Jamshidi needle biopsy of bone lesions

The technique and advantages of using a Jamshidi needle for skeletal biopsies are described, together with the results of 50 consecutive biopsies. A combined clinical, radiological and pathological approach to the lesions can provide the diagnosis in the majority of patients.     

Current aspects of iatrogenic lesions of the bone marrow

An overall study, accompanied by some statistics, is presented of delayed bone marrow injuries caused by drugs, such as chloramphenicol, phenylbutazone, oxyphenbutazone, gold salts, sulphamides and diphenylhydantoin. Unanimous agreement as to the aetiological interpretation of isolated cases, the seriousness of marrow damage, and the results obtained by treatment can be observed in various countries. The available epidemiological data are incomplete, though they point to a parallel between the appearance of panmyelopathy after chloramphenicol and the consumption of this drug. First noted in the U.S., this relationship later became apparent in several European countries and eventually in West Germany. Frequencies range from 1 per 6,000 to 1 per 36,000 subjects treated in California, Hamburg and Sweden.     

Miscellaneous uses of anabolic steroids

The endocrine side effects are mainly androgenic and concern particularly but not exclusively females and children. Depending on individual sensitivity, the dosage used and the androgenicity of the drug concerned, signs of virilization ranging from slight voice disturbances to severe derangement of reproduction can develop, the latter occurring in both sexes. Progestational effects are of little importance. Hepatic alterations are caused almost exclusively by 17 alpha-alkylated steroids and can range from abnormal liver function tests to life-threatening liver tumours. Atherogenic changes in the lipid-lipoprotein balance, again a domain of the 17 alpha-alkylated preparations, might increase the risk of coronary heart disease. The metabolic influences of anabolic compounds can--at excessive dosage levels--create a prediabetic condition and polycythaemia. The influence of anabolic agents on psyche and behavior in normal doses are mostly positive, rendering the drugs useful for adjuvant therapy in patients whose general condition is poor, irrespective of the origin. If given in excessive doses they can cause grave psychic and behavioral disturbances and possibly dependence. Anabolic-androgenic steroids should be used with caution in patients who are particularly sensitive to side effects, where fluid retention must be prevented, in subjects with liver diseases, skeletal metastases of mammary carcinoma, and when longitudinal growth is not completed. They are contraindicated in carcinoma of the prostate and mammary carcinoma in the male and their use should be discouraged in pregnancy and during lactation.     

Fractal dimension of the bone marrow in metastatic lesions

We previously reported that the distribution of the cells in normal bone marrow is fractal and self-similar. The purpose of this study was to determine whether the same is true in metastatic tumors. Thirty-two bone marrow biopsy sections (3 to 5 microm thick) of 28 patients were used to measure the fractal dimensions of the metastatic tumor cells' distribution. Microscopic images were obtained and were used for the fractal measurements. In the two-dimensional images, the fractal dimensions were 1.98 +/- 0.02 (95% +/- 5% cellularity), suggesting a compact nonfractal structure. The dimensions, however, were 1.72 +/- 0.1 (56% +/- 11% cellularity) for the normal components, with a P-value of <.0001 that is in agreement with our previous study. These results suggest that loss of the fractal structure in the metastatic lesions may be attributable to loss or suppression of the regulatory mechanisms maintaining the fractal morphogenesis of the bone marrow. This report provides a novel objective approach in the study of pathophysiology of the bone marrow disorders.     

MRI of posttraumatic cyst-like lesions of bone after a greenstick fracture

Posttraumatic bone-cyst formation is a known but rare process. Typical location is the distal radius, usually as a result of a greenstick fracture. The pathogenesis is unknown; however, subperiosteal migration of fat or hemorrhage with later absorption may cause cyst formation. We present the first reported case of MR imaging of this lesion. At MRI subperiosteal hemorrhage was found to be the cause of cyst formation.     

