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At least 1,261 records · Page 70Linked to original sources

Extensive extraspinal hyperostoses after long-term oral retinoid treatment in a patient with pityriasis rubra pilaris.

We describe a patient with severe pityriasis rubra pilaris in whom extensive extraspinal hyperostoses developed after 13 years of oral retinoid treatment. The most prominent abnormality was a bridging exostosis between the left acetabulum and collum. X-ray examinations of the spine during retinoid therapy showed no abnormalities. During oral retinoid treatment, it is important to ask the patient on a regular basis about any skeletal pains or mobility restriction. Normal spinal x-ray results are no guarantee that a patient is free of hyperostoses. Discontinuation of acitretin therapy resulted in a severe exacerbation of the patient's pityriasis rubra pilaris after 2 weeks. The clinical response to administration of azathioprine was clearly inferior to that of acitretin. However, low-dose oral methotrexate therapy appeared to be a good alternative in this patient, with a clinical result comparable to acitretin and no side effects after 6 months of therapy.

Acetabulum↗

The diagnostic significance and management of Gardner's syndrome.

Gardner's syndrome is a hereditary disorder characterised by gastrointestinal polyposis, bony osteomata, epidermoid cysts, desmoid tumours and unerupted teeth and odontomes. The major significance of the condition lies in the gastrointestinal polyposis and the high propensity of these polyps to undergo malignant change. The syndrome is no longer considered as a separate genetic entity to familial adenomatous polyposis (FAP) and the multiple stigmata are common to both conditions. A case of Gardner's syndrome is reported and the condition reviewed. The aim being to emphasise those features seen in the head and neck region and their particular importance in terms of early recognition and diagnosis of the underlying disease. The subsequent management of such patients is discussed.

Adult↗

Bifid mandibular condyle resulting from a sagittal fracture of the condylar head.

Sagittal or vertical fractures of the mandibular condyle and chip fractures of the medial part of the condylar head are very rare entities and their identification is difficult with conventional radiographs. We report a case of a unilateral bifid mandibular condyle which resulted following a sagittal condylar fracture. This was associated with a chip fracture of the medial part of the condylar head on the contralateral side. These types of condylar fracture do not require any surgical treatment, but early mobilization is indicated.

Exostoses↗

The presence of the antilingula and its relationship to the true lingula.

20 cadaver mandibles were studied for the presence of an antilingula and its relationship to the true lingula and mandibular foramen. Three independent observers evaluated the mandibles for the presence of an antilingula. It could be identified on all 40 sides. On 9 of the sides, there was complete concordance on the position of the antilingula between the three observers. On the other 31 sides, however, there was a variation between observers of up to 11 mm. In only 43% of the cases was the antilingula within 5 mm of the true lingula. In most cases, the true lingula was postero-inferior to the antilingula. There was a negative horizontal and positive vertical correlation between the position of the antilingula on one side and its position on the contralateral side.

Aged↗

Intermittent axillary nerve palsy caused by a humeral exostosis.

We report an uncommon case of intermittent axillary nerve palsy caused by a humeral exostosis in an 11-year-old boy. After excision of the cartilagenous exostosis of the proximal end of the left humerus, the pre-operative symptoms of axillary nerve compression were alleviated.

Axilla↗

Calcification in Dupuytren's disease: a report of two cases.

Two cases are presented of calcification within Dupuytren's tissue. Histological appearances of the tissue showed both cartilaginous and osseous metaplasia. This indicates that fibroblasts in Dupuytren's Disease may undergo this type of metaplasia in a similar fashion to fibroblasts elsewhere.

Aged↗

Skin tumors.

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Adenoma, Sweat Gland↗

Insulin-like growth factor-I levels and gene expression in ovine hereditary chondrodysplasia (spider lamb syndrome).

Hereditary Chondrodysplasia or Spider Lamb Syndrome (SLS) is an inherited, semi-lethal, musculo-skeletal disease affecting lambs primarily of Suffolk or Hampshire breeding. Deformities of the limbs and spinal column along with multiple sites of ossification at the anconeal process are diagnostic for the disease. Muscle atrophy is also predominant. We have investigated the relationship between SLS and circulating levels of IGF-I and the IGF-BPs in older (50-80 d of age) animals. Serum IGF-I levels were lower (P less than 0.01) in SLS affected lambs (117 ng/ml) than in phenotypically normal lambs (188 ng/ml) while serum levels of the 32 kDa BP increased (P less than 0.01) 77% in SLS affected lambs as compared to contemporary controls. All other IGF-BPs appeared to be unaffected in this group. Gene expression of IGF-I and -II in the liver and muscle of younger (16-22 d of age) lambs was also measured. There were no differences in IGF-II expression in either muscle or liver between SLS affected and phenotypically normal control lambs. Muscle IGF-I expression also did not differ. However, liver IGF-I expression in SLS affected lambs was nearly double that of control lambs (P less than 0.01). These data suggest that the regulation of IGF-I and the IGF-BPs may be involved in the physical manifestations of this disorder.

3-Hydroxybutyric Acid↗

Arthroscopic resection of an intra-articular osteochondroma of the knee in the patient with multiple osteochondromatosis.

