Acromegalic arthropathy in various stages of the disease: an MRI study

BACKGROUND

Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI).

METHODS

Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active (n = 10) and controlled acromegaly (n = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison.

RESULTS

Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, P = 0.001) and bone marrow lesions (15% vs 80%, P = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage (P < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects (P < 0.01).

CONCLUSIONS

Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.

Vertebral pneumatocysts

Objective: To review the prevalence and location of vertebral pneumatocysts and evaluate the CT findings of these benign lesions.Material and Methods: Retrospectively we reviewed CT images of 89 patients with suspected disc disease during a 6-month period.Results: Distinctive CT pattern of intraosseous pneumatocysts involving the cervical, thoracic and lumbar spine was found. In 8 patients (9%), 10 vertebral pneumatocysts were detected. Five were located in the vertebral body and 4 of these were associated with vacuum phenomenon in adjacent intervertebral discs. Five were located near the facet joint and all were associated with vacuum phenomenon in adjacent facet joint.Conclusion: Intraosseous pneumatocyst is a benign lesion, therefore biopsy and follow-up are unnecessary. Although vertebral pneumatocysts seem to be uncommon with a few reported cases, this study shows them to be more frequent than previously thought.

[Interest of imaging in tumors benign bone in children]

Benign bone tumors are more common than malignant tumors in pediatrics. The exostosis (ostéchondrome) is the most common. The different imaging techniques are pivotal in the study of tumors including its standard radiography. The aim of this work is to highlight the interest in imaging the diagnostic management of bone benign tumors in children through a retrospective study of 169 patients. All patients were investigated by plain radiography, scanner supplement with multiplanar reconstruction before and after injection of PDC and / or MRI 1. 5 Tesla was performed according to the indication. The average age is 6 years with a slight male predominance. Clinically, the swelling is present in 35% of cases. The pain in 29% of cases. The most common location is the metaphyseal long bone on: Femur: 25% of cases, humerus: 17% of cases, Tibia: 21% of cases. Main Benign tumors are found exostosis (20. 12%), bone cyst (31. 95%) and osteoblastoma (16, 57%). The imagery is used to specify the topography and extension of the lesion in the bone provide arguments in favor of benign and sometimes in favor of the cause of the injury. The only standard radiograph often provides a diagnosis of certainty in some cases.

Treatment of facet cysts associated with neurogenic intermittent claudication with x-stop

BACKGROUND

Facet degeneration often leads to the formation of synovial facet cysts. As facet cysts invade the spinal canal, they become a contributing factor to spinal stenosis. Previous studies have demonstrated successful treatment of neurogenic intermittent claudication (NIC), a major symptom of spinal stenosis, with an interspinous process device.

PURPOSE

To compare clinical outcomes of patients with and without synovial facet cysts treated with an interspinous process device.

STUDY DESIGN

Retrospective review of prospective data of consecutive patients undergoing the X-Stop procedure at an institution.

OUTCOME MEASURES

Visual Analog Scale; Oswestry Disability Index; sitting, standing, and walking tolerances; and satisfaction survey.

METHODS

Review of all patients from 2006 to 2010 undergoing X-Stop procedure at an institution. Imaging studies were used to identify the presence and measure the size of the facet cysts in 285 patients with a minimum of 6-month follow-up. Comparative clinical outcomes determined if X-Stop is a successful treatment option for patients with NIC in conjunction with synovial facet cysts (<3 mm, ≥3 mm).

RESULTS

Fifty-eight of 285 patients (20.4%) were determined to have a synovial cyst as a contributing component of spinal stenosis. Twelve of 58 patients were noted to have a cyst ≥3 mm. The mean follow-up time for patients with and without a facet cyst was 21 months (6-55±12 mo) and 22 months (6-61±12 mo), respectively. The age of the patient at the time of the operation with and without facet cysts was 73 (±10 y). Patients without synovial cysts, with synovial cysts, and cysts ≥3 mm had an average change in Oswestry Disability Index of 15.6, 15.8, and 16.2, respectively. Visual Analog Scale scores were 2.3, 1.8, and 2.3, respectively. In addition, on satisfaction surveys 72.4%, 82.0%, and 77.8% were either very or somewhat satisfied, respectively. Overall complications included 4 spinous process fracture, 4 hematomas, 1 wound infection, and 1 implant migration.

