[Osteomyelitis sicca in Crohn disease--coincidence or extraintestinal manifestation?]. / Osteomyelitis sicca bei Morbus Crohn--Koinzidenz oder extraintestinale Manifestation?

In patients with Crohn's disease arthritis of the large joints, osteomalacia, osteoporosis and aseptic bone necrosis as a consequence of malabsorption and glucocorticoid intake may occur. The case of a patient with long-standing Crohn's disease is presented who subsequently developed abacterial osteomyelitis of the jaw ("osteomyelitis sicca"). The symptoms of the osteomyelitis improved under immuno-suppressive therapy. Because the etiopathogenetic concepts for Crohn's disease and osteomyelitis sicca are similar, the latter could be a rare extraintestinal manifestation in Crohn's disease, not described previously.

[Oral submucosal pseudosarcomatous nodular fasciitis. Case report]. / Orale submuköse pseudosarkomatöse noduläre Fasziitis. Ein Fallbericht.

A case of enoral submucosal pseudosarcomatous fasciitis is described to demonstrate the possible localisation of this lesion in the oral cavity and correlated diagnostic problems. It is a rapid, local invasive growing, self-limiting tumor which seldom exceeds a diameter of 1-2 cm. Malign transformation and metastatic spread did not occur when the tumor was excised. A simple surgical excision is the adequate treatment. The knowledge of this lesion seems to be important for different-diagnostic exclusion of malignant mesenchymal tumors and to prevent in this way a too extended surgical therapy.

Ethanol embolization of a renal tumor, complicated by colonic infarction.

Since 1981 ethanol has been used to ablate renal tumors. Although initially was stated that no danger exists of accidental embolization of other arteries recently 2 patients were described with colonic infarction following renal ablation. We present a similar case, in which emergency surgery was performed to resect a necrotized part of the colon, and a colostomy was constructed. Recommendations in order to prevent this complication are discussed.

Bone scintigraphy in patients with juvenile kyphosis (M. Scheuermann).

A group of 32 patients between 10 and 16 years of age with a positive history and physical examination of juvenile kyphosis were studied. Both radiological and nuclear bone scanning studies of the spinal column were performed. Despite gross radiological abnormalities of the spinal column due to M. Scheuermann the bone scan was always negative. In 2 patients increased radionuclide accumulation was found due to active spondylodiscitis and a healing discitis. Our conclusion is that when a positive bone scan of a patient with M. Scheuermann is found one should consider other causes of involvement of the spinal column than juvenile kyphosis.

Detection of inflammatory bowel disease with 99mTc DTPA.

The possible scintigraphic detection of active inflammation of the bowel was studied after injection of Tc diethylene triamine pentacetic acid (DTPA). The study included 5 cases of proven active colitis ulcerosa or Crohn's disease and 6 volunteers without any gastrointestinal complaints. No significant differences in the images of both groups could be demonstrated. In both groups some accumulation of radioactivity in the intestines was found, but it was impossible to distinguish any anatomical entity. The sensitivity of Tc DTPA scanning seems to be insufficient to differentiate between a reactivation and a chronic inflammatory process.

Sensitivity of ultrasound in the detection of biliary tract obstruction.

In 28 patient with varying degrees of biliary obstruction, the ultrasonic findings were correlated with the serum bilirubin levels and with the size of the bile ducts as measured by percutaneous transhepatic cholangiography (PTC). With ultrasound, study of the intrahepatic ducts achieved the greatest accuracy (71%); examination of common bile ducts and the gallbladder were found to be less sensitive (54 and 53%). Ultrasound proved to be very accurate in biliary obstruction, when the serum bilirubin was above 4.8 mg/100 ml (80 mumol/1).