Association of the presence of bone bars on radiographs and hip fracture in postmenopausal Caucasian women.

AIM: To determine whether the presence of bone bars (BB) identified on anteroposterior hip radiographs are more prevalent in patients that have had a hip fracture as compared to patients without a fracture. MATERIALS AND METHODS: Ninety-two Caucasian women with a unilateral proximal femur fracture were retrospectively evaluated and randomly selected using radiology database records to comprise the investigational group. Ninety-eight age-matched Caucasian women without hip fracture were selected as a control group. Anteroposterior hip radiographs were evaluated for the presence of BBs by two musculoskeletal radiologists. Chi-square tests were used to assess whether fractures were more prevalent in patients with BB than those without BB. RESULTS: The patient population was comprised Caucasian women with a mean age of 79.8 ± 6.4 years in the control group and 79.9 ± 6.6 years in the investigational group. Regardless of the reader, BB were identified in a significantly higher percentage of women with a fracture (75 versus 39%, p < 0.001 or 53 versus 38%, p = 0.041) as compared to those without a fracture. CONCLUSION: BB are associated with hip fracture. Their presence is a trigger for requesting a dual-energy x-ray absorptiometry (DXA) examination to confirm or refute a diagnosis of low bone mineral density (BMD) and a subsequent increased risk of fracture.

Molecular pathology of chondroid neoplasms: part 2, malignant lesions.

This is the second part of a two-part review presenting an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. The first part presented a brief review of modern methods in molecular pathology, along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. This second part reviews the cytogenetic and molecular genetic findings in malignant chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images.

Molecular pathology of chondroid neoplasms: part 1, benign lesions.

This two-part review presents an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. This first part presents a brief review of methods in molecular pathology along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images. Malignant chondroid neoplasms will be considered in the second part of this review.

Oxidation of oxa and thia fatty acids and related compounds catalysed by 5- and 15-lipoxygenase.

The modified fatty acids, (Z,Z,Z)-(octadeca-6,9,12-trienyloxy)acetic acid, (Z,Z,Z)-(octadeca-9,12,15-trienyloxy)acetic acid, (all-Z)-(eicosa-5,8,11,14-tetraenyloxy)acetic acid, (all-Z)-(eicosa-5,8,11,14-tetraenylthio)acetic acid, 3-[(all-Z)-(eicosa-5,8,11,14-tetraenylthio)]propionic acid, (all-Z)-(eicosa-5,8,11,14-tetraenylthio)succinic acid, N-[(all-Z)-(eicosa-5,8,11,14-tetraenoyl)]glycine and N-[(all-Z)-(eicosa-5,8,11,14-tetraenoyl)]aspartic acid, all react with soybean 15-lipoxygenase. The products were treated with triphenylphosphine to give alcohols, which were isolated using HPLC. Analysis of the alcohols using negative ion tandem electrospray mass spectrometry, and by comparison with compounds obtained by autoxidation of arachidonic acid, shows that each enzyme-catalysed oxidation occurs at the omega-6 position of the substrate. In a similar fashion, it has been found that (Z,Z,Z)-(octadeca-6,9,12-trienyloxy)acetic acid, (Z,Z,Z)-(octadeca-9,12,15-trienyloxy)acetic acid, (all-Z)-(eicosa-5,8,11,14-tetraenylthio)acetic acid and 3-[(all-Z)-(eicosa-5,8,11,14-tetraenylthio)]propionic acid each undergoes regioselective oxidation at the carboxyl end of the polyene moiety on treatment with potato 5-lipoxygenase. Neither (all-Z)-(eicosa-5,8,11,14-tetraenylthio)succinic acid nor N-[(all-Z)-(eicosa-5,8,11,14-tetraenoyl)]aspartic acid reacts in the presence of this enzyme, while N-[(all-Z)-(eicosa-5,8,11,14-tetraenoyl)]glycine affords the C11' oxidation product. The alcohol derived from (Z,Z,Z)-(octadeca-6,9,12-trienyloxy)acetic acid using the 15-lipoxygenase reacts at the C6' position with the 5-lipoxygenase.

Osteosarcoma in a patient with McCune-Albright syndrome and Mazabraud's syndrome.

Sarcomas infrequently develop in osseous sites of fibrous dysplasia. We report a patient with Mazabraud's syndrome (polyostotic fibrous dysplasia and soft tissue myxomas) complicated by the development of osteogenic sarcoma in a bone affected by fibrous dysplasia. This is the third case of osteosarcoma within the small population of reported patients with Mazabraud's syndrome. There may be an increased incidence of malignant transformation in these individuals' dysplastic bones above that associated with patients suffering from fibrous dysplasia alone.

Magnetic resonance imaging in coccidioidal arthritis.

OBJECTIVE: The authors assessed the MRI findings of appendicular coccidioidal arthritis. DESIGN: T1- and T2-weighted MR images of affected joints, both with and without intravenous gadopentetate dimeglumine, were performed in nine adult patients (ten studies) and evaluated by three masted readers, using a four-point certainty scale for: synovial abnormality, articular cartilage loss, subarticular bone loss, abnormal marrow signal, enhancement of osseous and articular structures, and assessment of disease activity. Findings were correlated with biopsy results or clinical course. RESULTS: Eight patients had active and one had inactive arthritis, involving the knee (five patients), ankle (two patients), and elbow (one patient). Synovial complex was the most common finding in active arthritis (P < 0.025). Cartilage and subarticular bone loss were seen 56% and 89% of patients with active disease, respectively. Abnormal marrow signal was uncommon (two patients). All cases showed synovial and/or osseus enhancement. CONCLUSIONS: MRI findings in coccidiodal arthritis are described. Enhancement of thickened synovium and erosions was seen after intravenous gadopentetate.

