Candida arthritis after total knee arthroplasty--a case of successful treatment without prosthesis removal

Spondylolisthesis with or without spondylolysis is common in the lumbar spine. Associated fracture in the pedicle ('pediculolysis') is unusual. The margins of pedicular stress fractures, like spondylolysis, usually appear sclerotic. A patient with a pedicular stress fracture with minimal marginal sclerosis suggesting an injury of recent onset is presented here. There was associated bilateral spondylolysis. The findings in this patient suggest that established pediculolysis probably represents a stress fracture that has failed to heal.     

Role of chlamydia in chronic renal and urogenital diseases in man]

Specimens of the joint surfaces of the tibia from patients with OA and RA were exposed were examined for bone mineralization, bone formation, osteoid tissue and bone resorption. Judging from the appearance of the osteoblasts in OA the sclerotic changes are mainly focal with relatively little osteogenesis. No osteoclasia was seen in the sclerotic areas. Breakdown of the mineralized cartilage is followed by the development of cysts with highly cellular connective tissue with high osteoblastic activity and osteoclasia. Osteoid tissue is relatively sparse. The changes in RA are more diffuse with a more active osteoblastic activity and widespread zones of osteoid tissue as well as resorption by osteoclasts. It appears as if the increased uptake of 85Sr in OA is more dependent on the occurrence of relatively inert osteosclerosis than on a rapid turnover of the bone tissue.     

Female genital mutilation

The purpose of this communication is to describe atypical simple bone cysts of the femoral neck seen in adult patients. Two patients, aged 56 and 49, having cystic lesions which did not conform to a typical simple bone cyst, are reported. Common features including eccentric location, and thick lining tissue and sclerotic margin are not those of typical simple bone cysts seen in children. Local mechanical characteristics might be related to the atypical presentations.     

Spinal problems in mucopolysaccharidosis I (Hurler syndrome)

Bone-marrow transplantation has increased the survival of patients with mucopolysaccharidosis-I. We describe the spinal problems and their management in 12 patients with this disorder who have been followed up for a mean of 4.5 years since transplantation. High lumbar kyphosis was seen in ten patients which was associated with thoracic scoliosis in one. Isolated thoracic scoliosis was seen in another. One patient did not have any significant problems in the thoracic or lumbar spine but had odontoid hypoplasia, which was also seen in three other children. Four of the eight patients in whom MRI of the cervical spine had been performed had abnormal soft tissue around the tip of the odontoid. Neurological problems were seen in two patients. In one it was caused by cord compression in the lower dorsal spine 9.5 years after posterior spinal fusion for progressive kyphosis, and in the other by angular kyphosis with thecal indentation in the high thoracic spine associated with symptoms of spinal claudication.     

The high rate of antibodies to hepatitis E virus in young, intravenous drug-abusers with acute hepatitis B-virus infection in a Swedish community: a study of hepatitis markers in individuals with intravenously or sexually acquired hepatitis B-virus infection

Sclerotic fibroma is an uncommon fibrotic neoplasm that occurs both sporadically as well as in patients affected by Cowden's disease. We present an additional case of solitary sclerotic fibroma not associated with Cowden's disease. Although most of the lesion was sclerotic, there was a cellular area with some multinuclear cells. We conclude that sclerotic fibroma is a mesenchymal neoplasm whose clinical and histopathologic features are not only different but opposite to those of dermatofibroma.     

A case of rigid spine syndrome--histological findings of muscles

A 10-year-old boy with rigid spine syndrome was reported. He had mild weakness in the limb, and moderate weakness in the neck flexor and extensor muscles since early childhood. Because of limited flexion of the spine, he could not bend down. CT of the muscles revealed increased low density in the erector spine muscle, predominantly at the lumbar level. In the biopsy specimens obtained from the left biceps brachii and erector spine muscles, there was a variation in fiber size with scattered necrotic and regenerating fibers, and fibrosis, predominantly in the latter. Except for scattered fibers with rimmed vacuoles, the overall histopathological features were similar to those seen in progressive muscular dystrophies, suggesting that the dystrophic process is one of the major pathomechanisms for rigid spine syndrome.     

