Influence of clinical information on the detection of wrist fractures in children

The purpose of this investigation is to assess the importance of clinical information for the detection of non-displaced wrist fractures in children. Twenty non-displaced fractures of the distal radius in children younger than 15 years of age and twenty age-matched controls were evaluated by five blinded observers before and after giving clinical data, and a receiver operating characteristic (ROC) analysis using a continuous rating scale with a line-marking method was performed. The detection of the fractures was significantly improved with clinical information, and the main reason for this was an increase in true positive fraction. Availability of adequate clinical data should be emphasized for interpreting radiography.

Volar dislocation of the capitate

In this report we describe a case of volar dislocation of the capitate associated with dislocation of the ulnar side of the carpometacarpal joint. Forced dorsiflexion of the wrist caused the rotation and volar displacement of the proximal portion of the capitate. Dislocation of the capitate is rare and may be seen in more complex injuries. An awareness of this type of injury may contribute to prompt diagnosis and treatment.

[Prognosis for patients with angina pectoris accompanied by chronic renal failure]

Chronic renal failure (CRF) is one of the risk factors of a worse outcome for patients with coronary artery disease. However, few studies have assessed the outcome in such patients. This study investigated the clinical characteristics, treatment modalities, and prognosis for patients with angina pectoris accompanied by CRF and evaluated the validity of current treatment strategy for these patients. A total of 593 patients (248 with stable angina and 345 with unstable angina) admitted to our institution were studied. Renal failure was defined as serum creatinine of > or = 2.0 mg/dl. Patients were divided into 2 groups, with renal failure (46 patients) and without renal failure (547 patients), and the former group was further divided into 2 groups with hemodialysis (26 patients) and without hemodialysis (20 patients). The mean follow-up period was 2.5 +/- 1.2 years and the follow-up rate was 99%. The prevalences of congestive heart failure (26% vs 3%, p < 0.001), hypertension (72% vs 45%, p < 0.005), and multivessel coronary artery disease (65% vs 33%, p < 0.001) were higher in patients with CRF. The left ventricular end-diastolic volume was greater in patients with CRF than in patients without CRF (114 +/- 36 vs 85 +/- 24 ml/m2, p < 0.001). The calcification score of both coronary arteries and abdominal aorta evaluated by electron-beam computed tomography was higher in patients with CRF (2,187 +/- 2,727 vs 631 +/- 841, p = 0.03; 4,091 +/- 3,068 vs 2,191 +/- 2,249, p = 0.02, respectively). In-hospital cardiac mortality was higher in patients with CRF than in patients without CRF (8.7% vs 0.7%, p < 0.001). The cumulative survival was 88% at 1 year and 65% at 3 years in patients with CRF and 99% and 97% in patients without CRF, respectively (p < 0.001). The incidence of re-hospitalization due to congestive heart failure was higher in patients with CRF (19% vs 1.3%, p < 0.0001). The cumulative survival in CRF was 93% at 1 year, 57% at 3 years in the medical treatment group and 87% and 75% in the invasive therapy group, respectively (p = 0.1). Patients with angina pectoris and CRF had a poor prognosis under the current treatment strategy. Newly developed therapeutic strategies, such as rotational atherectomy, minimally invasive direct coronary artery bypass surgery and combinations, will be necessary to improve the long-term prognosis for these patients.

Peritumoral edema in osteoid osteoma on magnetic resonance imaging

OBJECTIVE

To determine whether there is a relationship between the peritumoral edema caused by osteoid osteoma seen on magnetic resonance (MR) imaging and the patient's age, duration of symptoms, or location of the lesion.

DESIGN AND PATIENTS

All histologically proven osteoid osteomas seen in our institutions during a 5-year period in patients with known age, gender, duration of symptoms, and available radiological and MR imaging examinations were included in this study. The extent of the edema in the bone marrow and extraosseous soft tissue around the nidus of osteoid osteoma on T2-weighted MR imaging were graded from 1 (nonexistent) to 4 (extensive) by two masked observers. The relationships between the patient's age, duration of symptoms, and location of lesions were evaluated by Pearson's correlation coefficient and analysis of variance.

RESULTS

Twenty-seven cases met the inclusion criteria. The observer agreement on grading was good. Patients of 15 years of age or younger had significantly higher grades than patients older than 15 years. There was a moderate negative linear correlation between the patient's age and peritumoral edema. No significant relationship was identified between edema and the duration of symptoms or the location of lesions.

CONCLUSION

Osteoid osteomas in younger patients tend to be associated with more extensive peritumoral edema.

Posterior interosseous nerve palsy caused by parosteal lipoma of proximal radius

Lipomas are common benign soft tissue tumors which tend to be indolent, and symptoms caused by nerve compression are unusual. However, a parosteal lipoma, occurring adjacent to the proximal radius may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. Two cases of parosteal lipoma of the proximal radius causing paralysis of the posterior interosseous nerve are reported. CT and MR imaging demonstrate the characteristic fatty mass around the radius and are specific in making the diagnosis. Surgical excision should be promptly performed to ensure optimal recovery from the nerve paralysis.

[Report management system using Web server and search engine]

PURPOSE

To develop a management system of written reports using a Web server and search engine.