Osteochondroma is usually located outside of the joint and is asymptomatic. We have witnessed the symptoms of intra-articular osteochondroma of the knee joint and resected it arthroscopically. A 54-year-old woman with multiple osteochondromatosis presented with pain and a click on the right knee. Click was palpable and audible at the lateral aspect of the patellofemoral joint. Arthroscopy revealed that osteochondroma in the anterolateral site of the distal femur impinged the lateral edge of the lateral facets of the patella and the inflammatory change of the lateral capsule of the patellofemoral joint. Arthroscopic resection of this osteochondroma completely eliminated the symptoms. To our knowledge, this is the first report of arthroscopic resection of an osteochondroma in the intra-articular joint.

Arthroscopy↗

Variations of structure and appearance of the oral mucosa.

Among the most important factors in a thorough clinical examination is the dentist's ability to recognize and make distinctions among normal oral structures, variations of normal structures, and pathologic entities. The practitioner's diagnostic acumen is essential to this process and is a skill gained and refined by clinical experience and continuing education. In this introductory article, the authors describe normal entities, anomalies, and benign soft tissue lesions of interest to the clinician. For presentation, these structures are organized according to their location within the oral cavity.

Exostoses↗

Common nail tumors.

Nail abnormalities are varied and numerous. They include warts, keratoacanthomas, onychomatricomas, fibrokeratomas, osteochondromas, tumors (ie, glomus, giant cell, Koenen's, and others), and Bowen's disease. Although the gravity of these conditions may vary, prompt diagnosis and treatment is of the utmost importance. This article discusses the most common defects associated with the nail unit and its surrounding tissue, as well as the differential diagnosis and treatment of these conditions.

Bowen's Disease↗

Anterior ankle impingement.

The anterior ankle impingement syndrome is a clinical pain syndrome that is characterized by anterior ankle pain on (hyper) dorsiflexion. The plain radiographs often are negative in patients who have anteromedial impingement. An oblique view is recommended in these patients. Arthroscopic excision of soft tissue overgrowths and osteophytes is an effective way of treating anterior impingement of the ankle in patients who have no narrowing of the joint space. For grade II lesions (osteophytes secondary to arthritis with joint space narrowing) arthroscopic treatment is a good option, because no other therapeutic option is available with the exception of an arthrodesis or prothesis.

Ankle Injuries↗

Position of single amino acid substitutions in the collagen triple helix determines their effect on structure of collagen fibrils.

Collagen II fibrils are a critical structural component of the extracellular matrix of cartilage providing the tissue with its unique biomechanical properties. The self-assembly of collagen molecules into fibrils is a spontaneous process that depends on site-specific binding between specific domains belonging to interacting molecules. These interactions can be altered by mutations in the COL2A1 gene found in patients with a variety of heritable cartilage disorders known as chondrodysplasias. Employing recombinant procollagen II, we studied the effects of R75C or R789C mutations on fibril formation. We determined that both R75C and R789C mutants were incorporated into collagen assemblies. The effects of the R75C and R789C substitutions on fibril formation differed significantly. The R75C substitution located in the thermolabile region of collagen II had no major effect on the fibril formation process or the morphology of fibrils. In contrast, the R789C substitution located in the thermostable region of collagen II caused profound changes in the morphology of collagen assemblies. These results provide a basis for identifying pathways leading from single amino acid substitutions in collagen II to changes in the structure of individual fibrils and in the organization of collagenous matrices.

Binding Sites↗

Acromial spur: relationship to aging and morphologic changes in the rotator cuff.

This study's objective is to elucidate the relationship between acromial spur formation and rotator cuff pathology or aging. The subjects comprised 1029 shoulders in control, cadaveric, and operative groups. A radiograph in the supraspinatus outlet view was taken in all subjects. The lengths of the incident spurs were measured and classified into 3 sizes (small, <5 mm; medium, <10 mm; and large, > or =10 mm). The rotator cuff was macroscopically classified as normal or as having bursal-side fraying, joint-side tear, intratendinous tear, bursal-side tear, complete tear limited to the supraspinatus tendon, or massive tear. In the control group, the overall incidence of spurs and spur size increased with advancing age (P < .001), but the majority of spurs were small (<5 mm). In the cadaveric group, the overall incidence did not correlate with advancing age (P > .05). However, spur size increased with age in subjects aged 50 years or older (P < .001). The incidence of spurs in rotator cuffs with bursal-side tears was highest and was significantly higher than that in normal cuffs and cuffs with bursal-side fraying and intratendinous tears. We observed 40% of medium spurs and 69% of large spurs in cases with bursal-side tears, complete tears limited to the supraspinatus tendon, and massive tears. In the operative group, the overall incidence correlated to advancing age (P < .001), reaching 80% or more in subjects aged 30 years or older. In addition, the size of spurs was larger than that in the other 2 groups in all age groups with few exceptions (P < .05). Small spurs were associated with advancing age. Morphologic change to the bursal side of the rotator cuff may enhance spur growth. The presence of a small spur has no diagnostic value for rotator cuff tears. Spurs measuring 5 mm or more, however, are of diagnostic value because of their high rate of association with bursal-side tear, complete tears limited to the supraspinatus tendon, or massive tears.

Acromioclavicular Joint↗