Clinicoradiological diagnosis of benign osteoblastoma of the spine in children.

Three cases of benign osteoblastoma of the spine in children are reported, diagnosed on the basis of clinicoradiological findings and confirmed at surgery and by histopathology. The authors feel that in all cases of painful scoliosis and painful torticollis, a careful search should be made for any suspicious area of sclerosis, especially in the posterior elements of the vertebrae, and all the positive or suspected cases should undergo nuclear bone scanning. All patients whose bone scan is positive should be subjected to computed tomography for differential diagnosis between osteoid osteoma and benign osteoblastoma.

Spinal brucellosis.

Twenty-four cases of spinal brucellosis are described. We believe that it is possible to distinguish this condition from spinal tuberculosis on the basis of the clinical and radiological findings.

Neuroendocrine response in acute heart failure and the influence of treatment.

Vasoactive humoral factors were measured in 27 patients before and during the first week of conventional treatment of acute heart failure. On admission, all patients were given frusemide intravenously, followed by oral digoxin and diuretic therapy. Before drug treatment, plasma renin activity and plasma angiotensin II concentrations were within normal ranges in the group of patients without previous diuretic treatment, but were significantly higher in those 16 patients already on diuretic drugs when admitted to hospital. After diuretic treatment, however, even the former group revealed activation of the renin-angiotensin system. Plasma concentrations of catecholamines were increased initially but normalized within 1 day. A majority of the patients initially had very high plasma concentrations of atrial natriuretic peptide (mean 276.9 +/- 39.0 pg ml-1) which decreased but did not normalize during the study period. High plasma levels of arginine vasopressin (mean 56.8 +/- 14.6 pg ml-1) were found, but tended to be reduced during treatment. Thus, patients with acute heart failure displayed increased plasma concentrations of atrial natriuretic peptide, arginine vasopressin and catecholamines, but these vasoactive hormones decreased in parallel to clinical improvement during diuretic therapy. In contrast, the renin-angiotensin system became clearly activated.

Percutaneous, tunneled silicone elastomer central venous catheters for total parenteral nutrition: low sepsis and thrombosis rate. A prospective study of 315 catheters.

Silastic catheters were inserted by the percutaneous route, and tunneled subcutaneously, in 315 patients who needed venous access for total parenteral nutrition. The catheters were managed with a daily program that included heat sterilization of the metal hub with an electrical soldering iron. This study aimed to evaluate prospectively the incidence of catheter-related sepsis and thrombosis. There was one case of pneumothorax. All catheters were x-rayed post-insertion: eight catheters were malpositioned initially. The median catheter duration was 18 days with a range of 2-138 days. The total duration was 240 catheter-months. Twenty-seven catheters were removed due to mechanical problems. Nine were removed because of suspected sepsis; six patients had negative blood and catheter cultures, while three grew pathogens. The sepsis rate was thus 0.95%. There were no clinical signs of thrombosis. Pull-out venography was performed in 93 patients. Fibrin sleeves were seen in the majority of cases. Two patients had wall-adherent, non-occlusive thrombus masses (2%); they both had proximal catheter positions. We conclude that there is a low risk of catheter-related sepsis and thrombosis with this technique.

Leri-Weill syndrome (dyschondrosteosis): a family study.

Madelung's deformity due to Leri-Weill Syndrome (Dyschondrosteosis) is a rare condition. Six cases of this entity involving two generations in one family are reported in this communication. The differential diagnosis of the various causes of Madelung's deformity are briefly discussed.

Severe aortic stenosis in elderly patients.

Clinical and non-invasive findings were compared with catheterisation data in 91 elderly patients (mean 65 years, range 52-78) with suspected severe aortic stenosis requiring operation. Heart catheterisation showed that forty nine patients had a valve area of less than or equal to 0.6 cm2, 36 had a valve area of 0.7 - 1.0 cm2, and six an area of greater than or equal to 1.1 cm2. Coexistent aortic regurgitation was found in 85% of the cases, but severe regurgitation was found in only one patient (1%). Seventy seven per cent of patients had chest pain, 74% had dyspnoea, and 46% had exertional vertigo or syncope. Coronary angiography, which was performed in 77 patients, showed coronary artery disease in 24% of those with a history of angina pectoris and in none of those without. All patients had echodense valves; aortic valve calcification was shown by x ray in 76% and in all but one by cineradiography. The peak of the systolic murmur was delayed in 98% of the patients. Although a prolonged left ventricular ejection time was characteristic of severe aortic stenosis, a normal value did not exclude this diagnosis. Most patients (84%) had increased QRS amplitude on the electrocardiogram. Echocardiography showed an increased left ventricular wall thickness in 90% of the patients in whom it was possible to define the myocardial borders. There was an inadequate blood pressure increase in response to exercise in 82%. In about 25% of the patients the exercise test was at variance with the New York Heart Association classification. Findings suggesting severe aortic stenosis resembled those reported for younger age groups. When most findings point to severe aortic stenosis, the absence of a single symptom or non-invasive sign does not exclude severe aortic stenosis.