CONCLUSIONS

No statistical difference was noted in any of the outcome measures among patients with small facet cysts, large facet cysts, or without facet cysts when treated with an interspinous process device. We can thus conclude that X-Stop is an appropriate treatment consideration for NIC with or without the presence of synovial facet cysts.

Bone cement in the management of cystic tumour defects of bone at National Orthopaedic Hospital, Igbobi, Lagos

BACKGROUND

Cystic bony defects are characteristics of bone tumours especially benign ones e.g. Giant cell tumours of bone [GCT] and some metastatic tumours to bone. These patients present late with significant cystic cavities at a time the cost and availability of prosthetic implants to replace these defects sometimes precludes resection. The objective of this study is to evaluate the outcome of filling these defects with bone cement augmented with plate and screw for stability.

METHOD

A seven year prospective study was carried out in patients presenting with large cystic bony defects secondary to bone tumours at the oncology unit of the National Orthopaedic Hospital, Igbobi, Lagos. Data such as age, sex, anatomic location of lesions, histological type of tumours, x-ray findings, operation performed with the number of packets of bone cement used to fill the resultant bony defects were retrieved from prepared proforma. The average follow-up was 36 months.

RESULT

The proximal tibia and distal femur accounted for 42.9% and 28.6% respectively of the 14 patients studied. Giant cell tumour was the most common histological diagnosis 78.6%. Bone cement was effective in meeting the local requirements of limb salvage, early functional recovery and as a temporising measure until the patients can avail themselves of better options. The complication encountered was that of anaphylactic reaction in 2 scrub nurses.

CONCLUSION

Bone cement augmented with appropriate implants has proven valuable as a stop gap in filling large cystic bony defects resulting from tumours.

Bone graft for large bone cysts of the femoral neck in patients on hemodialysis

Pathologic fracture of the femoral neck from an amyloid bone cyst in patients on long-term hemodialysis causes substantial morbidity. For patients with a bone cyst occupying more than 1/2 of the neck width, we have performed prophylactic internal fixation with an autogenous iliac bone graft. We describe our surgical technique and present clinical results from consecutively surgically treated patients. We determined whether our procedure successfully induced healing of the bone cyst, thus preventing a problematic sequel of fracture. From 1990 to 2003, 14 hips in 12 patients were treated, and the clinical results from these patients were retrospectively reviewed. One patient died 3 months after surgery; the remaining patients were followed for at least 3 years. In those 11 patients, bony healing was achieved in all cases with no recurrence of the cystic lesion. Considering the comparatively unsatisfactory results of internal fixation for pathologic fracture and THA for patients receiving long-term hemodialysis, our procedure gives surgeons another option for treating this difficult problem.

[Epidemiology of bone and soft-part tumors of the foot and knee]

DESIGN

Report of cases.

OBJECTIVE

Review of the cases in a period of 10 years with bone and soft tumors in foot and ankle, to knowing epidemilogical, clinic and patologic anatomy parameters to describe the behavior.

MATERIALS AND METHODS

Review of 166 cases from 1991 to 2000 and been analyze with descriptive statistic, association measurment for inside stratum, with odds ratio, hipótesis test with chi square for qualitative date and t to Student for quantitative date.

RESULTS

166 patients within 2 years to 78 years old, 81 with bone tumors and 79 with soft tumors, mostly benign, the most frequent was in the soft tissue ganglion and oseal benign exostosis in bone, 6 different malignant tumors, the principal affected zone were the toes, as a difference to literature, the most affected age group was 10 to 20 years followed to the 30 to 40 years old, we report 42 different patological diagnostics results to soft tissue and osseous tissue.

CONCLUSION

clinical features is not a useful parameter to differentiate between malign or benign tumors and does not allow to establish the biological behavior, we propose the diagnostic algorithm that includes the intentional clinical probe, comparative X-ray in three projections with soft technique, in suspicion to malignant lesion may require CT scan, MRI, osseous scan and finally biopsy which will improve the final outcome.

[Osteoarticular coccidioidomicosis. Clinical and pathological study of 36 Mexican patients]

Coccidioidomycosis (CM) is primarily a lung disease. Systemic spread occurs in 1% of cases and one of its manifestation is osteoarthritis.

