The radiologic spectrum of abnormalities of the foot in diabetic patients

Radiologically visible lesions in the feet of patients with long-standing diabetes mellitus are common and varied. They include osteoporosis, osteosclerosis, osteolysis, juxta-articular defects of the cortical bone, ischemic bone necrosis, new bone formation, spontaneous fracture and subluxation, and neuropathic arthropathy. These manifestations result from diabetic angiopathy and neuropathy and usually are complicated by infection. In this review the author describes these protean radiologic features in light of their pathogenesis and discusses the diagnostic problems encountered.

[The clinico-parasitological examination of a focus of intestinal nematodiases in Ha-Shon-Bin Province in the People's Republic of Vietnam and an analysis of 5 medamine treatment schemes]

An intensive focus of intestinal nematodiases in a foothill province of Vietnam is described; the incidence of ascaridiasis there was found to be 81.8%, trichuriasis 78.1%, and ankylostomiasis 12.3%. Polyinvasions were detected in more than 80% of the examinees. Analysis of five schemes of medamin therapy, used in three provinces in 595 patients with ascaridiasis, 490 ones with trichuriasis, and 323 ones with ankylostomiasis has shown that the treatment efficacy was reducing with the invasion intensity augmentation. In ascariasis the 3- and 5-day therapeutic schemes were the most effective, their efficacies being 68.4 and 82.0%, respectively; in trichuriasis and ankylostomiasis a 3-day scheme was the best, its efficacies being 74.0 and 71.9%, respectively. Retrograde ascarid migration occurred in 1.2% of 595 ascaridiasis patients after medamin therapy.

Quality factor and dose equivalent investigations aboard the Soviet space station MIR

Since Dec 1988, date of the French-Soviet joint space mission "ARAGATZ", the CIRCE device (Compteur Intégrateur de Rayonnement Complexe dans l'Espace) had recorded dose equivalent and quality factor inside the MIR station (380-410 km, 51.5 degrees). After the initial gas filling two years ago, the low pressure tissue equivalent proportional counter is still in good working conditions. Some results of three periods, viz Dec 1988, Mar-Apr 1989 and Jan-Feb 1990 are presented. The average dose equivalent rates measured are respectively 0.6, 0.8 and 0.6 mSv/day with a quality factor equal to 1.9. Some detailed measurements show the increasing of the dose equivalent rates through the SAA and near polar horns. The real time determination of the quality factors allows to point out high LET (Linear Energy Transfer) events with quality factors in the range 10-20.

A rare bone tumor in an unusual location: osteoblastoma of the vertebral body

Most osteoblastomas involve the posterior elements alone, or both the posterior elements and the vertebral bodies. Osteoblastomas confined in the body of the vertebrae are very rare. Spinal osteoblastomas are associated with localized pain in about 80% of cases and neurological deficits in 25% to 50% of cases. Nearly half of lumbar and thoracic osteoblastomas demonstrate coexistent scoliosis with the convex side away from the involved side of the vertebrae.

Unusual feature of soft-tissue calcification in chronic renal failure: tumoral calcification

Two cases of massive calcification in dialysed patients are described with computerized tomography correlation: one in the abdominal/pelvic cavity, which is a rare location, and the other in the abdominal wall. The cause of these calcified deposits is multifactorial and complex. Usually painless, they may cause restriction of joint movement by virtue of their bulky size.

Freiberg's disease in diabetes mellitus

We evaluated a total of 13 cases of Freiberg's disease in patients aged 47-77 years collected over an 8-year period. Seven were associated with diabetes mellitus and one with chronic renal failure; the remainder had no underlying disease. Atrophy of intrinsic small foot muscles secondary to neuropathy, which is prevalent in diabetes mellitus, may play a part in the development of Freiberg's infraction.

A rare cause of splenic infarct and fleeting pulmonary infiltrates: polyarteritis nodosa

A rare multi-system disease with an incidence of about 5/million per year, polyarteritis nodosa (PAN) occasionally may cause splenic vasculitis, usually at arteriole bifurcations, leading to multiple systemic infarcts with extensive confluent systemic necrosis. PAN may also be a cause of fleeting patchy pulmonary infiltrates or pulmonary nodular lesions. The diagnosis is usually difficult and delayed because the clinical manifestations are varied and depend on the site and the extent of the arterial involvement.

