Wrist Deformity in Children and Adolescents with b-thalassemia on Oral Iron Chelation Therapy.

OBJECTIVE: To describe a novel wrist deformity in b-thalassemia major patients, and their radiographic and magnetic resonance imaging findings. METHODS: 30 patients with b-thalassemia major who were noticed to have ulnar deviation at wrist joint were evaluated for previous history of medications, serum ferritin levels, presence of pain and swelling at the wrist joint, and the duration of iron chelation therapy. Radiographs of wrist and limited magnetic resonance imaging (MRI) sequences were obtained in 30 and 15 patients, respectively. RESULTS: Radiographs revealed varying severity of distal ulnar shortening, distal radial slanting and presence of soft tissue distal to the ulna. MRI showed similar deformities along with abnormal marrow signal at distal ulnar ends; in 8 patients, a soft tissue distal to the distal end of ulna was noted. CONCLUSIONS: Varying severity of radiological abnormalities, predominantly affecting the distal ulna, are present in children and adolescents with b-thalassemia receiving oral chelation therapy.

A complex injury of the distal ulnar physis: a case report and brief review of the literature.

Physeal fractures of the distal forearm are common injuries in children and adolescents. However, Salter-Harris type III and type IV fractures of the distal ulnar epiphysis are often high-energy injuries that require open reduction for restoration of anatomical alignment. These injuries are uncommon and there are few descriptions of them in the contemporary literature. Here we report the case of a 13-year-old boy with a type IV distal ulna fracture not diagnosed with standard radiography. After closed manipulation, an incompletely reduced physis was suspected on the basis of fluoroscopic imaging and comparison radiographs of the contralateral wrist. Computed tomography showed a large, displaced physeal fragment. The patient underwent open reduction and internal fixation. Thorough radiographic assessment should be conducted when there is a high suspicion for these fracture patterns. Appropriate diagnosis can lead to expedient reduction and expectant management of sequelae associated with these injuries.

A case of decapitation in Canosa, South Italy (5th-6th century A.D.).

The authors present the case of an adult male (20-25 years) with a stature of 175 cm and a body mass of 68 kg, showing many wounds caused by both stabbing and cutting weapons. The subject was found in a tomb in the archeological area on the hill of San Pietro (Canosa, Bari), where there is a Paleo-Christian site dating back to the 6th-7th century a.d. The skeleton shows clear signs of decapitation, due not to an execution but to a fight during a battle.

[Tumor-like bone lesions of the forearm after karate training]. / Tumorartige Knochenalterationen am Unterarm nach Karatetraining.

INTRODUCTION: Differentiation between malignant bone tumors and tumor-like lesions after repetitive microtrauma following sport activities can be difficult just using radiographic methods. METHODS: We present the case of a fifteen year old karate fighter, who was examined by imaging diagnostics because of a progressive swelling and pain in the distal right forearm. RESULTS: A tumor-like appearance with bone mass formation in the x-ray, an enhancement in the surrounding tissue shown in the MRI and an increased activity in the bone scintigraphy made the diagnosis of an osteosarcoma very likely. Blood tests were not helpful. Only the evaluation of a bone biopsy could demonstrate hypertrophic reparative bone formation after multiple osseous microtrauma. Cast immobilisation reduced the osseous alteration. With the start of the training the swelling reappeared again but then finally vanished after modifying the training technique. DISCUSSION: The case demonstrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports. It also stresses the importance of a correct technique in sports like karate.

Bioarchaeological evidence for trophy-taking in prehistoric central California.

Fourteen adult burials in a large (N = 224) prehistoric central California cemetery (CA-SCL-674) lack forearm bones. Twelve of these otherwise well-articulated primary interments have distal humeri bearing cutmarks with a distribution like that seen in fur seals butchered by Native Californians. Most of the burials with missing forearms are young adult males, a demographic profile that differs significantly from the full sample. Three of these males show evidence of perimortem trauma in addition to forearm amputation. Drilled and polished human radii and ulnae were recovered from the CA-SCL-674 cemetery in archaeological contexts separate from burials with missing forearms. A warfare-related trophy-taking practice is strongly suggested by these bioarchaeological data. Based on these data, it seems likely that 20% (N = 10) or more of the adult males (N = 59) in this population were victims of violence. Evidence of perimortem violence was much less common among women, with only about 2% (N = 2) of adult females (N = 86) subjected to trophy-taking. Examination of museum collections produced further evidence for perimortem forearm amputation among the Native American inhabitants of this area during the transition between the Early and Middle periods. The emergence of more hierarchical social systems during this period may have fostered warfare-related trophy-taking as a symbolic tool for enhancing the power and prestige of individuals within competing social groups.

Rickets in a litter of racing greyhounds.

