopecia, soft tissue loss in the right gluteal region, right coxo-femoral disarticulation, right sacro-iliac dislocation; 2) lesions that occurred intra vitam, including tattooings, dental wear, trichorrexis nodosa, nail hypoplasia, moderate osteoarthrosis of the lumbar vertebral column and of the coxo-femoral joints, tibio-tarsal osteosclerosis. The palaeopathological analysis of this unique mummy shed vivid light on the mutual interactions between disease, environment, and culture, that shaped human life in a distant past.

Austria↗

[Prognostic factors in idiopathic myeloid splenomegaly].

The study of the evolution of 168 cases of idiopathic myeloid splenomegaly allowed to point out the prognostic value of the clinical, hematologic, isotopic and radiological parameters. The correlation of these data with the histological type of the osteomedullary lesions at the time of the diagnosis, allows to confirm the long survival of the hyperplastic formes (type I), and the more reserved prognosis in advanced myelofibroses (type II and type III together) without it being possible to bring out a significant difference between the average presumption of survival of type II and type III considered each separately. Indeed, average survival is of 82 months for type I, and 60 months for type II and type III together. The regrouping of these two types seems to be justified and allows to individualize two anatomoclinical forms. One is characterized by hyperplastic marrow with reticulinic fibrosis, usually associated with enlarged spleen and sometimes even with polyglobulia but without radiological bone lesions. The other form is characterized by a marrow of middle importance or frankly hypoplastic, fibrous, with or without osteosclerosis, and shows moderate or marked radiological changes (respectively 16,9 p. 100 of the cases, and, as a rule, pancytopenia.

Adolescent↗

Intra-articular osteoid osteoma: diagnostic imaging in three cases.

PURPOSE: To report our experience pertaining to three cases of intra-articular osteoid osteoma assessed by means of integrated imaging and review of literature. MATERIALS AND METHODS: Medical records, radiologic and nuclear medicine findings pertaining to three cases of intra-articular osteoid osteoma were retrospectively evaluated and compared with those of surgery. All the patients (2 males, one female; age range 8-38 ys) affected by intra-articular osteoid osteoma respectively of the elbow, tibio-talar joint and hip were evaluated by means of radiographic examination and Magnetic Resonance Imaging (MRI). SE T1-w and T2-w, GRE T2*-w, GRE 3D T1-w and STIR pulse sequences were used and axial, coronal and sagittal images were acquired. Two patients underwent CT scan. One patient underwent skeletal scintigraphy. All the patients underwent surgery. RESULTS: In 2 out of 3 cases plain radiography allowed the radiologist to suspect the presence of the lesion. In the remaining one, plain radiography failed to detect both the nidus and the perilesional osteosclerosis; nevertheless, a small osteochondral erosion of the humeral condyle suggested the presence of joint inflammation, thus leading to further investigation. CT scan well depicted the presence of the nidus and, in one case, the presence of joint effusion. MRI was always able to detect the nidus, which presented as lesion of low to intermediate signal in T1-w images, low signal in the T2-w images in one patient and high signal in the remaining two; in these latter STIR images showed high intensity nidus and edema of neighbouring cancellous bone. Furthermore, in all patients MRI clearly depicted joint effusion. Skeletal scintigraphy demonstrated both the lesion and the inflammatory involvement of neighbouring soft tissue. In all patients histologic specimen confirmed the diagnosis of osteoid osteoma with joint inflammation and synovitis. CONCLUSIONS: According to our results and literature data the pre-surgical diagnosis of osteoid osteoma is very difficult to achieve. Indeed, only the combination of clinical information and radiologic and nuclear medicine findings enables the radiologist to make the right diagnosis.

Adolescent↗

[Prognostic value of bone and bone marrow lesions of primary myeloid metaplasia].