Normal growth hormone secretion in growth hormone insufficient children retested after completion of linear growth

Tuberculosis of the cervical spine is rare, comprising 3-5% of cases of tuberculosis of the spine. Eight patients with tuberculosis of the cervical spine seen during 1989-1992 were reviewed. They all presented with neck pain. The 4 children presented with a kyphotic deformity. In all the children the disease was extensive, with a large prevertebral abscess formation, while in the adults it was localised to one or two motion segments. Cord compression was present in 4 of the 8 patients. All the patients were treated with antituberculosis drugs and 6 underwent surgery. There was full neurological recovery in all patients. The kyphosis was improved though not fully corrected. There was a problem in stabilisation of severe involvement of the body and dens of C2. Surgery seems to play a major role in the treatment of tuberculosis of the cervical spine.     

Injuries in the adolescent porcine spine exposed to mechanical compression

STUDY DESIGN: An experimental porcine study in which functional lumbar spinal units were tested in compression to failure. Biomechanical, radiographic, magnetic resonance imaging, and histological characteristics are described. OBJECTIVES: To explain the different patterns of injury seen in adults and adolescents resulting from traumatic injury to the vertebrae and to explain the mechanism behind traumatic displacement of the ring apophysis seen in athletes. SUMMARY OF BACKGROUND DATA: Recent investigations of the spine in adolescent who have sustained trauma have shown injuries to the growth zone, whereas studies of adults have shown injuries to the vertebral body. A higher frequency of abnormalities in the discs, the vertebral bodies, the endplates, and the ring apophyses has been demonstrated in athletes with high loads on the spine. There is controversy over the etiology of these changes. METHODS: Twelve functional lumbar spinal units (vertebra-disc-vertebra) obtained from six young male pigs were tested in compression to failure. All units were examined with plain radiography and magnetic resonance imaging before and after compression. After the compression, histologic samples were taken from the injury site. RESULTS: Identical traumatic changes were seen in all functional lumbar spinal units, i.e., fracture in the endplate through the growth zone posteriorly and displacement of the anulus fibrosus with a bony fragment at the point of insertion of the vertebra. The nucleus pulposus was ruptured and displaced through the fracture line in all cases. The injuries were not seen on radiographs but were detected on magnetic resonance images, as confirmed on microscopic and histologic examination. CONCLUSION: This study shows that the weakest part of the lumbar spine of the juvenile pig, when compressed, is the growth zone and the junction between the point of insertion of the anulus fibrosus and the vertebra. This location of weakness may explain the high frequency of disc degeneration and "persisting apophysis" seen in the spine of athletes.     

Morphologic analysis of odontogenic cysts with computed tomography

PURPOSE: The purpose of this study was to analyze the effects of lesion site and epithelial keratinization on the morphologic characteristics of odontogenic cysts and clarify determinate factors for cyst morphology. MATERIAL AND METHODS: Computed tomographic images of 92 odontogenic cysts were analyzed: 31 primordial, 31 dentigerous and 30 radicular. Thirty-four cysts were located in the maxilla (6 primordial, 10 dentigerous, and 18 radicular) and 58 in the mandible (25 primordial, 21 dentigerous, and 12 radicular). Histologically, 31 cysts showed epithelial keratinization (18 primordial and 13 dentigerous). No keratinization was seen in radicular cysts. The morphologic features of cysts were assessed by measuring long length parallel to dental arch and short length vertical to it and calculating the long/short ratio. In addition, the computed tomography pattern of the cyst was classified into unilocular, lobulated, and multilocular patterns. Appearance of the sclerotic rim and surrounding cortex were classified into three and four patterns respectively to evaluate the developmental features of the cyst. RESULTS: As a whole, the long length of the primordial cysts was statistically larger than the other two cyst groups and resulted in a larger long/short ratio. Statistical differences of CT pattern were also seen among cyst groups. There was no preference in any cyst group for the appearance of the sclerotic rim and cortex. There were statistical differences between maxilla and mandible in short axis and long/short ratio. The maxillary cysts generally showed round shapes irrespective of their histologic characteristics. A multilocular pattern was more frequent in the keratinized group of mandibular primordial cysts. In dentigerous cysts, a multilocular pattern was seen only in the keratinized group and the long/short ratio was statistically larger; cyst shape was elliptical along the long axis. CONCLUSION: Our results demonstrated morphologic differences of odontogenic cysts caused by lesion site and keratinization. The dentigerous cyst with predominant keratinization should be included in the primordial cyst (odontogenic keratocyst) group.     

