Early detection of avascular necrosis of the femoral head by MRI

Male, Sprague-Dawley rats were treated with 0, 1, 10, 50, 100 ppm chlordecone (Cd) mixed in calcium-sufficient (Ca-S) or calcium-deficient (Ca-D) diet for 15 days. A significant decrease in body weight gain was observed in 100 ppm of Cd-treated rats. Cholinesterase (ChE) activity was significantly decreased in serum of Ca-D rats. Chlordecone did not alter serum ChE activity in both Ca-S and Ca-D rats. However, Cd decreases serum triglycerides, low density lipoproteins (LDL) and cholesterol in both Ca-S and Ca-D rats. Rats fed with Ca-S or Ca-D diet exhibited differential sensitivity to Cd-toxicity. Decreased levels of serum triglycerides, LDL and cholesterol suggest that Cd might interfere in lipid metabolism.     

Sonographic detection of parallel great arteries in the fetus

OBJECTIVE: Of all fetal malformations, those affecting the heart, particularly the great arteries, are most commonly overlooked during obstetric sonography. The appearance of normally related great arteries in the fetus is described. Abnormal parallel great artery orientation was detected on sonography in 24 fetuses over a 3-year period. This abnormality was most commonly due to double outlet right ventricle. CONCLUSION: Examination of the cardiac outflow tracts during obstetric sonography can detect great artery malformations prenatally, allowing optimum perinatal management.     

Borderline necrosis of the femoral head

To determine whether the histologic lesions classified by the system of Arlet et al as Type 2 (granular necrosis of fatty marrow) and Type 3 (complete medullary and trabecular necrosis) always progress to Type 4 (complete necrosis with marginal medullary fibrosis and appositional new bone formation), 10 femoral heads (nine patients) were monitored for 4 years using serial magnetic resonance images. These femoral heads had been diagnosed histologically as having either Type 2 (seven hips) or Type 3 (three hips) necrosis on initial core biopsies. On the initial magnetic resonance image, none of the femoral heads showed any focal lesions indicative of osteonecrosis. In all instances, superselective angiography showed interruption of the superior retinacular artery, and the bone marrow pressure was elevated. During a followup period of 48 to 54 months, no patient had a reactive low signal intensity band develop on T1 weightings, as evidence of a reparative process around the necrotic portion of the lesion, or any other findings of osteonecrosis on magnetic resonance images. These findings suggest that some Type 2 and 3 lesions of Arlet et al may not develop an obvious reactive interface of reparative revascularization and thus may not progress to definite and classic Type 4 osteonecrosis. This study supports the hypothesis that there is an ischemic threshold between reversible intraosseous hypoxia (bone marrow edema syndrome) and irreversible intraosseous anoxia (classic bone infarction or osteonecrosis) and suggests that borderline necrosis occurs in the transition zone of this ischemic threshold and is nonprogressive.     

Management of osteonecrosis of the femoral head

Osteonecrosis of the femoral head continues to pose a therapeutic challenge to orthopedic surgeons. This pathologic process results from the death of living components of bone from mechanical and biologic factors. Diagnosis, clinical symptoms, and classification systems are discussed. Several treatment regimens and their controversies are explored in this article.     

MR evaluation of the articular cartilage of the femoral head during traction. Correlation with resected femoral head

As a result of a high percentage of hypoactive upper poles of kidneys in traditional 99mTc-dimercaptosuccinic acid (DMSA) SPECT, a prospective study was conducted using 180 degrees acquisition technique compared with 360 degrees to minimize tissue attenuation. METHODS: Anterior 180 degrees, posterior 180 degrees and 360 degrees renal SPECT images were obtained simultaneously using a dual-head camera. Forty-one subjects without renal disease and 16 subjects with 21 cortical defects were included in this study. The total counts of the raw data in the anterior 180 degrees, posterior 180 degrees and full 360 degrees were calculated. Small regions of interest were drawn over the cortex of the kidney on coronal and reoriented sagittal slices. Quantitative evaluation of regional activity was performed on the same frames in all three acquisition methods. RESULTS: Comparison of the total renal counts between the anterior and posterior 180 degrees data showed reduced counts in the anterior 180 degrees data collection (P < 0.01). Visual evaluation of the reconstructed images from anterior 180 degrees, posterior 180 degrees and full 360 degrees data collection showed the best image uniformity in the posterior 180 degrees image. The upper/lower pole ratio in the posterior 180 degrees renal SPECT images increased significantly in comparison to full 360 degrees renal SPECT images (P < 0.01) and anterior 180 degrees SPECT images (P < 0.01). The renal defects were more clearly visualized in the posterior 180 degrees renal SPECT images than the full 360 degrees renal SPECT images. The defect/normal cortex ratios in the posterior 180 degrees renal SPECT images were much lower than those from the full 360 degrees SPECT images (P < 0.01) and those from the anterior 180 degrees SPECT images (P < 0.01). CONCLUSION: The posterior 180 degrees acquisition technique can avoid the problem of hypoactive upper pole and can be less time consuming in 99mTc-DMSA SPECT images. It also provides superior lesion contrast in the clinical evaluation of patients with renal scarring.     

