Case report 595: Paget's disease with congenitally fused cervical vertebrae.
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Biomedical subjects
Publications and source records attributed to T W Staple.
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The snapping tendon syndrome may be caused by abnormalities of the fascia lata, gluteus maximus muscle, or less commonly, the iliopsoas tendon. One case is reported in which fluoroscopic monitoring after computed tomography-guided injection of contrast material confirmed the diagnosis of snapping iliopsoas tendon syndrome.
Enchondroma protuberans of the rib may be indistinguishable from osteochondroma or chondrosarcoma. The problems of needle biopsy and the confusion which arose in the preoperative and intraoperative evaluation of two previous cases from the literature were avoided in the present case by total resection of the lesion. Where possible, total resection is recommended for accurate diagnosis.
There is a paucity of information regarding insufficiency fractures of the os pubis in rheumatoid arthritis. While only 7 such fractures have been recorded thus far in the English literature, we have encountered 5 os pubis fractures in the past 4-year period. We report these cases to heighten awareness of their existence, describe their sometimes misleading clinical presentations, and to discuss possible etiologic factors.
Twelve parasymphyseal insufficiency fractures of the os pubis are described in eight osteopenic postmenopausal women, three of whom had rheumatoid arthritis. The fractures involved both right and left pubic bones in three women. Radiographically lesions often appear deceptively destructive and malignant. In six patients, biopsy was performed and showed no tumor. Biopsy can be avoided in an osteopenic woman with recent increased activity, pubic pain, and the characteristic pubic lesion.
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Percutaneous needle placement before biopsy is a simple method of localizing occult breast lesions found by mammography. A biopsy of the exact area within the breast is done. Specimen radiography assures that the correct area is included for histologic study.
A case is presented of progressive acro-osteolysis of the hands combined with progressive mandibular ramus osteolysis and multiple cortical defects. The features of acro-osteolysis are reviewed and classified.
A CGR mammographic unit was modified to provide a more accurate method of measuring skin thickness. Evaluation of 418 normal patients indicated that skin thickness is greater in men than women, is less in older individuals, and, to a less extent, is greater in more obese patients. Height and race do not have a statistically significant bearing on skin thickness values. These "normal" values may prove useful as a screening criterion in evaluation of patients with possible acromegaly or Cushing's syndrome. Other potential applications are being investigated.
Trephine bone biopsies were performed in 67 patients. Routine radiography, laminagraphy, and radioisotopic techniques were employed to determine areas of involvement and exact sites for biopsy. Sites were selected on the basis of accessibility, possible complications, and chances of recovering diagnostic material. The biopsy material was informative in 81% of patients. One controllable hemorrhage, one temporary sinus tract, a small pneumothorax requiring no therapy, and two benign vasovagal responses were the only complications. Widespread malignant disease and osteomyelitis, particularly disk-space infection, are the most suitable lesions for trephine biopsy.
The authors describe a simple outpatient venous angiographic method of delineating arteriovenous fistulas constructed for chronic hemodialysis, and variations of the basic technique are offered to solve the problems of overlapping vessels and obscured anastomoses. A normal fistula produces enlargement of the involved artery only, but there may be enlargement of multiple veins in the extremity in which the fistula is constructed. Stenoses, occlusions, surgical variations, aneurysms, functional abnormalities in the direction and quantity of flow, and inadequate positioning of the dialysis needles are discussed.
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