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Joint changes in idiopathic hemochromatosis.

Two patients with idiopathic hemochromatosis and a distinctive arthropathy are presented. The joint findings are characterized by joint narrowing, prominent osteophytes, subcondral sclerosis and multiple lucent subchondral cysts, and chondrocalcinosis. The etiology of this arthropathy and its relationship to chondrocalcinosis are discussed. Occasionally, patients may present with this arthropathy before the onset of the classical signs of idiopathic hemochromatosis.

Bone Cysts↗

Solitary phalangeal defect in the hand. Report of 2 rare cases.

Two unusual causes of bone defect in the finger are described. In one patient, erosion of the proximal phalanx was caused by a ring that eroded its way through the soft tissue and bone after an injury. In the other, a subungual wart caused a defect on the distal phalanx.

Adolescent↗

Bone and soft tissue abnormalities of the upper extremity in diabetes mellitus.

Roentgenographic evidence of bone and soft tissue abnormalities may be noted in the upper extremities of diabetics. Major shoulder changes, typically associated with peripheral neuropathy, include humeral head deformity due to bone resorption, joint space narrowing, subchondral cysts and sclerosis, subluxation, and juxtra-articular soft tissue bone fragments. Charcot-type joints, characterized by severe joint destruction, sclerosis, multiple bone fragments, and soft tissue swelling may occur. Diabetic neuropathy can produce flexion contractures of the hand. Abnormalities not necessarily associated with clinical neuropathy include cystic bone changes, cortical bone erosions, soft tissue calcification (calcific tendinitis), and vascular calcification.

Aged↗

Osteoblastic response to successful treatment of metastatic cancer of the prostate.

Increasing sclerosis of bone in patients with prostatic cancer most commonly is associated with disease progression. In a study of serial radiographs in a group of 18 patients who experienced objective clinical remission after treatment of metastatic cancer of the prostate, eight (44%) showed an osteoblastic response as part of their healing reaction to successful therapy. The importance of a blastic response as a possible sign of clinical improvement is emphasized. Clinical, biochemical, and bone scan correlations are discussed as they apply to patients who respond favorably to treatment of metastatic cancer of the prostate.

Adenocarcinoma↗

Terminal phalangeal sclerosis in sickle cell disease.

Hand films of 100 patients with sickle cell disease were analyzed in order to establish the type, distribution, and incidence of terminal phalangeal sclerosis. Fifty hand films from patients with no known sickle cell disease matched for age and race were also studied. Twenty-four of 100 patients with sickle cell disease, with 14 less than 20 years old, showed clear evidence of terminal phalangeal sclerosis, while only 10% of the controls were positive. The incidence was significantly different from the control group (chi 2 = 4.1949, d.f. = 1, p less than 0.05) suggesting that terminal phalangeal sclerosis is a significant finding in a young patient with sickle cell disease.

Adolescent↗

Ribbing disease (multiple diaphyseal sclerosis): imaging and differential diagnosis.

OBJECTIVE: This study describes the clinical presentation and the course of Ribbing disease in six patients and illustrates imaging features on plain radiography, conventional and computed tomography, and 99mTc-methylene diphosphonate bone scans. MATERIALS AND METHODS: Between 1982 and 1990, six female patients presented with painful bony lesions that were believed to be Ribbing disease. Ten bones were affected: both tibiae in three patients, a unilateral tibia in one, both femora in one, and a unilateral femur in one. Plain radiographs and either conventional or computed tomography were available for all patients and 99mTc-methylene diphosphonate bone scans, for five patients. All patients underwent open biopsy and/or surgical decompression. RESULTS: The diagnosis was reached in all patients through a combination of clinical findings (lack of systemic signs of infection or laboratory values suggesting metabolic bone disease), imaging, histologic evaluation, and specimen cultures. Radiographs and tomographic studies showed benign-appearing endosteal and periosteal cortical thickening. Intense uptake of radionuclide tracer was confined to the shaft of all involved bones. All pathologic specimens revealed nonspecific changes that included a slow increase in the mass of cortical and endosteal bone. These specimens also assisted in excluding neoplastic or infectious causes for the new bone formation. CONCLUSION: Ribbing disease is a rare disorder that, on imaging studies, may simulate stress fracture, chronic infection, bone-forming neoplasia, or a systemic metabolic or endocrine disorder. Clinical and imaging features may suggest the correct diagnosis.

Adult↗

Intraspinal posterior epidural cysts associated with Baastrup's disease: report of 10 patients.

OBJECTIVE: This study was performed to describe the association of posterocentral epidural cysts with interspinous bursal fluid in Baastrup's disease using MRI and interspinous bursography. CONCLUSION: Interspinous bursal fluid in Baastrup's disease can extend into the posterocentral epidural space and cause various degrees of central canal stenosis. Bursography alone or combined with CT allows documentation of abnormal communicating channels between the interspinous bursa and epidural cyst.

Adult↗

Radiographic structural findings in the mandibular condyles of young individuals receiving orthodontic treatment.

Radiographic findings in mandibular condyles were studied from the pre- and post-treatment panoramic radiographs of 625 orthodontic patients. The subjects' mean age was 11 years at the start and 14 years at the end of active orthodontic treatment. Radiographic condylar findings were seen in 14 (2%) subjects before treatment and in 54 subjects (9%) after treatment (p < 0.001). In age-related controls (n = 783) condylar findings were seen in 3% (p < 0.001). The condylar finding was 'flattening only' in half of the patients and in one-third of the controls with condylar findings. Activator treatment was associated with condylar findings (p < 0.05). Condylar findings increased with age in the orthodontically treated subjects (p < 0.05) but not in the unselected population controls. This may mean that condyles become more sensitive with age in children. Increase with age may be partly due to the radiographic interpretation, since minor condylar findings are difficult to observe in young children, and partly due to differences in treatment modalities and the duration of treatment.

Activator Appliances↗