This study of the history of 117 cases of agnogenic myeloid metaplasia with myelofibrosis underlines the importance of anatomo-pathological and radiological parameters for prognosis. Histological staging of bone and bone marrow lesions at time of diagnosis enables one to confirm long survival of cases with hyperplasia (Group I) and more severe prognosis for advanced myelofibrosis (that is both groups II and III considered together) but does not enable to establish a significative difference between medium survival of cach group II and III considered separately. Those medium survivals estimated are the following: 82 months for group I; 60 months for both groups II and III. Thus, it is logical to consider together these two groups among which one can distinguish two anatomoclinical forms. One is characterized by bone marrow hyperplasia with reticulin myelofibrosis and is usually associated with large spleen and even in some cases with polycythemia but without radiologic bone lesions; the other is characterized by bone marrow of medium or hypoplasic constitution fibrosis, with or without osteosclerosis and with radiologic bone lesions of mode-rate or important extension (respectively 16.9 p. cent of cases) and is usually associated with pancytopenia.

Bone Marrow↗

[Clinical study of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach].

OBJECTIVE: To improve the level of diagnosis and treatment of optic nerve trauma at the canalicular segment. METHOD: Fifty-two patients with optic nerve trauma at the canalicular segment received decompression of optic canal through combined orbit, ethmoid and sphenoid approach. RESULT: The visual improvement rate of all 52 patients was 42.3%, 73.9% in 23 patients with secondary optic trauma and 17.2% in 29 patients with primary optic trauma. Patients's vision covered from 0.05 to 0.6 after six months. CONCLUSION: The advantages of decompression of optic nerve through combined orbit, ethmoid and sphenoid approach include easily operation and location, short approach, wide visual field and clear anatomy mark, so it is very safe and suited for those patients with dysplasia and osteosclerosis of ethmoidal or sphenoidal sinus. Orbital CT scan facilitates the diagnosis of optic canal fracture without false positive results. The curative effect is associated with the type of optic nerve trauma and the chance of surgery. Amaurosis shortly after trauma is a dangerous factor of poor prognosis, but it isn't impossible to improve vision if patients receive operation as early as possible.

Adolescent↗

[Myeloid leukemia with myelofibrosis (author's transl)].

Myelofibrosis is observed in 1/5 of the cases of C.M.L. It consists of reticulin fibers with few collagen and no osteosclerosis. It involves signs which usually indicate the extension of the myelosis to other organs and other types of cells: hepatosplenomegaly, erythroblastosis, thrombocytemia. Its prognosis is always bad. In one third of the cases, myelofibrosis develops early, and in two third it is late. Chimiotherapy is not responsible for it. These forms of C.M.L. with myelofibrosis appear as a special type of myeloproliferative disorder apart from the true C.M.L. and the true osteomyelofibrosis.

Alkaline Phosphatase↗

NTP Toxicology and Carcinogenesis Studies of 4-Hexylresorcinol (CAS No. 136-77-6) in F344/N Rats and B6C3F1 Mice (Gavage Studies).