Morbid changes of the mandible in familial polyposis of the colon

The study was made to ascertain whether the radiographs of the mandible of patients with familial polyposis of the colon show osteomas. Orthopantomography of the mandible was taken in 10 cases of familial polyposis of the colon and 6 cases of the unaffected family members. And radiographic and histological studies were performed in another autopsied case. As a result, radiographic studies revealed sclerotic masses of the mandible in 10 of the 11 cases. In some cases, the changes were also found in the maxilla. The number of sclerotic masses ranged from 2 to 11, and they were associated with odontomas in 2 cases and impacted teeth in one case. Two of the 6 unaffected family members were found to have one or two sclerotic masses. At autopsy of a case died of cancer of the sigmoid colon, a radiographic study of the excised mandible revealed 11 sclerotic masses measuring 5 mm in diameter each, as well as one impacted tooth. A bucco-lingual cross action through the mandible in the canine area revealed central osteomas. Histological examination showed the osteomas were composed primarily of mature, lamellar bony tissue.     

Acute sensory neuronopathy: identified with electrodiagnosis and magnetic resonance imaging

We report on a 13-year-old female with idiopathic acute sensory neuronopathy mimicking a sensory form of Guillain-Barré syndrome, which was identified by using electrodiagnosis and spine magnetic resonance imaging. Motor conduction results were normal, but no sensory nerve action potentials were seen in the four limbs. On magnetic resonance imaging of the whole spine, the diffuse gadolinium enhancement of the dorsal roots in the spinal canal was detected, without evidence of intramedullary lesions. The clinical symptoms and electrodiagnostic findings had persisted for more than 18 months of follow-up.     

Complications of CT-guided biopsy of the spine and sacrum

This study reviews the results of 94 computed tomography (CT)-guided Craig needle biopsies of the spine and sacrum performed at one center. An indication for biopsy in this study was prompted by abnormal findings identified by one or more of the following diagnostic modalities: radiography, CT, magnetic resonance imaging (MRI), or bone scanning. These patients then underwent CT-guided Craig needle biopsy of the spine and sacrum for further evaluation. There were 1 biopsy of the cervical spine, 19 of the thoracic spine, 66 of the lumbar spine, and 8 of the sacrum. Biopsy sensitivity was 94.5% and specificity was 96.8%. This accuracy compared with other diagnostic modalities showed biopsy to be the gold standard for diagnosis of spine or sacral lesions. Of the 94 cases reviewed, 6 complications were noted. All complications were acute in nature and included 1 aortic puncture, 2 psoas punctures with associated psoas hematomas, 1 biopsy of an incorrect level, and 2 aborted procedures secondary to patient discomfort. No infections or neurological sequelae were seen. Although the benefits of CT-guided biopsy over open biopsy have been shown previously, this review demonstrates it is not without significant risk.     

Smith-Lemli-Opitz syndrome: phenotypic extreme with minimal clinical findings

The effect of spine venom from the crown-of-thorns starfish (Acanthaster planci) on drug-metabolizing enzymes in rat liver was studied. The spine venom was prepared by saturation of spine homogenate with ammonium sulfate and the protein fraction precipitating 50% saturation was used as venom B. Venom A was the protein precipitated between 50 and 100% saturation. When venom B (100-200 mg/kg) was given to rats, liver microsomal GSH S-transferase and cytochrome P450 activities decreased while cytosolic GSH S-transferase activity was not changed. The decrease in these microsomal enzyme activities was seen from 12 hr to 24 hr after giving 100 mg/kg of venom B. Rats given venom A died, suggesting an involvement of the lethal factor in venom A. The data showed that the spine venom B from A. planci depressed microsomal GSH S-transferase and cytochrome P450 activities in rat liver and that this venom was distinct from the lethal factor of the spine venom.     