AIM

To describe the clinical and pathological characteristics of 36 patients with osteoarthritis by Coccidioides immitis (COA).

MATERIAL AND METHODS

The surgical pathology records of two medical institutions were reviewed; patients with clinical diagnosis of osteoarthritis and definitive histopathological diagnosis of COA were included in the study. Results were analyzed by contingence tables (RXC) and chi2 test.

RESULTS

Twenty six adults (19 men, seven women) and 10 children (seven males, three females) were studied. The chi2 analysis demonstrated a predominance of disease in men (72.2%, p = 0.008). There was no difference between males and females in relation to history of mycotic disease or diagnosis of lung disease after the diagnosis of COA. Bone involvement (76% of cases) was more frequent that pure joint lesions and the predominant radiological lesion was of lytic type. 30.5% of patients (11 cases) had multiple bone lesions and eight of them were men with multiple vertebral bone lesions.

DISCUSSION

The COA was the only manifestation of disease in 83% of the patients. Therefore is important to consider this etiology in patients of endemic area. The clinical and radiological spectrum of COA is wide and may include a dentigerous and synovial cyst or simulates metastatic disease. The recognition of the clinical manifestations of COA may contribute to an opportune diagnosis and treatment.

Prevalence of aneurysmal and solitary bone cysts in young patients

Aneurysmal and solitary bone cysts develop most commonly during skeletal growth. The objective of our epidemiologic study was to evaluate the prevalence, recurrence rate, and probability of recurrence-free survival for aneurysmal and solitary bone cysts in young patients. We did a population-based analysis of 141 histologically confirmed cases. Seventy-three patients with aneurysmal bone cysts and 68 patients with solitary bone cysts were registered. The annual prevalence was 0.32 per 100,000 individuals (range, 0-1.238) for aneurysmal cysts, with a 1.8:1 male to female ratio and a median age of the patients of 11.1 years (range, 1-19.7 years). For solitary bone cysts, the calculated annual prevalence was 0.30 (range, 0-0.963) with a median age of the patients of 1.1 years (range, 0.5-19.9) and a 1.96:1 male to female ratio. Recurrent lesions occurred frequently in young males. Secondary aneurysmal bone cysts were observed only in females. During skeletal growth, aneurysmal and juvenile bone cysts more often occur in males with a peak prevalence at approximately 11 years of age. A greater prevalence of aneurysmal bone cysts in young individuals is associated with skeletal growth and immaturity. Young age and male gender are associated with an increased risk of local recurrence.

Bone cysts in sarcoidosis: what is their clinical significance?

The incidence of bone cysts in sarcoidosis, a multisystemic disease, varies in different series, and these cysts are generally asymptomatic. We evaluated bone cysts in 516 sarcoidosis patients with available hand X-rays and in 200 patients with foot X-rays. Bone cysts were present in 21 cases (19 females, two males). The cysts were localized in phalanges of the hand in all cases, in feet in five cases, and in nasal bone in one. Six patients with bone cysts also had lupus pernio. Among those with cystic bone lesions, females were more frequent; extrapulmonary and skin involvement and lupus pernio were significantly more common. We diagnosed cystic bone lesions in 3.6% of our sarcoidosis patients and conclude that cysts were more frequent in females and in patients with lupus pernio.

Nasu-Hakola disease: a rare entity in Italy. Critical review of the literature

Nasu-Hakola disease (NHD, polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy, PLOSL) is a recessively inherited disorder characterized by systemic bone cysts and progressive presenile dementia associated with sclerosing encephalopathy. The disease has a worldwide distribution, but most patients have been reported in Finland and in Japan; in Italy there are anecdotal reports. The combination of neuropsychiatric symptoms and bone cysts is unique to this disease, which we believe to be underestimated in Italy. The molecular defect has been identified in loss-of-function mutations in the TYROBP gene in Finnish and in Japanese patients, and in the TREM2 gene in other families of different ethnic origins. We reviewed the international literature to define better the diagnostic steps and to draw the attention of neurologists and orthopaedic specialists to the disease. The identification of new cases followed by appropriate genetic counselling, genetic analysis, and study of the territorial distribution of affected patients could be a good strategy to follow in order to improve understanding of the disease.

Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging

OBJECTIVE

The purposes of this study were to evaluate the prevalence and determine the size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections on MR images of asymptomatic knees.