4-Hexylresorcinol, which is used as an anthelmintic and antiseptic, was nominated by the National Cancer Institute for study. Toxicology and carcinogenesis studies were conducted by administering 4-hexylresorcinol (greater than 99% pure) in corn oil by gavage to groups of F344/N rats and B6C3F1 mice of each sex for 16 days, 13 weeks, or 2 years. Sixteen-Day and Thirteen-Week Studies: In the 16-day studies, groups of five rats and five mice of each sex were administered 0, 31.3, 62.5, 125, 250, or 500 mg/kg 4-hexylresorcinol. Survival was not affected. Decreased body weights were seen in male rats that received 250 or 500 mg/kg 4-hexylresorcinol. No other effects were observed. In the 13-week studies, groups of 10 rats and 10 mice of each sex were administered 0, 62.5, 125, 250, 500, or 1,000 mg/kg of the chemical, 5 days per week. All rats and male mice and 9/10 female mice that received 1,000 mg/kg died before the end of the studies. Final mean body weights of male rats that received 250 or 500 mg/kg were 22% or 38% lower than that of the vehicle controls; final mean body weights of female rats that received 250 or 500 mg/kg were 16% or 9% lower. No compound-related gross or microscopic pathologic effects were observed in rats. No body weight effects were observed for mice. Mild to moderate nephropathy was dose related in male and female mice. Based on these results, 2-year toxicology and carcinogenesis studies of 4-hexylresorcinol were conducted by administering 0, 62.5, or 125 mg/kg to groups of 50 F344/N rats and 50 B6C3F1 mice of each sex, 5 days per week. Body Weight and Survival in the Two-Year Studies: Mean body weights of high dose male rats were 7%-11% lower than those of the vehicle controls throughout the study. Mean body weights of low dose male and dosed female rats were similar to those of the vehicle controls. The body weights of dosed male and dosed female mice were comparable to those of vehicle controls except during the last 16 weeks of the studies, when body weights were 6%-16% lower in the dosed groups. No significant differences in survival were observed between any groups of rats or mice of either sex (male rats: vehicle control, 30/50; low dose, 29/50; high dose, 33/50; female rats: 28/50; 32/50; 30/50; male mice: 36/50; 26/50; 30/50; female mice: 35/50; 32/50; 35/50). Nonneoplastic and Neoplastic Lesions in the Two-Year Studies: Two astrocytomas and an oligodendroglioma were observed in high dose male rats, a glioma was observed in one low dose male rat, and an oligodendroglioma was observed in one vehicle control male rat. These neoplasms were not considered to be related to 4-hexylresorcinol administration. Focal medullary hyperplasia of the adrenal gland was observed at increased incidences in dosed male mice (5/50; 16/50; 10/49). Pheochromocytomas in male mice occurred with a marginal upward trend (1/50; 2/50; 5/49). Historically, these neoplasms are observed in about 1% of corn oil vehicle control B6C3F1 male mice. The incidences of neoplasms of the harderian gland in male mice were slightly increased over those in the vehicle controls (adenomas or carcinomas, combined: 0/50; 4/50; 3/50). Decreases were observed in the incidences of mononuclear cell leukemia in dosed male (12/49; 7/50; 1/50) and female (16/50; 3/50; 2/50) rats, hepatocellular adenomas or carcinomas (combined) in dosed male mice (21/50; 9/50; 9/50), and circulatory system tumors in male (10/50; 4/50; 2/50) and female (6/50; 2/49; 0/50) mice. These decreased incidences of tumors in rats and mice are considered to be possibly related to 4-hexylresorcinol administration. The incidences and severity of nephropathy (male: 39/50; 43/50; 47/50; female: 7/50; 40/49; 47/50) and incidences of osteosclerosis (male: 5/50; 5/50; 15/50; female: 21/50; 25/49; 40/50) were increased in both dosed male and female mice and are considered to be related to chemical exposure. Genetic Toxicology: 4-Hexylresorcinol was not mutagenic for Salmonella typhimurium strains TA98, TA100, TA1535, or TA1537 with or without S9 metabolic activation. 4-Hexylre, TA1535, or TA1537 with or without S9 metabolic activation. 4-Hexylresorcinol induced forward mutations at the TK locus in mouse L5178Y cells in the presence of S9; no response was observed in the absence of metabolic activation. In cytogenetic assays with cultured Chinese hamster ovary (CHO) cells, 4-hexylresorcinol caused an increase in the frequency of sister chromatid exchanges (SCEs) in the absence of metabolic activation; no induction of SCEs was observed in the presence of S9. Chromosomal aberrations were not induced in CHO cells with or without metabolic activation. Data Audit: The data, documents, and pathology materials from the 2-year studies of 4-hexylresorcinol were audited at the NTP Archives. The audit findings show that the conduct of the studies is documented appropriately and support the data and results given in this Technical Report. Conclusions: Under the conditions of these 2-year gavage studies, there was no evidence of carcinogenic activity of 4-hexylresorcinol for male or female F344/N rats given doses of 62.5 or 125 mg/kg. There was equivocal evidence of carcinogenic activity of 4-hexylresorcinol for male B6C3F1 mice, as shown by marginally increased incidences of pheochromocytomas (and hyperplasia) of the adrenal medulla and of harderian gland neoplasms. There was no evidence of carcinogenic activity for female B6C3F1 mice given doses of 62.5 or 125 mg/kg 4-hexylresorcinol. Decreased incidences of three tumors types were considered related to 4-hexylresorcinol administration: mononuclear cell leukemia in male and female rats, hepatocellular neoplasms in male mice, and circulatory system tumors in male and female mice. Synonyms: 4-hexyl-1,3-benzenediol; 4-hexyl-1,3-dihydroxybenzene

Journal Article↗

Pycnodysostosis presenting with bilateral subtrachanteric fractures: case report.