Arytenoid cartilage sclerosis: normal variations and clinical significance

PURPOSE: Our purpose was to determine the variation in location, distribution, and sex predilection of arytenoid cartilage sclerosis in a population of patients without laryngeal cancer as an aid to understanding the significance of this entity when seen in patients with laryngeal cancer. METHODS: One hundred CT examinations of patients of different ages and with no history of laryngeal cancer or radiation therapy were evaluated for the presence of arytenoid cartilage sclerosis. The arytenoid cartilage was subdivided into three regions: superior process, body, and vocal process. Each region was assessed on each side separately on bone window scans. RESULTS: Arytenoid cartilage sclerosis was seen in 16% (n = 16) of the patients. Sclerosis was most common in the body (n = 12) and least common in the true vocal process (n = 2); the left side was the preferred location for all three regions. In 50% of the patients, at least two regions were affected. Eighty-one percent of sclerotic arytenoid cartilage was seen in women. CONCLUSION: Knowledge of the frequency and distribution of arytenoid cartilage sclerosis as a normal variant can aid in determining the risk of arytenoid cartilage involvement in patients with laryngeal cancer.     

Some aspects of cervical chordoma

This paper reviews 13 cases of chordoma in the cervical spine and base of the skull which have been seen at the Pack Medical Foundation over the past 25 years. Chordomas are dysonto genetic, malignant, slow-growing neoplasms that arise in remnants of the embryonic notochord. Concealed along the axial skeleton, these slow-growing tumors are usually well entrenched before they are accurately diagnosed. The majority of the chordomas of the spine occur in the sacroccygeal region. Of the 13 cases in the area of the cervical spine, 39% occurred in the region of the base of the skull and 61% in the area of the cervical spine. The treatment of the cervical tumors consisted of laminectomy to relieve the pressure on the cord and to remove as much of the neoplasm as possible. Some of the tumors at the base of the skull were nonresectable and were treated with radiotherapy. Radiotherapy was ultimately used in every case, either in combination with surgery or as a primary or subsequent method of management. The overall prognosis for palliation was fair but ineffective for cure.     

Imaging features of musculoskeletal brucellosis

Brucellosis is endemic in certain parts of the world. Musculoskeletal involvement is the most common complication of brucellosis, and the spine is most frequently affected. Between November 1985 and March 1993, 334 patients with radiologically proved musculoskeletal brucellosis were seen. Involvement of the spine was either focal or diffuse, with a predilection to the lumbar region. Erosions and sclerosis in vertebral end plates, changes of inflammation at scintigraphy or magnetic resonance (MR) imaging, and intact disks were hallmarks of the focal form. Osteomyelitis of neighboring vertebrae, involvement of the intervening disk, and moderate epidural extension were features of diffuse brucellar spondylitis. The great majority of joints with scintigraphic evidence of disease demonstrated normal radiographic findings. Evidence of osteomyelitis or destructive arthritis was encountered in only a few cases. Although radiography is sufficient for demonstrating focal brucellosis, MR imaging is better for assessing diffuse disease.     

Cervical stenosis: a developmental anomaly with quadriparesis during football

As seen by the graphic depiction of F.M.'s sagittal diameter (Fig. 3) and by the photographs of his air myelogram, cervical sagittal stenosis should be looked for and thought of as an underlying anatomic anomaly in the athlete who has recurrent episodes of "pinched nerve" with flexion and hyperextension of his cervical spine during blocking or tackling. It is significant that the patient underwent two "normal" cervical spine x-rays before tomograms and air myelogram pointed out the sagittal stenosis of his cervical canal. Sagittal stenosis must be thought of and looked for strenously in the athlete competing in high velocity collision sports where recurrent neck and upper extremity complaints are too often attributed to the pinched nerve complex and a "horseshoe" collar is the remedy.     