Rickets was diagnosed in six 14-week-old racing greyhound littermates presented with musculoskeletal disease. Physical findings included listlessness, profound muscle weakness, lameness, lateral bowing of the antebrachii and focal hard swellings proximal to the tarsi and carpi. Radiological findings included generalised osteopenia, axial and radial thickening of growth plates, and "cupping' of the adjacent metaphyses; the distal ulnar growth plates were most severely and consistently affected. The diagnosis was confirmed by demonstrating subnormal concentrations of 25-hydroxycholecalciferol in serum samples collected at admission. The pups' diet consisted of an inexpensive generic kibble formulated for adult dogs, porridge, milk, pasta, minced beef, vegetables and a small quantity of calcium carbonate powder. The pups were successfully treated by feeding a nutritionally complete, vitamin D-containing ration formulated for growing pups. Bilateral growth retardation of distal ulnar physes occurred as a sequel in one pup.

Pattern duplication by retinoic acid treatment in the regenerating limbs of Korean salamander larvae, Hynobius leechii, correlates well with the extent of dedifferentiation.

In the regenerating limbs of Korean salamanders, Hynobius leechii, retinoic acid (RA) induces duplication of skeletal structures in the proximodistal (PD) axis and often in the transverse axes. In the present study, the stage-dependent effects of RA for the duplication of limb skeletal structures at two amputation levels, the distal stylopodium and the distal zeugopodium, were studied using larval limbs of Korean salamanders. The results showed that the mean level of proximalization (MLP) by RA treatment increased during the stages of dedifferentiation and early bud formation while the MLP declined thereafter in both amputation levels. The decline of the MLP at the later stages of regeneration was due to the high frequency of hypomorphic regeneration or blocked regeneration. When the effects of RA treatment at two amputation levels were compared, the overall trends were similar but the actual timing was delayed for 2-4 days in the proximal level of amputation. Furthermore, the peak level of proximalization was achieved earlier and the peak level remained longer in the distal stylopodial level of amputation compared to the distal zeugopodial level of amputation. Since the histological observations revealed that the dedifferentiation period was also extended up to 2-4 days in the proximal level of amputation, the acid phosphatase activity during the course of regeneration was measured to look for a quantitative relationship between the enzyme activity and the states of dedifferentiation. The results show that the level and the duration of acid phosphatase activity in the upper arm regenerates are both higher and longer than those in the lower arm regenerates. Furthermore, RA treatment caused an increase in acid phosphatase activity. Thus our results suggest that the state of dedifferentiation might be closely linked to the extent of proximalization of regenerating limbs by RA treatment.

[Quantitative determination of the effect of induced alternating currents on the integration of autologous spongiosa transplants]. / Quantitative Bestimmung des Einflusses von induziertem Wechselstrom auf die Integration autologer Spongiosatransplantate.

In a right-left experiment on the ulna of beagles, the authors investigate the influence of induced alternating current on the number of healed-in autologeous spongiosa grafts taken from the same side of the body. At first an atrophic pseudarthrosis is produced in both ulnae of twenty animals by bone resection and electrocoagulation over six months. Following to spongiosa transplantation and plate osteosynthesis, the ulnae are stimulated during eight weeks with a sinusoidal current of 38 cps and an electromagnetically induced alternating-current voltage of 600 mV on an average. The blindfold evaluation of the X-ray picture is performed by four experts and shows significantly better results in the stimulated side. By variance analysis of the results of electronic planimetry of serial layers in the region of transplantation represented by microradiography, it is demonstrated that the greater bone density of the stimulated grafts compared to the control grafts is statistically significant. It has to be considered that these results refer strictly to the electric data and treatment times applied by the authors. Particularly the results are not valid for the unique application of electromagnetic fields without alternating-current component.

Diminution of bone mass in childhood diabetes.

Photon absorption measurements of forearm bone density in 196 insulin-dependent patients, age 6--26 years, were compared with findings in 124 controls. Expected density, gm. Ca/cm.2 bone width (M/W), was calculated from regressions of M/W on ulnar length for white and black male and female controls. There were no significant correlations between M/W differences from expected and serum Ca, Mg, P, or alkaline phosphatase levels, estimated physical activity level, insulin dosage, or the presence of joint contracture. White females averaged 8.2 per cent (+/- 1 S.E.M.) loss of M/W, as against white male average loss of 4.7 per cent +/- 1 and black female loss of 2 per cent +/- 2 (p less than 0.001); the black male population was too small for separate analysis. M/W loss greater than 10 per cent was seen in 29 per cent of white males, 19 per cent of blacks, and 48 per cent of white females (p less than 0.02). When the groups were further divided into those with duration of diabetes less than or equal to five years and those with duration greater than five years, significant reduction in M/W average loss over time was seen with white females (10.6 per cent +/- 1.2 to 3.7 per cent+/- 1.5, p less than 0.0001). Expression of this defect in bone mineralization is controlled by race and sex acting independently of each other.