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A mother-daughter kindred with carpal-tarsal osteolysis and evidence of renal involvement is presented. There was a similarity between the early clinical manifestations of this syndrome and those of rheumatoid arthritis. The distinction made in previous reports between the dominantly inherited form and the sporadic form with nephropathy is questioned.
23 (60%) of 38 human breast carcinomas had significant in-vitro osteolytic activity. All patients presenting with bone metastases or hypercalcaemia had active tumours. Over a subsequent three-year follow-up period, bone metastases did not develop in any of the 15 patients with inactive tumours, and metastases at other sites developed in only 2. Of the 23 patients with active tumours, 7 either had, or have since developed bone metastases; in 4 of these hypercalcaemia also developed. 14 tumours, chosen at random, were tested for in-vitro osteolytic activity in the presence and absence of aspirin, which inhibits prostaglandin synthetase. The activity of 8 of the 9 osteolytically active tumours was significantly, though not completely inhibited by aspirin. Although the number of patients is limited, these results indicate that the in-vitro osteolysis assay may detect substances, perhaps including prostaglandins, produced by breast tumours which affect prognosis and contribute to the subsequent formation of bone metastases.
A new case of idiopathic multicentric osteolysis presenting with cranial malformation and mental retardation is described. The patient could be followed for some years. Differential diagnosis is considered and a classification of osteolytic syndromes attempted.
Involvement of the skull by a rare disorder-massive osteolysis-led to CSF rhinorrhoea and meningitis. This is believed to be the first time that such a case has been reported.
A rare complication of massive osteolysis (disappearing bones, Gorham's disease)is presented--namely involvement and invasion of the thoracic duct by the angiomatous tissue spreading locally from involved upper thoracic vertebrae. The resultant chylothorax in our patient was investigated and the site of the lymphatic fistula established by lymphography. Operative obliteration of the chylous leak was successfully achieved and the patient has survived. A review of the literature shows this complication to have been fatal in six other cases, including Gorham's first patient.
Erosion of progressive resorption of the distal clavicle following trauma has been described but merits greater attention due to its frequency. Six cases of posttraumatic osteolysis of the distal clavicle are reported with emphasis on early radiographic detection. Soft tissue swelling, deminerlization, and loss of the subarticular cortex at the injured clavicular tip antecede the more commonly recognized gross erosion. Recognition of this early stage, with consequent immobilization, may shorten the course of this process and decrease the prolonged disability. The pathogenesis of the process is discussed and illustrated.
The well-known clinical and radiological findings of idiopathic osteolysis (Hajdu-Cheney) are described in a 17-year old man. He also had retarded puberty, recurrent dislocation of the patella, dental anomalies and markedly elevated alkaline and acid serum phosphatase. The differential diagnosis of this rare condition and its relationship to other bone dysplasias is discussed.
Migratory osteolysis is a recently recognized syndrome characterized by a migratory articular pain pattern of the lower extremities and associated radiographically with localized and reversible juxta-articular osteoporosis. Serial bone scans, both dynamic and static, appear to offer a new and more sensitive means for diagnosing and monitoring of this condition. The dynamic studies suggest that augmented osseous blood flow is responsible, at least in part, for increased radioactivity in clinically involved areas and presumably is mediating the osteoporotic process.
Anatomo-radiological study of a case of osteolysis of the femoral head and neck in a 56-year old male who had recieved, 22 years earlier, an intense radiotherapeutic treatment for a soft tissue tumour of the corresponding hip region. The treatment is considered as being the main etiological factor responsible for the bone lesions. The latter seems to have been favored by an indolent joint due to a thoracic cordotomy for post-irradiation pains; it may have been prepared by a secondary osteodystrophy which preceded the radiotherapy and seems due to two previous surgical excisions.
In a patient with progressive systemic sclerosis (PSS), osteolysis of the posterior portion of the rib cage developed in an insidious fashion, without symptoms or preceding trauma. Six previous examples of rib resorption in PSS are reviewed. The destructive mechanism is unknown but may be related to endarteritis and ischemia.
Severe clinical and radiological signs of the rare idiopathic osteolysis, type Hajdu-Cheney were manifest in a seven year old girl. A peculiar aspect of her face was evident since birth. The acroosteolysis and a general osteoporosis were radiologically visible when she was three years old. During the following 4 years there was a fast progression of the bone abnormalities and the shape of the skull became dolichocephalic.
Clinical, radiological and anatomical description of sellar chordoma giving, on a sixty seven years old man, an unusually large tumoral exophthalmos, a massive orbito-sphenoidal osteolysis and a chiasmatic syndroma. Discussion stresses the topographic data of chordoma in connection with the embryonal chordal cell rests. Patterns of evolution and neuro-ophthalmologic symptoms of cephalic chordoma are studied with the literature facts. Morphologic criteria, specifical ones and those differential diagnosis, are exactly scheduled.
The authors indicate the required methodologic conditions for the morphometric analysis of periosteocytic osteolysis, a reliable and specific feature of overactivity of the parathyroid gland. Indeed, significant periosteocytic enlargement has been found in 101 113 cases of primary hyperparathyroidism compared to 92 reference cases. The measurement of the size of the periosteocytic lacunae may be carried out either on hand of a micrometric eyepiece or of a picture analyser. It has to be carried out on decalcified bone sections of 5 microns thickness and it is necessary to measure at least 50 lacunae. The decalcification process unmasks an already partially decalcified crown of periosteocytic bone tissue the thickness of which is more important in the hyperparathyroidal bone than in normal bone. This zone has a peculiar collagen texture. The measurement of the peri-osteocytic enlargement is easy on stained sections of decalcified bone or on microradiographs of non-decalcified bone and, contrariwise, very dubious on stained sections of non-decalcified bone.
A case of "cryptogenetic osteolysis of the mandible" is reported. This is a rare affection as only 13 cases of "phantom mandible" are known, but other sites exist (91 cases of phantom bone are known). The diagnosis is suspected after radiography, and confirmed by anatomopathological examination. No treatment for this affection has been described.
Chronic frontal sinusitis and osteolysis in a herd of desert bighorn sheep (Ovis canadensis nelsoni) in Zion National Park, Utah, was attributed to bacterial infection secondary to aberrant nasal bot migration. Analysis of skulls and live adult sheep (equal to 1 year old) showed that 9 to 22 animals were affected. One ram and 1 ewe were treated by trephination and irrigation. Treatment was successful for the ewe, but not for the ram. Radiography, thermography, and blood profiles were used in an attempt to find a way to diagnose sinusitis in its early stages; at this point, only thermography shows promise.
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