"Tooth" sign in patellar degenerative disease

In the total examination of the knee, degenerative changes and ossification in the quadriceps tendon easily recognized on the lateral roentgenogram may cause confusion in diagnosis when seen on the axial view. Vertical ridging of the osteophytes at the patellar insertion of the quadriceps tendon can resemble dentate structure ("tooth" sign). Two hundred and fifty examinations of the knee in different age groups were reviewed and several anatomical sections of the quadriceps-patella insertion were studied. The "tooth" sign represents the relief of severe osteophyte formation in the bundle of the quadriceps tendon at its insertion into the patella.

Precocious onset of Paget's disease--a report of three cases and review of the literature

Paget's disease generally has its onset in mid-adult life, however cases are known to occur in young adults, albeit rare. Three patients with precocious onset of Paget's disease are reported and the literature is reviewed. The classical radiographic appearance of Paget's disease of bone is described.

Oral hydralazine therapy for chronic refractory heart failure

The hemodynamic effects of oral hydralazine were investigated in ten patients (nine in NYHA Class IV and one in Class III) with chronic refractory heart failure. With hemodynamic monitoring, adequate oral doses of hydralazine (50 or 75 mg) were determined and then administered every six hours. Hemodynamics were determined at 2-3, 6-8 and 24 hours on hydralazine therapy. Arterial pressure decreased slightly (5%) and systemic vascular resistance decreased significantly (42%). Cardiac and stroke volume index increased by 70 and 66%, respectively, without any significant change in heart rate, pulmonary capillary wedge or right atrial pressure. Hemodynamic improvement was associated with clinical improvement without a major complication. During the follow-up period of 3-7 months, seven of nine patients were in NYHA Class II and one in Class III. One other patient died suddenly six weeks after discharge. These findings suggest that hydralazine in an effective oral vasodilator for the treatment of refractory heart failure.

Analysis of dose, dose-rate and treatment time in the production of injuries by radium treatment for cancer of the uterine cervix

A retrospective study has been made of 15 patients who had developed severe complications to the bladder, rectum and ureters after radiation therapy for carcinoma of the cervix. Comprehensive dose distribution in the pelvis were calculated with computer assistance to visualize how the normal organs had been irradiated. The risk of normal tissue injury was analysed graphically with respect to the maximum radium dose, dose-rate and irradiation time. The two groups of data representing the injured and non-injured organs separate much better in a dose-rate versus dose plot than in a conventional Strandqvist type dose-time plot. This implies that in radium therapy, the dose-rate rather than the treatment time, is the important parameter in modifying the risk of normal tissue injury. Our results show a good separation of injured from non-injured cases only when the maximum values of dose and dose-rate were used. This suggests that clinically significant injury may develop from relatively small regions of high dose and dose-rate. Since the dose-rate varies from point to point in the pelvis (unlike treatment time), comprehensive determinations of dose-rate distributions are required in order to locate the sites of potential injuries.

Studies on human monocytes with a multiparameter cell sorter

Suspensions of human lymphocytes and monocytes separated by the Ficoll-hypaque method from the peripheral blood show a Coulter volume distribution, measured with a multiparameter cell sorter, characterized by a minor peak at 500 mu3, containing 5-15% of the cells, and a major peak at 200 mu3. Using fluorescent latex particles we have found that the monocytes, the cells that ingest the latex particles, all lie in the 500 mu3 peak; conversely, all of the cells in the 500 mu3 peak are monocytes. When the cell suspensions are incubated, the monocytes increase both the average volume and in absolute numbers. The number of monocytes approximately doubles during 3 days of incubation, when it reaches its maximum value. At that time we have found that all of the monocytes lack receptors for sheep red blood cells and all possess receptors for human gamma-globulin. The increase in monocyte number appears, therefore, to arise from the enlargement of "monocyte presursors" that resemble lymphocytes in volume and resemble both the monocytes and the B lyphocytes with respect to surface sheep red blood cell and human gamma-globulin receptors.

Osteoid-osteoma inducing pronounced overgrowth and deformity of bone

A rare complication of osteoid-osteoma is localized overgrowth and/or deformity of bone. Six of 64 cases reviewed had this growth disturbance. All patients developing deformities had their onset of symptoms before 5 years of age. Not one of the patients had limb equalization or correction of the deformity after removal of the osteoid-osteoma. The longest follow-up was 8 years. Speculations on the underlying cause for this form of growth abnormality, and the incidence in infants and very young children suggests that immediate surgical treatment is the best course of action.

Vitamin D-resistant rickets and 25-hydroxycholecalciferol

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The use of tomography in the diagnosis of skeletal disorders

Tomography has definite proven value as a technique in studying objects obscured by overlying shadows. It is an adjunct study to conventional radiographs when the necessary detail for diagnosis is lacking in the routine examination. Particularly in skeletal tumors, tomography can be helpful in disclosing lesions too small to be noticed in the routine radiograph or resolve details in question in the conventional film that are pertinent to the diagnosis. This technique has also been of great benefit in detailing the anatomic structures of the spine, temporomandibular joints and sternoclavicular articulations. It has been of particular value in the evaluation of fracture-healing or the presence of pseudarthrosis and arthritis affecting the larger joints of the body.

Volume feedback and generalization techniques in shaping speech of an electively mute boy: a case study

An “electively mute” 12-yr.-old boy was successfully treated using positive reinforcement procedures. Visual feedback from the volume-level meter of a tape recorder was used to help in inducing sounds and to aid in raising speech volume. Various other techniques were employed to increase the rate of speech and to generalize it to a variety of environmental situations.