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Biomedical subjects

D M Forrester

Publications and source records attributed to D M Forrester.

10 recordsLinked to original sources

Case report 749: Primary glomus tumor of bone.

We report a case of primary intraosseous glomus tumor in a 30-year-old man who was found to have an expanding, lytic lesion in the distal phalanx of his left thumb. The histological appearance was atypical in that areas of myxoid stroma resembled chondroid material. The unusual location and microscopic appearance caused diagnostic problems. Immunohistochemical studies, including strong positive staining for MSA and negative staining for keratin and S-100 protein, were helpful in establishing the correct diagnosis.

Adult

Pro-oxidative interactions of dithranol with human phagocytes promote oxidative damage to DNA of bystander leucocytes.

Dithranol at therapeutic concentrations (5-40 micrograms ml-1) induced strand breaks in human leucocyte DNA in vitro in a dose-related manner. Leucocytes from individuals with chronic granulomatous disease (CGD) incurred substantially less DNA strand breaks than did normal leucocytes during exposure to dithranol indicating that activated phagocytes are involved. H-7, 4-beta-bromophenacyl bromide (BPB) and staurosporine, all inhibitors of protein kinase C, decreased both dithranol-mediated activation of the phagocyte respiratory burst and induction of DNA strand breaks. Similar effects were observed with the hydrogen peroxide scavenger catalase. These results suggest that dithranol induces DNA strand breaks, mainly as a result of pro-oxidative interactions with phagocytes.

Acetophenones

Trauma to the foot.

Minor trauma to the foot may cause stress fracture, avulsion fracture or ligamentous and tendon injury. Plain radiographs are frequently normal. Radionuclide bone scan is a sensitive detector of early bone injury. A stress fracture may develop focal uptake or diffuse uptake throughout the bone involved. MR imaging is the most sensitive means of evaluating injury to the soft tissues. Acute edema, partial tear, complete tear, and chronic tendinitis have distinct features on T1- and T2-weighted images. Major trauma occurs most commonly as a result of falls from heights and from motor-vehicle accidents. Plain films are useful in the initial evaluation of the extent of trauma. CT is particularly useful in evaluating calcaneal fractures that involve the subtalar joint. Both MR imaging and CT scans are useful in detecting injured or entrapped tendons associated with fracture-dislocations.

Foot Injuries

Magnetic resonance imaging of foot and ankle trauma.

MRI is a useful diagnostic tool in the assessment of traumatic lesions of the foot and ankle. It is especially useful in demonstrating acute and chronic tendon and ligament injuries. Subtle fractures, including osteochondral, nondisplaced, and stress fractures, are well shown with MRI but may be difficult to detect on radiographs. A bone scan may also be used to detect these fractures; however, with MRI the fracture extent may be determined. MRI is also useful in diagnosing complication of trauma, such as ischemic necrosis and bone and soft-tissue infections.

Ankle Injuries

Imaging of the sacroiliac joints.

The sacroiliac joints present unique problems in diagnosis for both the clinician and the radiologist. Each of the imaging modalities presents advantages and problems. The specific clinical problems determine whether advanced imaging modalities such as scintigraphy, CT scan, or magnetic resonance imaging will complement the information on the plain radiographs.

Arthritis, Infectious

Calcific tendinitis of the neck.

When a calcific deposit in the shoulder, hip or elbow ruptures, it results in severe pain and tenderness. Few clinicians are aware that the longus colli muscle of the neck is also subject to acute tendinitis. When it occurs, the pain and spasm mimic infectious spondylitis or meningitis. Four patients are presented with acute tendinitis of the longus colli muscle and the classic radiographic findings of soft-tissue swelling and amorphous calcium deposits in the tendon.

Adult

Migrating bone shards in dissecting Charcot joints.

Extensive periarticular calcification is characteristic of Charcot joints. Fragmentation of the articular margins of bone contributes to the bony detritus, but the majority forms de novo in the joint capsule. Occasionally the calcific debris is seen far removed from the joint. Dissection of a chronically distended joint along muscle planes is most commonly associated with the inflammatory joint disease of rheumatoid arthritis. Its occurrence in Charcot joints is documented by arthrography, which demonstrates continuity of the joint space and the distant calcifications.

Adult

Dysphagia and Forestier disease.

Forestier disease (ankylosing hyperostosis) is a well-recognized and common disease entity. Although these patients rarely have complaints related to their spine, they are seen by the otorhinolaryngologist because of dysphagia, since the osteophytic spurs may impinge on the posterior pharyngeal wall. Since the plain roentgenogram and barium swallow is so specific, biopsy examination of the pharyngeal mass is not necessary.

Cervical Vertebrae

The radiology of bone and soft tissue sarcomas.

Solitary lesions of bone often have characteristic radiographic patterns that suggest the diagnosis of a specific bone tumor. Differentiation of tumor from infection, however, frequently may be impossible, and the majority of bone lesions require biopsy for histologic confirmation of the type of tumor or for identification of the infectious organism. Soft tissue masses, unlike bone tumors, most commonly look alike. They too require biopsy, but in this case to distinguish a benign mass from a soft tissue sarcoma. Special radiographic techniques such as isotopic and CAT scans or angiography add information about the morphology and response of adjacent bone, but fail to differentiate one category of disease from another or to establish a histologic diagnosis of the type of tumor.

Adolescent

Periostitis and pseudoperiostitis.

Increased metabolic activity with the periosteum is demonstrated radiographically by the presence of a linear shadow of bone paralleling the cortex, most commonly reflecting increased osteoblastic activity and thus representing periosteal new bone. This is frequently seen in psoriatic arthritis and Reiter's syndrome. A similar picture occurs with increased osteoclastic activity and reflects rapid demineralization, simulating periostitis. This change must be recognized as a reflection of osteoporosis, lest the condition be misdiagnosed as inflammatory disease.

Arthritis