Biomedical subjects
Publications and source records attributed to M L O'Neal.
We report a case of ocular sebaceous carcinoma, involving incidental discovery in an elderly woman and its recurrence following inadequate eradication. We review the clinical presentation and treatment options with emphasis on potential errors in clinical judgment leading to recurrence.
Fibular dimelia accompanied by complete tibial agenesis is a rare developmental anomaly that has been reported in the anatomic and clinical literature as both a dimelia and a diplopodia. Previous reports have offered variable descriptions of structural aberration and possible modes of altered embryologic development. We present a clinical and radiographic history of the progressive development of this anomaly, and a detailed postsurgical dissection and histopathologic examination. The specific mirroring of the separate components in this case has not been previously reported, and suggests that a reestablishment of limb polarity may have occurred during embryogenesis. Our detailed morphologic investigation strongly suggests a central role for the mesenchymal precursor from which chondro-osseous morphology subsequently emerges, and the relevance to establishing muscular attachments.
The clinician must have an understanding of the spectrum of potential problems that can occur in the pediatric patient with a limb deficiency. These various complications-osseous, nonosseous, infection, phantom limb phenomenon and pain, pre-existing conditions, and psychosocial-are discussed.
The contemporary trend of converting departments of anatomy into departments of cell biology has brought with it the task of examining archive collections and storage facilities to figure out how to best utilize the available space. During one such inspection at the University of Louisville School of Medicine, a human sternum containing a dull metal projectile was uncovered. The projectile was easy to characterize as a bullet that had been deeply embedded in the bone. Less clear, however, were the circumstances detailing how the bullet had become lodged in the sternum, or how long the sternum might have been in storage at the University of Louisville. Radiographs of the sternum revealed a halo of surrounding density that dissipated in intensity from the margins of the bullet. Our initial hypothesis was that lead had been leached from the bullet into the bone matrix. To better assess what in fact contributed to this density, the sternum and the bullet were analyzed by energy-dispersive spectroscopy (EDS) to determine their elemental composition. That the bullet was composed of lead and aluminum was not surprising, but the extent to which the presence and dissolution of the bullet had affected the composition of the bony sternum was not entirely expected. The contribution of metal ions from the bullet to the inorganic matrix of bone was most notable for aluminum but nearly negligible for lead. This finding confirmed that bone affinity for metals is dependent upon the metal and supports previous reports that have suggested that lead is released from bone as soluble blood product during bony remodeling, whereas aluminum results in a significant elevation of bone density.
We report the occurrence of a bipartition and occult growth plate fracture in the medial cuneiform of a 5-year, 11-month-old traumatic amputee. Initial radiographs of the foot taken in an oblique projection revealed what appeared to be an osseous fracture of the medial cuneiform. Histologic examination of the pathologic specimen showed that the radiolucent cleft separating the two foci of ossification was actually a hyaline synchondrosis (growth plate) functioning in the normal endochondral transformation of the bone. Histology also detailed a previously undetected fracture traversing the synchondrosis that was sustained during the accident. This unusual case demonstrates that radiographic discontinuity often does not correspond to anatomic discontinuity and should not be misdiagnosed as an osseous fracture. Yet, as with all growth plates of the chondro-osseous skeleton, occult injury to the growth mechanism should be suspected in instances of obvious trauma. Discriminating between normal development of the skeleton and skeletal pathology can be a challenge to the treating physician. Therefore, an awareness of possible anatomic variations will enhance diagnostic evaluations.
STUDY DESIGN: Twelve spontaneously occurring fractures of the spin in nine skeletally immature animals were investigated. OBJECTIVES: These fractures were analyzed radiographically, morphologically, and histologically. SUMMARY OF BACKGROUND DATA: The most commonly injured regions were the cervical and lumbar regions. Multiple-level fractures were noted in three specimens. METHODS: Morphologic and histologic examination invariably detected fractures in cases of spinal cord injury without radiographic abnormality. RESULTS: The end-plate physes and synchondroses were found to be the "weak links" for propagation of fractures. Radiographically benign-appearing ring apophyseal fractures were found histologically to propagate from the end-plate physis through the vertebral body via the contiguous neurocentral synchondroses. CONCLUSIONS: The observed morphologic and histologic fracture patterns should provide a better understanding of the probable comparable pathoanatomy of spine and spinal cord injuries in children.