MATERIALS AND METHODS

MR images of 102 asymptomatic knees were evaluated with regard to the prevalence of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections. The MR examinations were performed in patients (mean age, 42.8 years; age range, 18-73 years) with clinically suspected meniscal lesions in the contralateral knee. The craniocaudal, anteroposterior, and mediolateral diameters of detectable abnormal fluid collections were measured.

RESULTS

Medial meniscal cysts (mean size [craniocaudal x anteroposterior x mediolateral], 9 x 6 x 13 mm) were found in four asymptomatic knees. Neither lateral meniscal cysts nor ganglionic cysts of the cruciate ligaments were identified. Twenty-six synovial cysts of the popliteal space (Baker's cyst)-consisting of 11 gastrocnemius portions (mean size, 19 x 8 x 10 mm) and 15 semimembranosus portions (mean size, 20 x 7 x 9 mm)-were found in 19 knees. Twenty-four (92%) of these cysts had a maximal diameter of 30 mm or less. Fluid-filled bursae were found in 49 knees. The deep infrapatellar bursa was most commonly involved (42 knees; mean size, 6 x 3 x 5 mm). Fluid-filled anserine bursae (mean size, 27 x 12 x 10 mm) were detected in five knees.

CONCLUSION

Meniscal cysts may be present in asymptomatic knees, at least on the medial side. Synovial cysts of the popliteal space can be found in approximately one fifth of asymptomatic knees. Their maximal diameter is usually smaller than 30 mm.

Prevalence of ganglion cysts originating from the proximal tibiofibular joint: A magnetic resonance imaging study

PURPOSE

To determine the prevalence of proximal tibiofibular ganglion cysts in patients undergoing outpatient magnetic resonance imaging (MRI) of the knee.

TYPE OF STUDY

Observational cross-sectional study.

METHODS

From November 2000 to June 2001, every MRI of the knee performed at an outpatient imaging center was reviewed by a single examiner for the presence of a proximal tibiofibular ganglion cyst. In addition to the reason for ordering the MRI, demographic information on all patients was gathered.

RESULTS

A total of 654 knee MRI scans were performed at the outpatient imaging center during the study period. This study population consisted of 310 men and 344 women, with an average age of 43.4 years (range, 11 to 88 years). There were 308 left and 346 right knees imaged. The most common clinical diagnosis in these 654 patients was meniscal tear (42.8%). A total of 5 patients had a proximal tibiofibular ganglion cyst detected on MRI, yielding a prevalence of 0.76% (95% confidence interval [CI] = 0.1% to 1.4%). These cysts ranged in size from 1.0 to 2.8 cm in maximum diameter. Three were found in men and 2 in women. The mean age of these patients was 47.6 years (range, 42 to 54 years). The most common preimaging diagnosis in these patients was a medial meniscal tear (in 3 of 5).

CONCLUSIONS

This study is the first to provide data on the prevalence of proximal tibiofibular ganglion cysts in a population of patients with knee pain significant enough to warrant MRI. Over half of the patients found to have proximal tibiofibular ganglion cysts had no symptoms or signs attributable to them.

[Problems in diagnosis of vibratory articular skeletal syndrome]

Vibratory syndrome is still one of the essential problems in occupational health care. A literature review indicates that the majority of studies focus on vascular changes with very limited data on radiological articuloskeletal changes. Non-acute disease manifestation and the lack of clear-cut radiological criteria of skeletal changes contribute to diagnostic problems. The situation presented cannot be accepted as satisfactory in terms of certification consequences at the individual and population levels. There is a need to continue epidemiological studies which should allow for developing diagnostic criteria formulated in a simple way, as well as quantitative and qualitative rating of radiological skeletal changes.