废杂铜拆解工艺概述

拆解是含铜废品再生的首要任务,文章论述了废杂铜常用的拆解工艺及其流程,指出我国宜选择环境污染小、投资合理、资源回收利用率高的废杂铜拆解工艺。     

Arthritis, hypercalcemia, and lytic bone lesions after hepatitis B vaccination

We report a case of arthritis, hypercalcemia, and lytic bone lesions that occurred shortly after repeated administration of recombinant hepatitis B virus (HBV) vaccine in a 44-year-old man who had had myasthenia gravis 20 years earlier. He presented with ankle and knee arthritis and hypercalcemia. Radiographs revealed small lytic lesions and densitometry showed severe osteopenia. Quantimetric bone biopsy confirmed major bone loss and showed dramatic increase in bone turnover, as well as an unusual periosteal apposition of woven bone. Short term treatment with prednisone and furosemide and longterm treatment with clodronate allowed rapid improvement. After one year, the patient remains clinically asymptomatic. Despite negative immunologic investigations to sustain the hypothesis of HBV vaccination as a causal factor, we believe the bone lesions could be attributed to unusual bone "hyperremodeling" triggered by an immune process in a predisposed individual.     

Focal calvarial bone lesions. Comparison of logistic regression and neural network models

RATIONALE AND OBJECTIVES: To assess the accuracy of logistic regression (LR) and artificial neural networks (NN) in the diagnosis of calvarial lesions using computed tomography (CT) and to establish the importance of the different features needed for the diagnosis. METHODS: One hundred sixty-seven patients with calvarial lesions as the only known disease were enrolled. The clinical and CT data were used for LR and NN models. Both models were tested with the leave-one-out method. The final results of each model were compared using the area under receiver operating characteristic curves (Az). RESULTS: Of the lesions, 73.1%, were benign and 26.9% were malignant. There was no statistically significant difference between LR and NN in differentiating malignancy. In characterizing the histologic diagnoses, NN was statistically superior to LR. Important NN features needed for malignancy classification were age and edge definition, and for the histologic diagnoses matrix, marginal sclerosis, and age. CONCLUSION: NNs offer wide possibilities over statistics for the study of calvarial lesions other than their superior diagnostic performance.     

Considering Mycobacterium haemophilum in the differential diagnosis for lytic bone lesions in AIDS patients who present with ulcerating skin lesions

Incidence of neural tube defects in Poland in the 90's was 2.68 in 1000 births. The value of incidence has not been changed within last twenty years. Mortality caused by neural tube defects in Poland is much higher than in many other European countries and the United States. High rates of incidence of neural tube defects in Poland is probably caused by low utilisation of methods of secondary prevention in a group of low-risk pregnant women. Since methods of primary prevention of neural-tube defects are available; primary prevention with folic acid, should be immediately implemented in Poland.     

Observations on bone formation and remodelling in advanced atherosclerotic lesions of human carotid arteries

Immunolocalisation and histochemical techniques were used to examine mineralised bone deposits within late stage atherosclerotic plaques of human carotid arteries. These specimens showed characteristic features of osteogenesis. Large calcifications were often observed in close association with or integrated within mineralised bone. Smooth muscle cells (alpha-actin positive) were often located around osteoid-like matrix, together with focal accumulations of macrophages (CD68 and HAM56 positive). Local accumulations of mast cells (tryptase positive) were consistently observed in close association with the bone. Multinucleated giant cells in close apposition with mineralised bone demonstrated typical osteoclastic morphology, and were positively stained for acid phosphatase and the macrophage marker CD68. Thus, all the normal features of bone formation and resorption were observed in this microcosm of osteogenesis within atherosclerotic plaque; the term 'osteosome' seems appropriate for the structure. These osteosomes have numerous advantages for experimental studies of the various osteogenic factors responsible for bone metabolism, especially following short-term tissue culture. This ex vivo technique was used to demonstrate the distribution and the multiple cellular sources of bone morphogenetic protein 6.     

Detection of metastatic bone lesions in patients with prostate carcinoma: 99Tcm-monoclonal antibody imaging