Dual-energy X-ray absorptiometry in osteonecrosis of the femoral head

Osteonecrosis of the hip classically produces a heterogeneous density in the femoral head, although the bone marrow ischemia extends down to the femoral neck and trochanters. Also, bone insufficiency fractures due to diffuse bone loss have been implicated in the genesis of osteonecrosis. OBJECTIVES: To use dual-energy X-ray absorptiometry to quantify the bone changes produced by osteonecrosis of the hip and to compare bone mineral density values in patients with osteonecrosis of the hip and in controls. METHODS: Bone mineral density was measured at the femoral neck (total femoral neck, Ward's triangle, and trochanter), femoral head and lumbar spine using dual-energy X-ray absorptiometry (DPX, L Lunar) in 22 patients with osteonecrosis of the hip and in 22 age- and sex-matched controls. RESULTS: In the patients with osteonecrosis, bone mineral density on the affected side was higher than on the opposite side at the femoral head (+18%), femoral neck (+7%), and Ward's triangle (+6%) and lower at the trochanter (-4%). These differences were most marked at the more advanced end of the osteonecrosis spectrum. As compared to age-specific normative values, the osteonecrosis patients had moderately decreased bone mineral density values at the lumbar spine (-0.53 +/- 1.1 SD or -6 +/- 1.5%) and at the femoral neck on the normal side (-0.9 +/- 1.4 SD or 12 +/- 1.8%). As compared to the controls, bone mineral density was significantly decreased at Ward's triangle (-25%; P: 0.04) and nonsignificantly decreased at the lumbar spine (-4.7%; P: 0.15) and at the femoral neck (-15%; P: 0.09).     

Anticardiolipin antibodies and osteonecrosis of the femoral head

The current study evaluated the prevalence of anticardiolipin antibodies, which have been associated with thrombotic phenomena, in patients with nontraumatic osteonecrosis of the hip and assessed whether the presence of such antibodies is associated with an increased risk for the development of bone necrosis. Forty consecutive patients (25 men and 15 women) with nontraumatic osteonecrosis of the hip were studied. Their ages ranged from 19 to 56 years (average, 34.3 years). Anticardiolipin antibodies were present in 37.5% (15 of 40) of the tested patients, a significantly higher rate than is seen in healthy subjects, of whom only one of 100 had low titer anticardiolipin antibodies (1%). Six of 40 patients tested positive for immunoglobulin M alone, and six of 40 patients tested positive for immunoglobulin A alone. Three of 40 patients tested positive for immunoglobulin M and immunoglobulin A isotype. The results of the current study indicate an increased incidence of anticardiolipin antibodies in patients with nontraumatic osteonecrosis of the femoral head, which may reflect that anticardiolipin antibodies play a role in the pathogenesis of bone necrosis by predisposing to thrombotic phenomena.     

Necrosis of the femoral head after kidney transplantation

OBJECTIVE: Presentation of our experience in the treatment of war injuries to the thoracic esophagus at the Split University Hospital, Croatia, during the 1991-1995 wars in Croatia and Bosnia-Herzegovina. METHODS: Retrospective analysis of clinical and surgical data on patients with war injuries to the esophagus. RESULTS: Of 2494 treated injured persons, 5 patients (0.2%) had injuries to the esophagus. We performed temporary double-exclusion of the esophagus in all our patients, followed by gastric interposition after partial esophagegtomy in three patients and simple suturing with pericardial protection of the esophagus in one patient. One of our patients died after double-exclusion due to septic complications in spite of antimicrobial chemoprophylaxis regularly performed in all injured persons. Final surgical outcome and mortality rate (20%) in our patients were quite satisfactory. CONCLUSION: Prompt transportation, appropriate diagnostic methods and an adequate surgical treatment can markedly reduce mortality and complications rate in war injuries to the thoracic esophagus.     