Loss-of-function mutations in TYROBP (DAP12) result in a presenile dementia with bone cysts

Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL; MIM 221770), also known as Nasu-Hakola disease, is a recessively inherited disease characterized by a combination of psychotic symptoms rapidly progressing to presenile dementia and bone cysts restricted to wrists and ankles. PLOSL has a global distribution, although most of the patients have been diagnosed in Finland and Japan, with an estimated population prevalence of 2x10-6 (ref. 2) in the Finns. We have previously identified a shared 153-kb ancestor haplotype in all Finnish disease alleles between markers D19S1175 and D19S608 on chromosome 19q13.1 (refs 5,6). Here we characterize the molecular defect in PLOSL by identifying one large deletion in all Finnish PLOSL alleles and another mutation in a Japanese patient, both representing loss-of-function mutations, in the gene encoding TYRO protein tyrosine kinase binding protein (TYROBP; formerly DAP12). TYROBP is a transmembrane protein that has been recognized as a key activating signal transduction element in natural killer (NK) cells. On the plasma membrane of NK cells, TYROBP associates with activating receptors recognizing major histocompatibility complex (MHC) class I molecules. No abnormalities in NK cell function were detected in PLOSL patients homozygous for a null allele of TYROBP.

Clinical manifestations of AB-amyloidosis: effects of biocompatibility and flux

BACKGROUND

Highly permeable biocompatible dialysis membranes may postpone the development of AB-amyloidosis, but the relative contribution of enhanced flux or reduced inflammation by highly biocompatible membranes and sterile dialysis fluid remains unknown.

METHODS

In this retrospective investigation, 89 patients with end-stage renal disease maintained on regular haemodialysis for at least 10 years and treated with one type of dialysis membrane exclusively were selected for analysis. They were divided into three groups: low-flux, bioincompatible cellulose (I), low-flux, intermediately biocompatible polysulphone or PMMA (II), or high-flux, highly biocompatible polysulphone or AN69 (III). In addition, the patients were analysed according to the microbiological quality of the dialysis fluid, which had been tested regularly and was classified either as standard or as intermittently contaminated. The clinical manifestations indicative of AB-amyloidosis, namely, carpal tunnel syndrome, arthropathy and bone cysts, were diagnosed after recruitment.

RESULTS

Clinical symptoms were most pronounced in group I, intermediate in group II, and lowest in group III. Patients treated with intermittently contaminated dialysis fluid showed a higher prevalence of AB-amyloidosis than patients with less contaminated dialysis fluid. Logistic regression analysis demonstrated that the flux characteristics of the dialyser and the microbiological quality of the dialysis fluid as well as the biocompatibility of the dialyser were independent determinants of AB-amyloidosis.

CONCLUSION

It would be prudent clinical practice to employ high-flux biocompatible membranes in conjunction with ultrapure dialysis fluid for the treatment of end-stage renal disease patients who need to remain on long-term haemodialysis.

Zygomatic air cell defect (ZACD). Prevalence and characteristics in a dental clinic outpatient population

OBJECTIVES

To determine the prevalence and characteristics of zygomatic air cell defect (ZACD) among a general dental clinic population.

METHODS

The panoramic radiographs of 2734 dental clinic outpatients were examined for the presence of ZACD. ZACD was defined as a nonexpansile, nondestructive cyst-like radiolucency in the zygomatic process of the temporal bone which appears similar to the mastoid air cells and which does not extend further anteriorly than the zygomaticotemporal suture.

RESULTS

ZACD was found in 40 patients (1.5%) with a mean age of 49.6 (s.d. 18.0) years. Twenty cases (50%) each occurred in males and females. Meta-analysis of three large case series comprising 4579 patients revealed a total of 76 cases of ZACD (1.7% prevalence) occurring over an age range of 15-83 years. Thirty-four (44.7%) occurred in males while 42 (55.3%) occurred in females. Bilateral ZACD were found in 17 patients (22.4%).

CONCLUSIONS

ZACD is not a rare anatomical variant, and clinicians planning eminectomy or other surgical procedures involving the zygomatic arch are advised to obtain appropriate presurgical imaging studies to avoid the need for creative intra-operative reconstruction.

Tumours and tumour-like lesions of bone. The UHWI experience. University Hospital of the West Indies

A review of all primary tumours and tumour-like lesions of bone diagnosed in patients who attended the University Hospital of the West Indies over a 10-year period revealed 136 cases comprising 69 benign and 54 malignant tumours, and 13 cases of tumour-like lesions. The prevalence and clinical characteristics of the various lesions are discussed and compared with the findings in other series. The results of this analysis provide demographic data useful in the differential diagnosis of bone lesions locally.