A rare cause of laryngeal distress: chondrosarcoma of the larynx

Laryngeal chondrosarcomas are much less aggressive lesions than chondrosarcomas that arise elsewhere in the body. Two cases of chondrosarcoma of the larynx encountered during a seven year period are presented, with a review of the literature. Computed tomographic (CT) and magnetic resonance imaging (MRI) findings are described. The MRI findings of laryngeal chondrosarcoma are compared to those of cartilaginous tumors elsewhere in the body. The differential diagnosis, prognosis, and treatment of laryngeal chondrosarcomas are discussed.

Real time quality factor and dose equivalent meter "CIRCE" and its use on-board the Soviet orbital station "MIR"

During the French-Soviet space mission "Aragatz," the experiment CIRCE (Compteur Integrateur de Rayonnement Complexe dans l'Espace) recorded the dose rate and quality factor values inside the MIR station. This paper presents results obtained with a new active dose equivalent meter based on microdosimetric techniques and using a low pressure tissue equivalent proportional counter. In terms of lineal energy CIRCE device works in the 0.2-1200 keV micrometer-1 range in tissue. Preliminary studies were performed in photon, neutron and heavy ion beams, and in the real stratosphere cosmic radiation field. Long term measurements on-board MIR station from December 1988 to April 1989 gave an average quality factor value equal to 1.9 +/- 0.3. Through the South Atlantic Anomaly (SAA), the quality factor was equal to 1.4. The temporal orbital variations of the dose rates and quality factors have been established in space dosimetry for the first time.

Subcutaneous soft tissue densities: a computed tomography indicator of severe pancreatitis

Twenty patients with known acute pancreatitis had 50 computed tomography studies. Those with severe pancreatitis showed streaky and fluffy soft tissue densities in the flanks and some in the gluteal regions. The appearance and disappearance of this finding correlates with the extravascular movement of fluid due to severe pancreatic inflammation.

[The clinical efficacy of and tolerance for lariam (mefloquine) in tropical malaria in the south of the Socialist Republic of Vietnam]

The study was performed in the area of distribution of tropical malaria resistant to 4-aminoquinolines (Vietnam) on 30 patients receiving lariam (mefloquine). The results were compared to the standard therapy with quinine and fansidar. They indicate a high efficacy of and a good tolerance to the drug tested. The use of lariam leads to a more rapid (as compared to the standard treatment) elimination of parasitemia and complete eradication of the disease relapses. The findings make it possible to recommend lariam for the prevention and treatment of tropical malaria.

Acute interstitial nephritis associated with cefotetan therapy

We report a case of acute interstitial nephritis associated with cefotetan therapy. Cefotetan should be considered a potential cause of acute renal failure in patients who develop rash, eosinophilia, and fever in association with an acute deterioration of renal function.

"Idiopathic destructive arthritis" of the shoulder: a still fascinating enigma

Idiopathic destructive arthritis of the shoulder is uncommon, and all previous reports appeared in the nonradiologic literature. The clinical, radiological, and laboratory findings are described. This rare form of rapidly destructive arthritis of the shoulder bear resemblance to several neuropathic-like arthropathies, and its etiopathogenesis is still unclear.

[Clinico-parasitological research in a focus of intestinal nematodiasis in Habak Province (the Socialist Republic of Vietnam) and the efficacy of medamine treatment in these infestations]

The authors described the focus of intestinal nematodiasis in Vietnam with the rate of infestation on the average 74.6% for ascaridiasis, 30.8 for trichocephaliasis and 20.2% for ancylostomiasis. The high rate of the geohelminthic infestation was related with the use of untreated feces for the vegetables rearing. The clinical symptoms of intestinal nematodiasis were featured by dyspepsia, pain and asthenoneurotic syndromes. The first field trials of mediamine treatment were performed for 267 patients in the high-intense foci of intestinal nematodiasis in the tropics. In trichocephaliasis patients therapeutic efficacy of the drug was 74%, in ancylostomiasis patients it was 71.9, in ascaridiasis patients 68.4%. Retrograde ascarid migration was noted in two patients.

The pelvic digit: CT correlation and review of the literature

Four additional cases of the developmental anomaly known variously as pelvic "ribs" or "digits" are presented with CT correlation in three cases. Comparison is made with the 12 cases reported in the literature, and their differential diagnosis is discussed.