Bone scintigraphy has been shown to be sensitive in determining bone involvement in patients with malignancy, but it does not allow the assessment of bone marrow lesions in early disease. The aim of this study was to detect bone marrow invasion using 99Tcm-labelled monoclonal antigranulocyte antibody (AgMoAb) in patients with prostate carcinoma. We studied 56 patients whose mean (+/- S.D.) age was 67 +/- 7 years. The mean prostate-specific antigen level was 6.1 ng ml-1 (normal range 0-5 ng ml-1). Twelve patients were in stage A, 16 in stage B, 17 in stage C and 11 in stage D. Six patients had been receiving chemotherapy and four patients radiotherapy before scanning. Bone scans were obtained 2 h after the intravenous injection of 555 MBq 99Tcm-methylene diphosphonate (99Tcm-MDP). Within a week, bone marrow imaging was performed 4 and 24 h after the injection of 555 MBq 99Tcm-AgMoAb. Metastatic bone lesions were detected on the 99Tcm-MDP scans of 14/56 (25%) patients, of whom one was in stage A, two in stage B, four in stage C and seven in stage D. Hypoactive lesions in bone marrow were detected in 25/56 (45%) patients, of whom two were in stage A, five in stage B, seven in stage C and 11 in stage D. Bone marrow metastases were confirmed in six patients by computed tomography (CT) and magnetic resonance imaging (MRI) and in two patients by marrow aspiration biopsy. A false-positive immune scintigram was found in three patients previously receiving radiotherapy or chemotherapy. We suggest that 99Tcm-AgMoAb scintigraphy is a sensitive procedure for the detection of bone marrow lesions. However, the reason for false-positive and false-negative results should be considered and CT, MRI and marrow biopsy should be performed when clinically necessary.     

Miscellaneous symptoms occurring in workers engaged in the manufacture of PVC

Five cases of lincomycin-clindamycin-associated acute pseudomembranous colitis, demonstrating a spectrum of clinical, histological and radiological severity, were encountered over a five-months period. All patients presented with watery diarrhoea without the passage of macroscopic blood or pus. Two patients were seriously ill with fulminant colitis, but responded rapidly to corticosteroids given parenterally and supportive therapy. The diagnosis of acute colitis should be considered in all patients developing diarrhoea during or up to three weeks after beginning therapy with lincomycin or clindamycin and can be confirmed by sigmoidoscopic examination. Withdrawal of the antibiotic and symptomatic treatment is appropriate for mild cases of colitis, but our experience suggests that corticosteroid therapy is safe and effective in severe cases. Indiscriminate use of these antibiotics should be avoided.     

Clinical evaluation of myeloma osteoclastic bone lesions: II. Induced hypocalcemia test using salmon calcitonin

Acute effects of salmon calcitonin (SCT) were tested by an SCT induced hypocalcemia test (SCT delta Ca test) in 70 cases of multiple myeloma (MM) (including 52 untreated patients) with bone involvement. Response to SCT in terms of maximum induced hypocalcemia (M delta Ca) was compared to normal controls (NC) and correlated with the main presenting features and clinical status. Acute effects are significantly more marked in MM than in NC (p less than .001). There is a good correlation with the extent of lytic bone lesions (p less than .01), the presence of hypercalcemia (p less than .02) and the myeloma cell mass (p less than .05). After correction for bone involvement response to SCT (M delta Ca) was stronger in IgA lambda MM than in IgG kappa (p less than .01). It is of particular interest that acute effects are significantly more marked in cases of active disease than in non-active disease. We conclude that the SCT delta Ca test might be of practical value in the management of MM.     

Treated plasma cell lesions of bone with MRI signs of response to treatment: unexpected pathological findings

Two cases of treated plasma cell lesions of bone are reported for which contrast-enhanced MRI had suggested necrosis, based on lack of enhancement after gadolinium injection, and in which pathologic examinations revealed the presence of extensive viable neoplastic tissue. These cases highlight the need for cautious interpretation of contrast-enhanced MRI signs of response to treatment and inactivity of lesions in the setting of plasma cell neoplasms.     

A prospective study of drugs and pregnancy. 4. Miscellaneous drugs

The results are presented of a prospective study on drug use during pregnancy involving antibiotics, analgesic drugs and iron and vitamin preparations. The study was conducted in Malm? between 1963 and 1965. No unfavourable effect of the use of antibiotics, mainly penicillin and sulphonamides, could be demonstrated. Among 15 women who had an infant with hypospadias, three had used penicillin during the first trimester, but this may well be coincidental. Analgesic drug use shows a variability which resembles that previously described for psychopharmaca. No effect on the malformation rate or infant survival could be found. A possible lengthening of the mean duration of pregnancy occurred after the use of analgesic drugs during the 2nd or 3rd trimesters. Women who are going to have a dead or malformed infant use iron and/or vitamin preparations less often during late pregnancy than women who prove to have a normal infant. When such drugs were used, the percentage of pregnancies ending in birth before the 38th week is reduced, and the birth weight among term babies is higher. The associations between pregnancy outcome and the use of iron and vitamin preparations is probably indirect, due to social factors associated with drug use.