Assignment of the locus for PLO-SL, a frontal-lobe dementia with bone cysts, to 19q13

PLO-SL (polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy) is a recessively inherited disorder characterized by systemic bone cysts and progressive presenile frontal-lobe dementia, resulting in death at <50 years of age. Since the 1960s, approximately 160 cases have been reported, mainly in Japan and Finland. The pathogenesis of the disease is unknown. In this article, we report the assignment of the locus for PLO-SL, by random genome screening using a modification of the haplotype-sharing method, in patients from a genetically isolated population. By screening five patient samples from 2 Finnish families, followed by linkage analysis of 12 Finnish families, 3 Swedish families, and 1 Norwegian family, we were able to assign the PLO-SL locus to a 9-cM interval between markers D19S191 and D19S420 on chromosome 19q13. The critical region was further restricted, to approximately 1.8 Mb, by linkage-disequilibrium analysis of the Finnish families. According to the haplotype analysis, one Swedish and one Norwegian PLO-SL family are not linked to the chromosome 19 locus, suggesting that PLO-SL is a heterogeneous disease. In this chromosomal region, one potential candidate gene for PLO-SL, the gene encoding amyloid precursor-like protein 1, was analyzed, but no mutations were detected in the coding region.

Treatment of simple bone cysts in children with curettage and cryosurgery

A retrospective study in children with simple or unicameral bone cysts treated with curettage, cryosurgery, and bone grafting was conducted. The purpose of this study was to evaluate local tumor control and bony healing after this method of treatment. Five (12%) of 42 treated patients had a local recurrence with a mean clinical follow-up of 24.5 months. Surgical complications consisted of two superficial wound infections, one radial nerve palsy, and two fractures, which all resolved completely. A review of the literature was performed to compare our results with historic controls using steroid-injection therapy and curettage with bone grafting alone. We believe that the use of cryosurgery as adjuvant therapy in the surgical treatment of simple bone cysts is of value in controlling local recurrences and achieving bony consolidation.

Intraosseous ganglion of the patella

Osteolytic cystic lesions of the patella are rare lesions. A review of the literature revealed only one previously reported example. The pathogenesis and radiological and pathological features of intraosseous ganglion cysts are discussed. In addition, the differential diagnosis of lytic patellar lesions is discussed.

[Solitary bone cysts. Morphologic variation, site, incidence and differential diagnosis]

Analysis of 402 solitary bone cysts demonstrates the wide morphological variation of this cystic lesion with regard to histology and radiology. Aside from metaphyseal location in femur (33%) and humerus (23%), solitary bone cysts are also often located in calcaneus (11%), tibia (11%) and pelvis (10%). Most patients are in the second decade of life. Differentiation between this benign lesion and malignant bone tumors is very important in daily clinical routine. The diagnosis cannot be based solely on radiological findings because of the variation of solitary bone cysts and the special forms, such as calcifying solitary bone cyst. Therefore, exact histological diagnosis is of particular importance.

Intraosseus ganglia of the wrist

PURPOSE

To determine the prevalence of intraosseous ganglion cysts in patients with unexplained wrist pain and evaluate the radiographic methods used for their detection.

MATERIALS AND METHODS

Four hundred patients with unexplained wrist pain were prospectively examined. All patients underwent standard three-view radiography of the wrist. Patients with cystic areas on conventional radiographs underwent further examination with bone scanning. Ultimately, 17 patients whose bone scans demonstrated increased radiotracer uptake that localized to a particular carpal bone underwent magnetic resonance (MR) imaging.

RESULTS

Of these 17 patients, intraosseous ganglion cysts were diagnosed in 15. Some of these ganglia were occult on conventional radiographs and were detected only at bone scanning and MR imaging.

CONCLUSION

Intraosseous ganglion cysts in the wrist are more common than previously reported. In some patients, bone scanning, conventional radiography, and/or MR imaging will aid surgical resection that could provide symptomatic relief of unexplained wrist pain.

[Maxillary fissure cysts in Senegal. Analysis of a series of 14 cases]

The fissurary cyst is an non-odontogene and epithelial cyst. Their frequency in Senegal compared to the epidemiological records in European countries had led the authors to carry out a study. Around 14 fissurary cysts have been recorded in a seven year period. The teeth affected by the tumour could be saved in case of an early diagnosis.