The cell density of human femoral head cartilage

The human femoral head cartilage in 63 subjects with ages ranging from 16 to 100 years demonstrates that in the course of aging the cell density of the whole cartilage thickness decreases about 40 per cent. The reduction of the cellularity with age is more accentuated in the superficial than in the deeper zone and is even limited to the superficial zone during the latter part of aging. Proportionately the cell loss is similar in the superior and inferior poles of femoral head suggesting a uniform distribution of age related changes. In absolute value, the decrease of the superficial cell density is much higher in the inferior than in the superior pole; the decrease may be related to the propensity of this region to fibrillation.     

Corticosteroids and avascular necrosis of the femoral head in childhood

The time-course of psychopathological symptoms, of extrapyramidal side effects, and of changes in cerebrospinal fluid (CSF) concentration of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were simultaneously studied during Haloperidol treatment of 14 psychotic patients with chronic organic brain damage. After 15 days of treatment significant antipsychotic effect was found, while Parkinsonism scores in clinical and experimental tests increased only slightly. CSF concentration of HVA increased significantly by 150% compared to the baseline value (p less than 0.05) and 5-HIAA remained unchanged. No correlation was found between the clinical and biochemical variables studied. The comparison of these results with those obtained in patients without brain damage suggests that different psychopathological and extrapyramidal responses to neuroleptics are not strictly associated with specific HVA changes in CSF.     

Sonographic detection of pneumoperitoneum: an experimental and clinical study

The sonographic appearance of intraperitoneal air collection has been studied in 46 patients. In 30 patients (group I), a pneumoperitoneum had been iatrogenically induced either during aspiration of ascitic fluid or during laparoscopy. Three normal volunteers (group II) had been subjected to graded intraperitoneal air injection to quantify the smallest amount of air detectable by ultrasound (US). In eight patients (group III) the sonographic demonstration of free intraperitoneal air led to a diagnosis of hollow visceral perforation; whereas in another five patients (group IV) the sonographic findings reinforced the clinical suspicion of a 'sealed off' perforation in the presence of negative roentgenograms. In all patients intraperitoneal air was seen as an echogenic line with a posterior reverberation or ring down artefact. In patients with free air, this was best seen in the perihepatic spaces with the patient in the supine, left lateral decubitus or prone position. As little as 5 mL of air could be consistently detected in all three volunteers (group II). Artefacts leading to a pseudopneumoperitoneum on US included; (i) the artefacts distal to an overlying rib; (ii) ring-down artefact from air in the adjacent lungs; and (iii) hepatodiaphragmatic interposition of colon. With proper sonographic technique and principles of interpretation these can be distinguished from true intraperitoneal air. Although sonography may be more informative than conventional radiology in patients with hollow visceral perforation, we did not find it more sensitive than conventional roentgenograms in detecting free intraperitoneal air. Sonography, however, is distinctly superior in patients with a sealed off perforation in whom conventional roentgenograms are frequently negative.     

Intertrochanteric femoral osteotomy with concentric reduction of the femoral head in treatment of residual congenital acetabular dysplasia

A method of classification based upon increase of the anteversion and valgus deformity of the upper femur associated with a dysplastic acetabulum and subluxation of the femoral head demonstrates 4 main groups: I or II in patients 1 to 3 years of age; III, patients approximately 2 years of age; IV, patients with absolute contraindication for surgical intervention. The Monticelli technique employs a Kirschner wire for the internal fixation and incorporates it in a hip spica. The results of the surgical treatment are very gratifying when classification and specified indications are correct. In follow-up observations ranging from 3 to 11 years, with an average of 7 years, there were practically no complications other than a few superficial skin infections.     

Osteonecrosis of the femoral head in patients having received cortisone treatment

8-Methoxypsoralen (8-MOP) and long-wave UV light (UVA 365 nm) are now being use to treat vitiligo and psoriasis. Cultured human lymphocytes exposed to these agents in vitro show an increased infrequency of sister chromatid exchanges, related to 8-MOP-DNA photoadducts. Although these data raise questions regarding the biologic consequences of this therapeutic regimen, it is unknown whether 8-MOP and UVA cause mutations or extracutaneous somatic cell recombinants in vivo. Exchanges may represent cellular repair of DNA damage.