A 50-year-old woman had bilateral subtrochanteric fractures over a period of 9 months; both fractures were found to be in osteosclerotic femora. The patient was multiparous with 5 normal children. Since subtrochanteric fractures represent only 5 per cent of all femoral neck fractures the occurrence of bilateral subtrochanteric fractures in a relatively young woman suggested an unsuspected underlying disease. Clinical and laboratory investigations showed no evidence of systemic, metabolic, infective or malignant disease. The patient's short stature, peculiar facies in association with osteosclerosis in medullated long bones and typical radiographic findings: hypoplastic claviculae, absent ungual tufts of distal phalanges, hypoplastic paranasal sinuses, and obtuse mandibular angles suggested the proposed diagnosis of pycnodysostosis, a rare autosomal recessive osteosclerotic condition, that has been described in less than 50 cases, including only one Jew. Despite 2 technically difficult surgical hip operations, a 3-year follow-up showed good remedullarization of both fractured femora and no limitation in the patient's daily activities.

Bone Screws↗

Osteomyelosclerosis. A histopathological study of osteomedullary lesions on 32 cases.

The pathological features of the osteomyleoproliferative syndrome development were studied by trephine biopsy on 32 cases out of which 28, lesionally characterized by myeloproliferation, reticulin hyperplasia, intravascular hematopoiesis, myelofibrosis, myeloslerosis, and osteosclerosis, were interpreted as primary osteomyelosclerosis. Dynamic relationships between the myelogenous tissue and the osteogenous one are emphasized in the development of disease.

Adolescent↗

The radiologic spectrum of abnormalities of the foot in diabetic patients.

Radiologically visible lesions in the feet of patients with long-standing diabetes mellitus are common and varied. They include osteoporosis, osteosclerosis, osteolysis, juxta-articular defects of the cortical bone, ischemic bone necrosis, new bone formation, spontaneous fracture and subluxation, and neuropathic arthropathy. These manifestations result from diabetic angiopathy and neuropathy and usually are complicated by infection. In this review the author describes these protean radiologic features in light of their pathogenesis and discusses the diagnostic problems encountered.

Diabetes Complications↗

[IDIOPATHIC HYPERCALCEMIA IN THE CHILD: 2 NEW CASES AND REVIEW OF THE LITERATURE].

Several reports of idiopathic hypercalcemia of childhood have been published since Lightwood in 1932 described dwarfism associated with mental retardation, strabismus, hypercalcemia, nephrocalcinosis and osteosclerosis. The present paper adds two new cases. The first patient was 15 months old when first seen with stunted physical and mental growth, a systolic murmur, and a serum calcium value of 13 mg. %. This child suffered several severe infections and in spite of a low calcium intake and the administration of chelating agents her blood calcium rose until death six months later. The other patient, three years old, also had delayed physical and mental development, typical facies, a systolic murmur, skeletal lesions, and nephrocalcinosis. Varied therapeutic attempts failed.Idiopathic hypercalcemia of childhood is reviewed in the light of the 94 reports already published.

Chelating Agents↗

[Tarsometatarsal syphilitic osteoarthropathy].

Bone lesions that develop in the course of tertiary syphilis in the tarsus and the metatarsus are considered by most of the authors as being exceptionaly rare. In the author's statistics the tarso-metatarsal localizations are just as frequent as the tibial ones--generally recognized as elective localizations. A total of 10 cases are presented, of patients with tarso-metatarsal luetic osteoarthropathy, characterized by a mosaic of destructive lesions (osteoporosis, osteonecrosis, osteolysis, bone goma, spontaneous amputations of bone segments), coexisting with bone-constructive lesions (osteophitosis, compact layer condensation, osteosclerosis, peridiaphisal-epiphiseal muff), with periostal and articular reactions. The general clinical signs, the neurological symptoms, the local clinical signs and the specific serologic reactions fill in the nosological frame of the tarso-metatarsal luetic osteoarthropathy, a clinical entity clearly defined by the author. The fact is stressed that, as a rule, cutaneous lesions on the soles of the feet are wrongly taken for simple callosities, while, in fact, these are perforating lesions of the sole, a revealing peripheral sign, which, correctly interpreted, allows for making the diagnosis of tertiary syphilis with tarso-metatarsal osteoarthropathy.