METHODS

All the reports written through word processing software in the local area network in the radiology department were automatically transferred to one of the PC servers, in which a Web server and search engine were in operation. Previous reports, approximately eighty thousand, were also registered. Using Web browsers and the program developed by hypertext mark-up language and JavaScript, all the reports were readily accessible by keywords, or by any words within reports.

RESULTS

Over 100, 000 reports were easily accessible using Web browsers, based on our one-year experience. Maintaining the Web server and search engine, and upgrading the program were easily managed in our daily practice.

CONCLUSION

The report management system we developed is flexible, scalable, and easy to maintain. It is an effective way to manage a large volume of radiology reports written through word processing software.

Paravertebral ligamentous ossification: DISH, OPLL and OLF

This is an overview of paravertebral ligamentous ossification based on our 5-year experience in ossification of posterior longitudinal ligament (109 cases) and ossification of ligamentum flavum (18 cases). Paravertebral ligamentous ossification is designated as the disorder caused by frequently coexisting ossification of paravertebral ligaments, DISH, OPLL, and OLF. The frequency of the occurrence of isolated ossification of PLL and OLF in Japan is still uncertain. DISH, which is not rare in Europe or North America, is frequently associated with ossification of the posterior aspect of the vertebral bodies, but it may be less symptomatic. The major cause of the probably higher incidence of symptomatic patients in Japan may be due to associated narrowing of the spinal canal.

Reactive heterotopic ossification. Its patterns on MRI

The purpose of this report is to analyze common features of reactive heterotopic ossification, zone phenomenon and involution. Eleven cases evaluated with plain radiography and MRI were classified based on the location: intramuscular, periosteal, and intermediate (mainly the insertion site of muscles). Zone phenomenon tends to be complete in the intramuscular type and incomplete in the periosteal type. Involution is also more evident in the intramuscular type.

[Radiology information system using HTML, JavaScript, and Web server]

We have developed a radiology information system using intranet techniques, including hypertext markup language, JavaScript, and Web server. JavaScript made it possible to develop an easy-to-use application, as well as to reduce network traffic and load on the server. The system we have developed is inexpensive and flexible, and its development and maintenance are much easier than with the previous system.

Diffuse lipomatosis: imaging features

A case of diffuse lipomatosis is reported. A 54-year-old man presented with a large mass in the left gluteal region. Plain radiographs showed hyperostosis of the phalanx of the left third toe. The diagnosis was aided by magnetic resonance imaging and computed tomography which clearly demonstrated a diffuse overgrowth of fatty tissue in the left buttock and the extremity involving the subcutaneous and gluteal muscular tissue.

Axial spondylometaphyseal dysplasia

We present a previously undescribed skeletal dysplasia characterized by mild platyspondyly, small thorax with cupping of the anterior ends of the ribs, irregular proximal femoral metaphyses, and lacy appearance of the iliac wings. Two of the three cases were siblings. Retinitis pigmentosa and optic atrophy are associated findings.

CONCLUSION

We describe a new type of spondylometaphyseal dysplasia (SMD) and propose the name axial SMD.

Eccentric simple bone cysts of the femoral neck in adults

The purpose of this communication is to describe atypical simple bone cysts of the femoral neck seen in adult patients. Two patients, aged 56 and 49, having cystic lesions which did not conform to a typical simple bone cyst, are reported. Common features including eccentric location, and thick lining tissue and sclerotic margin are not those of typical simple bone cysts seen in children. Local mechanical characteristics might be related to the atypical presentations.

Single vertebral compression and involvement of the posterior elements in tuberculous spondylitis: observation on MR imaging

To examine the atypical presentation of tuberculous spondylitis we evaluated seven cases seen in our hospitals during a five-year period (1989-1994) with procedures including MR imaging and CT scan. Three of the seven cases showed collapse of the single vertebral bodies with relatively spared disk spaces. Posterior elements were also involved on MR imaging in three cases, but the involvement of adjacent disks and vertebral bodies militated against metastases.

Complications of skeletal trauma

Complications of skeletal trauma include a wide variety of problems. Vascular complications are of prime importance in the early phase of the trauma. Most skeletal problems, including problems in fracture healing, osteomyelitis, and osteonecrosis, become clinically important in the later stages. It is hoped that radiologists' attention to such problems may make early detection possible and may improve the functional outcome in such patients.

Aggressive appearance of non-ossifying fibroma with pathologic fracture: a case report

An 11-year-old boy presented with a lytic lesion in the proximal humeral metaphysis. In spite of an aggressively reactive appearance on plain radiography and MR imaging, this lesion proved to be a non-ossifying fibroma. Fracture of the cortical shell probably contributed to the relatively wide zone of transition and periosteal reaction on plain radiography and the reactive change on MR imaging.

Embryonal rhabdomyosarcoma of foot with expansive growth between metatarsals

The case of a 14-year-old girl with rhabdomyosarcoma of the right foot is reported. Plain radiography showed a large nonspecific soft tissue tumor between the metatarsals with bowing of the metatarsals away from the mass. MR imaging showed a large soft tissue mass involving the metatarsals. The findings were conflicting, because the tumor had an infiltrative soft tissue mass and bowing of the metatarsals more suggestive of slow expansive growth. Bowing of short tubular bones may be a process similar to cortical saucerization, which is typically seen in Ewing's sarcoma, and it can be one of the findings of high grade neoplasms, such as embryonal rhabdomyosarcoma.