Congenital digitus minimus varus (overlapping of the fifth toe) is often bilateral and may result from an anatomic deformity of the extensor digitorum longus tendon. Although bifurcation of the tendinous slip to the fifth toe has been reported as an anatomical variant, in those patients affected with overlapping fifth toe, a pronounced asymmetry between the medial and lateral components may occur. Not only do the two slips to the fifth toe differ in girth, but the morphology of the separate tissues reflects a dissimilar level of organization. Surgical techniques for correction of secondary overlap should consider the possibility of altered gross and histologic anatomy of the extensor tendon when attempting to preserve function.
We retrospectively studied the incidence of primary surgical revision for stump overgrowth in a population of childhood and adolescent amputees. The anatomic location and the etiology of amputation are critical to the occurrence of overgrowth needing revision. Metaphyseal-level amputations are the most likely to develop overgrowth requiring revision (50%), whereas diaphyseal amputations are slightly less likely (45%). Joint disarticulations never develop overgrowth. Traumatic amputations are the most frequent mode of injury requiring revision of overgrowth (43%), followed by congenital or intrauterine amputations (30%) and elective amputations (20%). Radiographic classification of the osseous overgrowth helps define its severity and degree of ossific progression. Surgical revisions are usually performed when overgrowth reaches a grade 3 classification. The majority of skeletally immature diaphyseal- or metaphyseal-level amputees, including those with certain preexisting orthopaedic conditions, retain the ability to develop osseous overgrowth at the apex of the stump skeleton.
Explore the source record for details and available documents.
Chronic sinusitis is now recognized as a common clinical syndrome in adults and children. An astute physician can diagnose chronic sinusitis during the physical exam, but fiber-optic rhinoscopy and x-rays (plain films and computerized tomography) are required to confirm this diagnosis, evaluate the severity of the sinusitis and determine follow-up treatment. Appropriate treatment plans are prescribed for an adequate duration to eliminate infection and inflammatory components of the pathologic process of the sinuses involved. Antibiotics, decongestants, and inhaled or systemic corticosteroids are required in the treatment of patients with chronic sinusitis. When combined with close clinical follow-up, successful resolution is expected. Surgical intervention is needed in the medically refractory and symptomatic cases, or when complications develop. The frequent diagnosis of chronic sinusitis in the past 1-2 decades is, in part, due to the enhanced awareness and clinical skills of the treating physicians, but other concerns about environmental influences such as frequent respiratory tract infections in childhood and air quality issues are considered potentially important.
Postnatal development and maturation of the human sternum are highly variable. Endochondral ossification centers (sternebrae) form within each cartilaginous segment of the sternum, with each center enveloped by a spherical growth plate. Within a cartilaginous center there may be either one or two ossification centers, those with two centers retaining and reflecting features of their bilateral embryonic origin. Malaligned bifid centers are clearly associated with rib articulation asymmetry as well. Expansion of individual ossification centers progresses within the peripheral cartilaginous domains of the sternum. With respect to the rostrocaudal axis, sternebrae form between the costosternal articulations. Consistent with the biology of endochondral transition, cartilage canals are evident throughout unossified regions of the hyaline matrix. Expanding ossification of adjacent sternebrae results in depletion of the common area of cartilage between the two sternebrae, and eventually in physiologic epiphysiodesis. Fusion of the mesosternebrae reciprocates the initial pattern of sternebral ossification site appearance, proceeding in a caudal-to-cranial direction. Union of adjacent sternebrae, initiated through a central osseous bridge, progresses through anterior, lateral, cephalocaudal, and posterior domains to achieve synostosis. Accessory and bifid centers of ossification within the same intercostal space coalesce prior to adjoining adjacent sternebrae. Manubriosternal fusion is rare due to the presence of a fibrocartilaginous joint restricting ossification. The xiphoid process remains connected to the most caudal mesosternum via a common zone of hyaline cartilage that ossifies by middle to late adulthood. A single pattern of development does not appear fundamental to successful growth of the sternum, as morphological variants were common.