Modification of a Dionex System 12 ion chromatograph for sequential determination of the main components in atmospheric precipitation

A modification of a Dionex System 12 ion chromatograph is described which enables organic anions (acetate and formate), inorganic cations (ammonium, sodium and potassium) and inorganic anions (chloride, nitrate and sulphate) to be determined sequentially in one measuring procedure. The modified instrument consists of a programmable controller unit, a conductimetric meter, two conductimetric detectors of the Dionex System 12 ion chromatograph, the HPIC-AS4A and HPIC-CS3 modern separation units, AMMS-1 and CMMS-1 micro-membrane suppressor columns, a unique system of valves from Dionex and two dual pumps from Biotronik. The limits of detection are between about 1 and 3 micrograms/l for chloride, nitrate and sulphate and between about 2 and 10 micrograms/l for acetate, formate, ammonium, sodium and potassium. The reliability of the method was demonstrated by analysing two NBS simulated rain water Standard Reference Materials. Some examples are given of the application of the method to the sequential determination of the main precipitation components in typical samples from urban and rural regions of the F.R.G. The ion concentrations varied between about 0.02 and 300 mg/l.

Detection of ionizing radiations with the SOS Chromotest, a bacterial short-term test for genotoxic agents

The effects of 3 types of ionizing radiation, gamma-rays, neutrons and accelerated alpha-particles, were examined using the SOS Chromotest, a bacterial colorimetric assay for genotoxic agents based on the measurement of the SOS response in Escherichia coli. The SOS Chromotest appeared to be a sensitive and simple assay to detect quantitatively these radiations as well as their biological effects. The range of adsorbed doses for which induction was observed was similar for the 3 types of radiation, the minimum inducing doses being in the order of 2.5-5 Gy. We discuss the possible use of these observations to study the molecular action of radiations and to compare their genotoxic effects with those of chemicals.

The role of free fatty acids in hypoxia-induced injury to renal proximal tubule cells

Phospholipase activation with resulting phospholipid breakdown and lipid byproduct accumulation may play a critical role in hypoxic cell injury. To explore this role, mildly hypoxic rabbit renal proximal tubules (PT) in suspension were treated in vitro with exogenous phospholipase A2 (PLA2). This treatment produced severe tubule cell injury measured by alterations in tubule cation homeostasis, respiratory rates, and adenosine nucleotide metabolism. This injury was associated with loss of the major membrane phospholipids, phosphatidylcholine (PC) and phosphatidylethanolamine (PE), with accumulation of lipid byproducts, lysophosphatidylcholine (LPC), lysophosphatidylethanolamine (LPE), and free fatty acids (FFA). Addition of fatty acid-free bovine serum albumin (BSA) to PTs reduced markedly FFA levels and improved significantly derangements in metabolic parameters of hypoxic PTs treated with exogenous PLA2, suggesting that FFA accumulation was a critical factor in this injury process. Effects of increasing durations of hypoxia (30, 45, and 60 min) with or without reoxygenation recovery demonstrated increased FFA levels, especially polyunsaturated FFA, which correlated better with the degree of hypoxic injury than alterations in membrane phospholipid and lysophospholipid levels. PTs undergoing hypoxia and reoxygenation recovery exposed to BSA were not protected. Although 60 min of hypoxia with 60 min reoxygenation produced accumulation of FFA to levels nearly identical to those seen in hypoxic PTs treated with exogenous PLA2 and BSA, with a similar distribution of various FFA species, hypoxia/reoxygenation produced a more severe degree of cell injury than that observed with hypoxia plus exogenous PLA and BSA.(ABSTRACT TRUNCATED AT 250 WORDS)

Importance of adenosine triphosphate in phospholipase A2-induced rabbit renal proximal tubule cell injury

The pathogenesis of ischemic renal tubular cell injury involves a complex interaction of different processes, including membrane phospholipid alterations and depletion of high-energy phosphate stores. To assess the role of membrane phospholipid changes due to activation of phospholipases in renal tubule cell injury, suspensions enriched in rabbit renal proximal tubule segments were incubated with exogenous phospholipase A2 (PLA2). Exogenous PLA2 did not produce any significant change in various metabolic parameters reflective of cell injury in control nonhypoxic preparations despite a significant decrease in phosphatidylethanolamine (PE) and moderate increases in lysophosphatidylcholine (LPC) and lysophosphatidylethanolamine (LPE). In contrast, exogenous PLA2 treatment of hypoxic tubules resulted in a severe degree of cell injury, as demonstrated by marked declines in tubule K+ and ATP contents and significant decreases in tubule uncoupled respiratory rates, and was associated with significant phospholipid alterations, including marked declines in phosphatidylcholine (PC) and PE and significant rises in LPC, LPE, and free fatty acids (FFA). The injurious metabolic effects of exogenous PLA2 on hypoxic tubules were reversed by addition of ATP-MgCl2 to the tubules. The protective effect of ATP-MgCl2 was associated with increases in tubule PC and PE contents and declines in LPC, LPE, and FFA contents. These experiments thus indicate that an increase in exogenous PLA2 activity produces renal proximal tubule cell injury when cell ATP levels decline, at which point phospholipid resynthesis cannot keep pace with phospholipid degradation with resulting depletion of phospholipids and accumulation of lipid by-products. High-energy phosphate store depletion appears to be an important condition for exogenous PLA2 activity to induce renal tubule cell injury.