Aged↗

[X-ray diagnosis of hemophiliac pseudotumors].

Of 259 hemophiliacs bone pseudotumors were diagnosed in 11 (4.3%); they were localised in the femur (6 cases), calcaneus (4) and in the iliac bone (3). Two cases of combined femoral and calcaneal lesions and 4 cases of bone fracture were observed. As a rule, pseudotumors developed in hemophiliacs with severe disease. An x-ray picture of a pseudotumor depended on its site and was characterized by a large soft tissue tumor shadow, often with calcinosis, and serious destructive changes in bones in the form of round foci of 7 cm in diameter with clear-cut contours. An edge defect of the cortical layer was defined in the diaphysis of the femoral bone (15 cm long). Destructive changes were often accompanied by osteosclerosis and periostitis.

Adolescent↗

Soluble receptor activator of nuclear factor kappaB Fc diminishes prostate cancer progression in bone.

Prostate cancer (CaP) develops metastatic bone lesions that consist of a mixture of osteosclerosis and osteolysis. We have previously demonstrated that targeting receptor activator of nuclear factor kappaB ligand (RANKL) with osteoprotegerin (OPG) prevents the osteolytic activity of CaP and its ability to establish tumor in bone. However, OPG can block tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-mediated apoptosis, suggesting that the clinical use of OPG may prevent apoptosis of tumors mediated by TRAIL. Thus, methods to block RANKL activity, other than OPG, may be important. Accordingly, we evaluated the ability of soluble murine RANK-Fc (sRANK-Fc) to prevent progression of established CaP in a severe combined immunodeficient mouse implanted with fetal human bone. We first confirmed that sRANK did not block TRAIL-mediated apoptosis of LuCaP cells in vitro and that it did block LuCaP-conditioned media-induced osteoclastogenesis in vitro. Then, LuCaP 35 CaP cells were injected into the marrow space of the bone implanted in the severe combined immunodeficient mice implanted with fetal human bone and allowed to develop into tumors for 6 weeks. Either vehicle or sRANK-Fc was then administered for 6 weeks. sRANK-Fc diminished tumor-induced osteoblastic lesions as demonstrated by radiograph, bone mineral density measurement, and bone histomorphometry. sRANK-Fc also reduced systemic bone remodeling markers, including serum osteocalcin and bone-specific alkaline phosphatase and urine N-telopeptide of collagen. Finally, sRANK-Fc decreased serum prostate-specific antigen levels and tumor volume in the bone, which indicates decreased tumor burden. In contrast, sRANK-Fc had no effect on s.c. implanted LuCaP cells. We conclude that sRANK-Fc is an effective inhibitor of RANKL that diminishes progression of CaP growth in bone through inhibition of bone remodeling.

Animals↗

The expression of selected immunocytochemical diagnostic markers in the case of chondrosarcoma with a mesenchymal component.