Non-invasive assessment of aortic and mitral regurgitation.

A non-invasive method for the assessment of the degree of regurgitation in aortic and mitral regurgitation is presented. Regurgitant volume was obtained by subtracting effective stroke volume (SV eff), determined with a CO2-rebreathing method, from total stroke volume (SV tot) determined by M-mode echocardiography. Regurgitant volume and a non-invasive regurgitant index (SV tot/SV eff) were compared with semiquantitative angiography in 49 patients [mean age = 62 +/- 11 (SD) years], who on the basis of the angiography were allocated to four different groups (no, slight, moderate and severe regurgitation). Eighteen normal subjects [mean age = 26 +/- 9 (SD) years], not subjected to angiography, served as a control group and are included in the group without regurgitation. When the cube formula was used for the determination of SV tot, the average regurgitant volumes for the different groups were: 0.5 +/- 24 (SD), 15 +/- 22, 85 +/- 48 and 138 +/- 65 ml and the corresponding SV tot/SV eff ratios were: 1.0 +/- 0.3, 1.2 +/- 0.3, 2.4 +/- 0.8 and 3.8 +/- 1.5, respectively. There were significant differences (P less than 0.01) between the groups with slight, moderate and severe regurgitation respectively both for regurgitant volume and regurgitant index, but no significant difference between the group with slight regurgitation and the group without regurgitation. This study suggests that the severity of aortic and mitral regurgitation can be estimated non-invasively by the combined use of a CO2-rebreathing method and echocardiography.

Predictive value of interpeduncular distance measurement in children.

The value of measurement of the interpeduncular distance (IPD) in the investigation of a suspected pathologic intraspinal lesion was assessed in a series of 55 children referred for myelography from a university department of paediatrics. An IPD exceeding +2 SD was almost always associated with skeletal abnormality. Myelography disclosed pathologic lesions in two-thirds of 14 such patients. When no skeletal malformation was present, a large IPD (i.e. exceeding +2 SD) was found as expected. Myelography disclosed pathologic lesions in 2 of 6 such patients. Among 31 patients with normal IPD measurements 8 had pathologic lesions. Measurement of IPD may be of little value in the investigation of intraspinal changes in the lumbar region in children.

Scoliosis angle. Conceptual basis and proposed definition.

The most commonly used methods of assessing the scoliotic deviation measure angles that are not clearly defined in relation to the anatomy of the patient. In order to give an anatomic basis for such measurements it is proposed to define the scoliotic deviation as the deviation the vertebral column makes with the sagittal plane. Both the Copp and the Ferguson angles may be based on this definition. The present methods of measurement are then attempts to measure these angles. If the plane of these angles is parallel to the film, the measurement will be correct. Errors in the measurements may be incurred by the projection. A hypothetical projection, called a 'rectified orthogonal projection', is presented, which correctly represents all scoliotic angles in accordance with these principles. It can be constructed in practice with the aid of a computer and by performing measurements on two projections of the vertebral column; a scoliotic curve can be represented independent of the kyphosis and lordosis.

Primary results of conservative treatment and osteotomy in coxa plana: a radiological comparison.

In comparison with conservatives measures, does varus and derotation osteotomy accelerate recovery and prevent femoral deformation in Perthes Disease? In groups of 25 treated with osteotomy, and 22 treated conservatively, the primary anatomic result after reossification was judged from the radiographs by visual appraisal, and that is without introducing any measurements. The severity of the disease (the maximum epiphyseal involment) was the same in both treatment groups. The anatomic result (the shape of the femoral head after reossification) was in both groups found to be related closely to the age of patient and the severity of the disease. There was no demonstrable improvement in anatomic result in the osteotomized group. This could be explained by a similar effect of the conservative and surgical treatments or that neither was effective.

Coxa plana: a radiological comparison of the rate of healing with conservative measures and after osteotomy.

Subtrochanteric osteotomy has been reported to interrupt the destructive phase of coxa plana and speed up the rate of healing. The aim of this investigation was to test the validity of these statements. The material comprised twenty-five patients treated by osteotomy and thirty-three patients treated by support in a Thomas's splint. For every patient the extent of the radiological changes was estimated and plotted against time as a percentage of the normal epiphysial volume. The graph so obtained represents the rate of destruction and re-ossification, as well as the maximum involvement of the epiphysis. The curves for each group of patients were superimposed in a graph with all the minima coincident in time. The two patterns of curves are closely similar. It was confirmed statistically that the rates of destruction and re-ossification did not differ between the two groups. The results afford no evidence that osteotomy interrupts the disease or speeds up healing.