Computed tomography of parosteal osteosarcoma

Twelve patients with parosteal osteosarcomas were evaluated by computed tomography (CT). CT accurately defined the extent of the tumors for purposes of surgical planning, although tumor bone often could not be distinguished from thickened host bone. Nine tumors invaded the medullary cavity, a feature that implies a poorer prognosis when the tumor also contains high-grade areas. Six CT studies accurately detected the medullary invasion, but three did not. Lucent areas within dense tumors contained either benign tissue or high- or low-grade tumor; CT did not differentiate among these different tissues. CT also did not reveal small satellite nodules of tumor beyond the main tumor mass.

Periosteal new bone in patients on intermittent haemodialysis: an early indicator of aluminium-induced osteomalacia?

Periosteal new bone forming along the distal shafts of the tibia, fibula and pelvic inlet was observed to be an unusual feature in patients on intermittent haemodialysis. Sequential skeletal surveys of 13 patients exhibiting this feature were reviewed and correlated with the biochemical, histological and clinical data. The radiological features comprised periosteal new bone, minimal or no evidence of secondary hyperparathyroidism, sclerosis (not in the classical 'rugger jersey' spine distribution but affecting, particularly, the femoral heads) and, in several patients, numerous fractures, particularly of the ribs. There were 10 patients with osteomalacia, in seven of whom the features were consistent with aluminium-induced bone disease. We suggest that the finding of periosteal new bone in the above distribution in a patient on intermittent haemodialysis should alert the clinician to the possibility of aluminium intoxication.

Does aspiration of bones and joints affect results of later bone scanning?

To determine the effect, if any, of needle aspiration on 99mTc bone scanning, three different areas of 15 dogs were first aspirated and then imaged with technetium bone scintigraphy. The hip joint was aspirated, the distal femoral metaphysis was drilled and aspirated, and the tibial periosteum was scraped with an 18- or 20-gauge needle. Varying amounts of trauma were inflicted to simulate varying difficulties at aspiration. 99mTc bone scans were obtained from 5 h to 10 days later. There was no evidence of focal technetium uptake after any hip joint aspiration. This was consistent regardless of the amount of trauma inflicted or the time from aspiration to bone scanning. Metaphyseal cortical drilling and tibial periosteal scraping occasionally caused some focal uptake when scanning was delayed greater than 2 days. When osteomyelitis or pyarthrosis is clinically suspected, joint aspiration can be performed without fear of producing a false-positive bone scan.

Microvascular and histologic effect of circumferential wire on appositional bone growth in immature dogs

Circumferential wires were placed around both midshaft femora of six immature dogs. On one side the wires were placed under the periosteum and on the other side the wires were placed over the periosteum. All wires were tightened to an equivalent tension. A diffuse growth of periosteal new bone occurred in those femora in which wires were placed under the periosteum but not in those over the periosteum. Corresponding microangiographs at 3 weeks in those femora in which wires were placed under the periosteum revealed dramatically increased medullary and periosteal vascularity coupled with histologic active trabecular bone formation. In those femora in which the wires were placed over the periosteum, even though the placement of the wires should supposedly have been the most detrimental, vascularity was not restricted. There were perfused vessels within the cortex directly under the wires. At 8 weeks the wires in both preparations were becoming encased in the growing cortical bone. Cerclage did not devitalize immature bone nor did it restrict adjacent appositional bone growth.

The influence of a free periosteal transplant on bone healing in the irradiated tibia. A radiological histological and biochemical study on rabbits

The influence of periosteal transplants on irradiated bone cavities was studied in ten adult rabbit hind legs. The left hind legs were irradiated with a single X-ray dose of 20 Gy one week before operation. The right hind leg was used as a control. Radiological, histological and biochemical findings were recorded for specimens obtained 8 and 12 weeks after operation. Non-irradiated periosteal transplants on irradiated bone cavities induced more rapid and intense mature bone formation than irradiated periosteal transplants on the same areas. Ossification of bone cavities occurred even more rapidly, when neither the bone nor the transplant had been irradiated. These results indicate that a free periosteal transplant enhances ossification on irradiated bone cavities, whereas ossification may be inhibited or delayed after radiation therapy. A similar effect on diseased human mandibular bone has been observed in our clinical trials.

Transient idiopathic periosteal reaction associated with dysproteinemia

Periosteal reaction with new bone formation in a child is a radiographic finding with an extensive differential diagnosis. The present case is that of a child who presented with a clinical syndrome of fever, bone pain in the forearm and leg, bony tenderness in these areas, radiographic evidence of a periosteal reaction in both tibiae and ulnae, and an abnormality of serum proteins. It was a self-limited disease process requiring no specific treatment, with eventual return to normal of both the radiographic and serum protein abnormalities. Its relationship to Caffey's disease remains to be defined.

Hand osteoarthropathy in pianists

We evaluated radiographs of the hands of 20 pianists. The radiologic manifestations arising from long-term stress and strain applied to the hands were recorded. The changes are characterized by: 1) alignment adaptation consisting of axial radial rotation of the digits, particularly the fifth but also the third and fourth, 2) degenerative changes at the distal interphalangeal DIP and metacarpophalangeal MCP joints, and 3) mechanical remodeling manifested as periostal thickening and flattening of the phalangeal tufts associated with sclerosis. These findings suggest the existence of an occupational entity which might be described as pianist's osteoarthropathy.