Small cell osteosarcoma of the soft tissue.

The lesion we described is an osteoid producing mitotically active spindle cell soft tissue neoplasm, which has light and ultrastructural features of an osteosarcoma. By immunohistochemistry it marks with p30/32MIC2-directed antibodies but fails to react with antibodies associated with other soft tissue neoplasms. The precise histogenesis of the lesion is unknown, but failure to elicit a periosteal reaction makes the periosteum less likely to be the primary tissue of origin. The failure to demonstrate any radiologic or histologic evidence of involvement of the underlying bone leaves the soft tissue as the most reasonable site of origin, although the parosteal region cannot be completely excluded.

Rickets and osteomalacia are still around.

The terms rickets and osteomalacia describe gross, histologic, and radiologic abnormalities common to more than 50 diseases that vary in cause and clinical presentation. Rachitic and osteomalacic syndromes seen in current clinical practice usually are resistant to vitamin D forms and are most often caused by phosphate loss or 1,25(OH)2D deficiency, or both. Radiographic identification of rachitic or osteomalacic syndromes and accurate diagnosis of a particular cause is essential, as many patients' conditions can be improved or cured with proper therapy.

Imaging of the pelvis and hip.

Imaging is basic in the orthopedic evaluation of hip disorders. For optimal evaluation of these images, the orthopedic surgeon must not only correlate normal anatomy and pathology with radiographic findings, but must also be familiar with the newer modalities of CT, magnetic resonance imaging and ultrasound and the role and place of these studies in the evaluation of musculoskeletal disorders. This article correlates normal anatomy of the hip with these modalities and discusses the details of these techniques, particularly CT and MRI, that are pertinent to the orthopedic surgeon.

Radiologic reporting of skeletal trauma.

The radiologist's report of skeletal trauma should include accurate, appropriate comments directed to the clinical objectives of the referring physician. An organization of these reports is suggested, addressing general and specific description of fractures with a discussion of pertinent clinical considerations.

Imaging of the elbow with an emphasis on trauma.

This article provides a review of imaging of the elbow with an emphasis on trauma. The pertinent bone and soft-tissue anatomy of the elbow is discussed, with particular attention paid to the soft-tissue anatomy of imaging importance. The pediatric patient is considered and the basic radiographic examination is outlined. Finally, selected problems of elbow trauma are addressed and the various types of fractures are detailed.

Snapping scapula: a review of the literature and presentation of 14 patients.

The syndrome of pain at the vertebral edge of the scapula and snapping associated with movement of the shoulder that occurs spontaneously after trauma or surgical procedures to the shoulder girdle is relatively common. The snapping is described in the literature as being due to an exostosis on the undersurface of the vertebral angle of the scapula, which rides across the rib cage. The pain has been reported to be the result of inflamed bursae located between the scapula and adjacent thorax or over the scapular exostosis. This retrospective study of a small group of patients with the syndrome attempts to define, by detailed x-ray studies, the presence or absence of exostosis at the vertebral angle. In none of these cases was a bony abnormality or exostosis identified clinically or radiologically. The irritating symptoms can be relieved by physiotherapy; surgery is unnecessary.

Kyphosis and pulmonary function in cystic fibrosis.

Spine deformity and chronic pulmonary disease are commonly seen in patients with cystic fibrosis (CF). In order to assess the prevalence of kyphosis, a retrospective evaluation of all initial standing chest radiographs of our CF patients matched with our "reference" population was undertaken. We also studied the possible correlation between the degree of kyphosis and the pulmonary function tests ( PFTs ), consisting of thoracic gas volume and maximal expiratory flows. In our population, the study confirmed an increased prevalence of kyphosis in CF patients (p less than .01), which occurred mostly in girls after 12 years of age (p less than .018). The kyphosis appeared to be, in most instances, of mild degree and was not related to any of the PFTs . No measurable increase of kyphosis was observed over a 3-year period in the group. Longer prospective study and the relationship of kyphosis to endocrine function in CF at puberty should be undertaken.

Radiographic disease patterns at the carpus.

Radiographic analysis of the wrist includes evaluation of general nonspecific alterations of the carpus, changes specific to one or several diseases, the location of the abnormalities, and the pattern of disease. Correlation with clinical history is extremely important. Some diseases, such as gout, are usually detectable clinically. Others, such as chondrocalcinosis or chronic infection, may have been unrecognized prior to the radiographic study. Special investigations are necessary in difficult cases.

Relation between pelvic phleboliths and diverticular disease of the colon.

The frequent occurrence of colon diverticula and pelvic phleboliths in older persons in Western society has been attributed to the long-term effects of a low-fiber diet. If diet is a common factor for both processes, their incidence should be related. A statistical study was performed to correlate the number and size of pelvic phleboliths with the amount of colon diverticular disease present at barium enema. Examination of barium enemas of 203 patients (98 male, 105 female) aged 60-69 years showed no statistical difference between the genders in regard to the location and amount of either diverticular disease or number and size of pelvic phleboliths . There was no statistical correlation between the amount of diverticular disease and the mere presence or absence of pelvic phleboliths . However, when phleboliths were present, there was a definite statistical correlation between the number and size of the phleboliths and the degree of diverticular disease present. On the basis of this study, the relation between phleboliths and colon diverticula seems complex and needs further examination.

Osteoporosis, osteomalacia, rickets, and Paget's disease.

Although the common form of osteoporosis associated with aging can be treated, it is best to avoid the problem by not letting the disease develop. Osteomalacia is caused by inadequate or delayed mineralization of bone and is treated by correcting the abnormal intake, loss, or metabolism of vitamin D, phosphate, and calcium. Paget's disease is characterized by osteoclastic resorption of bone with new bone laid down in a disorganized fashion.