Resolution of Trp near UV CD spectra of calmodulin-domain peptide complexes into the 1La and 1Lb component spectra

PURPOSE: To document the MR appearances of vertebral metastases in breast cancer on treatment and to determine whether a single T1-weighted (T1-W) sequence of the spine could provide a quick and effective method of response assessment. PATIENTS AND METHODS: One-hundred and nine spinal magnetic resonance (MR) examinations in 41 metastatic breast cancer patients on treatment were reviewed. The changes in number, size and signal intensity of vertebral metastases during 68 intervals (mean length 6.9 months) were documented. T1-W signal intensity (SI) before and after treatment was assigned to three patterns: (A) low homogeneous SI; (B) low heterogeneous SI; and (C) high homogeneous SI. For each interval between MR examinations, an objective assessment of the overall response (disease regression, no change, disease progression) to treatment of metastases was made based on standard assessment criteria. RESULTS: The number and size of treated vertebral metastases increased in 47% and 43% of cases and showed no change in 53% and 54% of cases, respectively. A reduction in size of lesions was seen in 3% of cases only and no reduction in the number of lesions was seen. T1-W [corrected] signal intensity changes occurred in approximately one-third of cases documented. The most commonly observed SI change in 25% of all intervals (17 of 68) was from type A to type B. There was no correlation between SI change and response to therapy. T1-W [corrected] MR response assessment, based on changes in size and number of vertebral metastases, accurately predicted progression of disease in 79% of cases and stable disease in 75% of cases. It did not predict regression of disease. CONCLUSION: A T1-W MR spinal assessment is a simple and effective method of evaluation of therapeutic response of lytic and sclerotic vertebral metastases in breast cancer being able to distinguish patients with progressive disease from those with a favourable response (no change or disease regression) to therapy. These findings have important clinical implications.     

Intravenous long term infusions of the rat without anesthesia

The lumbar-spine radiographs of 67 patients with idiopathic chondrocalcinosis articularis were reviewed for disc calcification and other changes. Calcification was present in 21 (31%) of the patients, seen most frequently at the L 2-3 disc space. The 21 patients as a group were significantly older than the 46 patients without disc calcification, and also had a much higher incidence of chondrocalcinosis in peripheral joints. There was no association with back pain or spinal stiffness. The 21 patients with disc calcification included six patients with a destructive peripheral arthropathy, and three of them had destructive changes affecting the lumbar spine. Three patients with a destructive peripheral arthropathy were also included in the group without disc calcification, and one of these had a destructive arthritis of the lumbar spine. For comparison, there was a 55% incidence of spinal chondrocalcinosis in nine patients with primary hyperparathyroidism and peripheral joint chondrocalcinosis, and a 6% incidence in 100 anteroposterior lumbar spine radiograph 'controls', taken before intravenous urography, although in this latter group the changes were minimal and confined to the margin of a single disc in each case.     

Pathological consideration of a "blister-like" aneurysm at the superior wall of the internal carotid artery: case report

OBJECTIVE AND IMPORTANCE: Although the incidence is low, a very small aneurysm with a thin wall and no neck arises at the superior wall of the supraclinoid portion of the internal carotid artery and is called a "blister-like" aneurysm. However, the pathogenesis of such a vascular lesion remains uncertain. CLINICAL PRESENTATION: A 57-year-old man developed a fatal subarachnoid hemorrhage caused by the rupture of a blister-like aneurysm at the superior wall of the internal carotid artery. An autopsy was performed, and the lesion was pathologically examined. RESULTS: The internal elastic lamina and media had disappeared at the border between the eccentrically sclerotic and normal carotid wall. The gap in the internal elastica was covered with normal adventitia and fibrinous tissue. This portion was not composed of collagenous tissue as ordinarily seen in an aneurysmal wall. Neither infiltration of inflammatory cells nor dissection of the artery were observed. CONCLUSION: The blister-like aneurysm appeared to be a laceration of the carotid wall based on degeneration of the internal elastic lamina.