The case of 52-year-old man is presented, who had suffered from pains in his right brachial region and in whom, upon admission to the Lower Silesia Centre of Oncology, a tumour of 20 cm in diameter and restricted mobility was disclosed in the right brachial region and proximal 1/3 of his right arm. Radiograms of his right humerus disclosed non-uniform restructuring of the osseous tissue, dominated by osteosclerosis in the upper half of his right humerus, while in the surrounding dift tissues of the proximal portion non-uniform shades were seen of calcified appearance. The patient was qualified to surgical biopsy and histopathological examination of the sample disclosed Chondrosarcoma G II. Following amputation of the right upper extremity together with the scapula, the tumour was subjected to histopathological and immunocytochemical examination in the Department of Pathomorphology, Lower Silesia Centre of Oncology. In numerous samples of the tumour dedifferentiated chondrosarcoma was diagnosed with a dominating component of malignant fibrous histiocytoma (MFH), which was confirmed by detecting a high expression of alpha-1-antichymotrypsin (ACT) within the spindle-shaped cell component of the chondrosarcoma. Spindle-shaped elements in dedifferentiated chondrosarcoma (DChSa) may represent patterns of fibrosarcoma, osteosarcoma or the malignant fibrohistiocytoma (MFH) type and they are present as if in the form of restricted fields with no reciprocal infiltrates. Moreover, due to the worse prognosis in the case of the MFH component in dedifferentiated chondrosarcoman as compared to that in classical chondrosarcoma, common evaluation of the material was made by a surgeon, radiologist and histopathologist, accompanied by a minimum panel of immunocytochemical tests (ACT, Vimentyna, Desmina, S-100). This enabled a final diagnosis for all tumour components to be established and prognosis to be made regarding the further fate of the patient.

Biomarkers, Tumor↗

Intraarticular osteoid osteoma of the elbow.

The case of a man who developed osteoid osteoma of the elbow is presented. Intraarticular osteoid osteoma of the elbow is a rare lesion presenting both diagnostic and therapeutic problems. The radiologic features of intraarticular osteoid osteoma include osteosclerosis (usually a dominant feature at initial imaging and typically enveloping the nidus), joint effusion and periosteal reaction that can involve the bone in which the osteoid osteoma arises and the adjacent bones. Awareness of these features facilitates correct diagnosis, thereby enabling timely and appropriate treatment.

Adult↗

[MR imaging of degenerative lumbar disc disease emphasizing on signal intensity changes in vertebral body].

Magnetic resonance imaging was performed in 400 patients with degenerative disc disease. Signal changes and their sites in the vertebral body were classified and referred to narrowing of the intervertebral disc space. MR findings were compared with those of plain roentgenograms of the lumbar spine. Signal changes in the vertebral body were noted in 83 cases (102 vertebral bodies). Low-intensity abnormality on both T1- and T2-weighted images (WI) was the most common finding, and was most frequently seen at the end plate and/or the angle. These changes were correlated with narrowing of the disc space and osteosclerosis on the plain roentgenogram of the lumbar spine. Signal changes occasionally occurred in the inner region of the vertebral body, and these lesions tended to show a high-intensity abnormality on T1-WI. We conclude that signal changes in degenerative disc disease are not specific, but are sometimes difficult to distinguish from the signal changes in other conditions such as spinal tumor or bone marrow disorder.

Humans↗

[Fluoride toxicity].

Many years have passed since domestic water fluoridation was adopted to reduce the incidence of caries in developed countries; however, since there is an additional dose of fluorides ingested with foods and drinks prepared with such waters, the problem has emerged of possible adverse effects on health associated to them, so that in some countries fluorine integrator selling is allowed only with preventive medical prescription. Owing to the affinity for calcifited tissues, fluorine has a powerful effect on bone cellular order (mediated by growth factors' upregulation system IGF-2, TGF-beta, PDGF, bFGF, EGF, BMP-2 and PTH), on function and length, since it can provoke chronic joints-pain, ligaments-calcification, osteosclerosis. Moreover, sodium-fluoride may cause adverse effects on testicular activity (connected to oxidative-stress depending on increased activity of peroxidases and catalases) due to inhibition of 2 androgenesis-regulator enzymes DELTA(5)b-HSD and 17beta-HSD. Furthermore, insoluble gut formed calcium-fluoride may be responsible for hypocalcemia inducing a secondary hyperparathyroidism with bone matrix resorption, osteoporosis, osteomalacia and, perhaps, lowered level of phosphorus. At encephalic level, then, high doses of fluorine cause the onset of neurological symptoms and of a decreased spontaneous motor activity due to a reduction in the number of nicotinic acetylcholine receptors. Nevertheless, epidemiological studies about fluoride toxicity have established that such oligoelement may be safely used at odontoiatric dosages.

17-Hydroxysteroid Dehydrogenases↗