Free revascularised periosteum transplantation: an experimental study

Two different types of revascularised periosteal graft were used to bridge an experimental bone defect and compared with control groups. Revascularised tibial periosteal grafts completely filled the defect with new bone, whereas revascularised rib periosteal grafts failed to do so.

Periosteal new bone in uraemic osteodystrophy

Out of 54 patients requiring haemodialysis approximately one quarter were found to have periosteal new bone associated with severe renal osteodystrophy. This feature has been analysed and correlated with biochemical, clinical, and histological parameters. No direct correlation was found with the duration of haemodialysis, but there is a good correlation with histological indices of osteitis fibrosa and serum parathormone levels. Periosteal new bone regressed or totally disappeared in eight patients after parathyroidectomy and renal transplantation. It is suggested that periosteal new bone may be a useful indicator of hyperparathyroidism in this type of patient.

Spontaneous subperiosteal hematoma of the orbit

Spontaneous subperiosteal hematoma of the orbit is extremely rare. This is a case of an 81-year-old woman. The presenting symptom was protrusion of the right eye with severe intraorbital pain. Computed tomography scanning showed a high-density area in the upper part of the right orbit, which, at operation, was found to be a subperiosteal hematoma of the orbit.

Radiographic evaluation of solitary bone lesions

Diagnosis of solitary bone lesions through the use of plain film requires a careful evaluation of several diagnostic variables, the recognition and association of different radiographic signs, and an analytic approach to diagnosis. Diagnostic principles are discussed that can aid the physician in arriving at a correct diagnosis or in narrowing the diagnostic possibilities.

Massive periosteal new bone formation in ulcerative colitis

A case of periosteal new bone formation in a 14-year-old girl with recurrent ulcerative colitis is reported. There was exacerbation of the periosteal new bone formation during acute episodes of colitis, and incorporation of the periosteal appositions into the underlying bone during remission.

Bone scintigraphy in evaluating the viability of composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and free non-revascularized periosteal grafts

We studied the value of bone scintigraphy in the assessment of anastomotic patency and bone-cell viability in free bone grafts revascularized by microvascular anastomoses in twenty-seven dogs. The dogs were divided into three different groups, and scintigraphy was carried out using technetium-labeled methylene diphosphonate in composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and periosteal grafts placed in different recipient beds. The viability of the grafts was evaluated by histological examination and fluorescence microscopy after triple labeling with oxytetracycline on the first postoperative day, alizarin complexone on the fourth postoperative day, and DCAF on the eleventh postoperative day. A positive scintiscan within the first week following surgery indicated patent microvascular anastomoses, and histological study and fluorescence microscopy confirmed that bone throughout the graft was viable. A positive scintiscan one week after surgery or later does not necessarily indicate microvascular patency or bone-cell survival, because new bone formed by creeping substitution on the surface of a dead bone graft can result in this finding.

1-Alpha-hydroxy vitamin D in dialysis bone disease: radiological changes after 6 and 12 months of treatment

Biochemical, radiological and histological indicators of dialysis bone disease were studied before, 6 months (58 patients) and 12 months (48 patients) after starting treatment with 1 alpha-OH D3. Radiographic healing of subperiosteal erosions was seen after 6 months in 60% and after 12 months in 77% of affected patients. Radiographic improvement, however, was not significantly related to reductions in resorptive surfaces seen on quantitative bone histology, nor to changes in plasma concentrations of immunoreactive parathyroid hormone. Metastatic calcification appeared or increased in 43% of patients after 6 months and 52% after 12 months. Periosteal new bone developed or increased in 14% of patients after 6 months and 17% after 12 months. Both metastatic calcification and periosteal new bone formation were associated with high plasma phosphate concentrations, but not with plasma calcium, alkaline phosphatase or parathyroid hormone concentrations. Treatment with 1 alpha-OH D3 produces radiological improvement in the majority of patients with dialysis bone disease, but the lack of correlation with histological changes confirms the need for regular radiographic examination. Metastatic calcification and periosteal new bone formation probably represent toxicity of 1 alpha-OH D3 but may be minimised by phosphate restriction.

Radiologic and pathologic analysis of solitary bone lesions. Part II: periosteal reactions

The activated periosteum has a deceptive anatomic constancy amidst change. The change involves the production of matrix and, in the process, proliferation and expenditure of cells. When the demand for a reaction is excessive, nearby extraperiosteal soft tissue serves as a ready source for additional modulating cells, just as it does for fracture callus. The configuration of a periosteal reaction is an index of the nature and intensity of the inciting process.

[Periostal new bone formation in ulcerative colitis during adolescence (author's transl)]

Periostal new bone formation can be observed as a symptom secondary to numerous diseases. In gastrointestinal disease this hypertrophic osteoarthropathy occurs very rare. The present case report demonstrates an extensive periostal proliferation involving the long bones in a 14 years old girl with longstanding ulcerative colitis.