Comparison of the toxicity of the radiocontrast agents, iopamidol and diatrizoate, to rabbit renal proximal tubule cells in vitro

Radiographic contrast agent-induced acute renal failure is an increasingly recognized clinical event. Multiple factors have been implicated in its development. Recent experiments have demonstrated that sodium diatrizoate, a common ionic radiocontrast agent, is moderately toxic to proximal tubule cells in vitro, and that this toxicity is enhanced by hypoxia. In this study, we compare toxicities of the nonionic radiocontrast agent, iopamidol, and the commonly used ionic contrast agent, diatrizoate. Suspensions enriched in proximal tubule segments were exposed for 82.5 min to 10 or 25 mM diatrizoate or 10 or 25 mM iopamidol with or without 22.5 min or 30 min of hypoxia. Cell viability parameters, including basal and uncoupled respiratory rates, tubule cell potassium and calcium levels and cell ATP content were measured. No consistent differences in tubule viability parameters were observed between tubule suspensions exposed to 10 mM concentrations of the radiocontrast agents during either oxygenated or hypoxic conditions. Under oxygenated conditions, both 25 mM iopamidol and diatrizoate exposure produced greater metabolic alterations in renal tubules than control conditions, but the effects were not statistically significant. With concomitant hypoxia, the alterations after 25 mM diatrizoate exposure were significantly greater than those seen after exposure to 25 mM iopamidol. Iopamidol had less of a detrimental effect on renal tubule potassium content and both basal and uncoupled respiratory rates than that of diatrizoate under these conditions. Thus, diatrizoate is more toxic to rabbit renal proximal tubule cells than iopamidol in vitro, and this difference in toxicity is enhanced by hypoxia.(ABSTRACT TRUNCATED AT 250 WORDS)

High energy phosphates, phospholipids, and calcium in ischemic renal tubular cell injury

Substantial data is available supporting critical roles for high energy phosphates, calcium, and phospholipids in ischemic cell injury. Although it has been proposed that one of these compounds may be most critical and defines the "final common pathway" for lethal cell injury, it is more accurate to define the pathogenesis of ischemic cell injury as the simultaneous derangement of several critical metabolic process which act in concert to produce a cascade of events that finally lead to plasma and subcellular membrane dysfunction incompatible with the maintenance of cell viability and integrity. As detailed in Figure 1, a tentative scheme is proposed interrelating high energy phosphate depletion, cellular calcium derangements, and membrane phospholipid degradation and loss. Ischemia directly leads to declines in the rate of oxidative phosphorylation due to a lack of oxygen availability. A fall in cellular ATP levels develops. Ischemia also promotes a redistribution of intracellular calcium pools and results in phospholipase activation and phospholipid degradation. When phospholipid degradation occurs concomitantly with a decline in high energy phosphate levels, phospholipid synthesis cannot keep pace with phospholipid degradation and net membrane phospholipid loss occurs. An increase in plasma membrane calcium permeability develops and the influx of calcium down its electrochemical gradient from extracellular to intracellular spaces occurs. This calcium is taken up and sequestered in mitochondria and causes further alterations in mitochondrial structure and function, leading to further declines in cellular ATP content.(ABSTRACT TRUNCATED AT 250 WORDS)

Ring sequestrum: radiographic characteristics of skeletal fixation pin-tract osteomyelitis

Major pin-tract infections are a potentially dangerous complication associated with the use of skeletal transfixation pins. The presence of a characteristic radiographic finding, the ring sequestrum, is virtually diagnostic of this abnormality. The clinical and radiographic findings in seven patients treated for this complication are presented. Thermal necrosis without infection presents as a zone of sclerosis around the tract. A narrow, radiolucent halo may surround the dense bone. When a narrow ring sequestrum is surrounded by a radiolucent halo, there is associated infection.

Cerebro-costo-mandibular syndrome with consanguinity

The cerebro-costo-mandibular syndrome is a rare disorder characterized by unique posterior rib defects, micrognathia, and mental deficiency. The mode of transmission is undetermined. This report describes the first case with documented parental consanguinity as well as hitherto undescribed CT and skeletal findings.