Learning from the Japanese Registry: how will we prevent long-term complications? Niigata Research Programme for beta 2-M Removal Membrane

As compared to Europe and USA, the survival rate of chronic haemodialysis (HD) patients in Japan is demonstrated by the Japanese Registry to be high. However, another Japanese Registry nationwide survey on their quality of life revealed serious osteoarticular disorders increasing with the duration of HD. Selecting plasma beta2-microglobulin (beta2-M) as a marker, a prospective study on the long-term clinical effect of a beta2-M-removable membrane (PMMA BK membrane) has been performed and the changes in joint pains and plasma beta2-M have been followed for 5 years. In addition, the incidence of carpal tunnel syndrome (CTS) and bone cysts among 225 patients maintained on HD with BK membrane was analyzed retrospectively. By continued use of BK membrane, plasma beta2-M was maintained at a significantly lower level than that in HD with conventional cellulosic membranes. The total score of joint pain in HD patients treated with BK membrane was significantly decreased and maintained at this low value throughout 5 years. In HD patients treated with BK membrane for a long period, the occurrence of CTS and bone cyst was less and postponed, as compared to patients on HD with conventional cellulosic membranes. HD-related amyloidosis had not been observed for 5 years in patients treated with BK membrane from the introduction of haemodialysis.

Cystic radio-lucency of carpal bones in haemodialysis patients. An early indicator of the onset of carpal tunnel syndrome

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radiolucency of carpal bones in 35% of the hands. Radiographs were classified into three groups: Group A--cyst growing, Group B--cyst not growing, and Group C--cyst absent. The prevalence of carpal tunnel syndrome was 100% (27/27) in Group A, 5.6% (1/18) in Group B, and 6.5% (6/93) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.

Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance

PURPOSE

To determine the relationship between labral cysts and labral tears and glenohumeral instability.

MATERIALS AND METHODS

Magnetic resonance (MR), clinical, and arthroscopic examinations of the shoulder and the surgical findings of 20 patients were correlated and retrospectively analyzed. A cystic-appearing mass adjacent to the labrum was the selection criterion for inclusion.

RESULTS

MR imaging showed labral tear intimately associated with cystic-appearing mass in these 20 patients. The tear and cyst complex was located anteriorly in two patients, posteriorly in nine, and superiorly in nine. The mass extended into the spinoglenoid notch in six patients, the suprascapular notch in three, and both notches in four. Physical examination showed glenohumeral instability in the direction of the labral tear and cystic-appearing mass in 11 patients (55%). Findings at intraarticular surgery, performed in eight patients, confirmed a labral tear with communication between the joint space and the cyst.

CONCLUSION

Glenoid labral cysts are associated with glenoid labral tears and shoulder instability.

Pathological fractures secondary to unicameral bone cysts

We carried out a retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. Most lesions were in the metaphysis of a tubular bone, the commonest sites being the the upper part of the humerus and femur. The percentage of bone occupied by the cyst in the transverse plane was more than 85% in both anteroposterior and lateral radiographs in every case of pathological fracture. In most cases, the cyst recurred and sometimes became large without any acceleration of healing.

Primary bone tumours of the shoulder: an audit of the Leeds Regional Bone Tumour Registry

An audit of the prospectively gathered data of the Leeds Regional Bone Tumour Registry found that primary bone tumours of the shoulder constituted 145 of 2039 cases (7%). Seventy-five per cent of these occurred in the proximal humerus, 20% in the scapula and 5% in the outer half of the clavicle. Malignant and benign tumours were of equal overall frequency (73 vs 72) but the malignant lesions tended to occur in an older population (mean ages 43 years and 17 years respectively). Simple bone cyst was the commonest diagnosis in children, chondrosarcoma in the middle age group and osteosarcoma in the over-60s. Presenting symptoms were a poor guide to whether the lesion was malignant or not and the correct preoperative diagnosis was made only in a minority of cases. In 134 cases the diagnosis made by the referring pathologist was confirmed by the Bone Tumour Registry but in 11 cases, the diagnosis was changed by the Tumour Registry and differed with important clinical implications. Bone tumour registries provide a valuable source of cumulative information about uncommon tumours and facilitate accurate diagnosis, teaching and research.

Packing with high-porosity hydroxyapatite cubes alone for the treatment of simple bone cyst

In 23 patients, simple bone cysts were treated by curettage followed by packing the cavity with cubes of high-porosity hydroxyapatite (HA). In 22 patients, HA was packed exclusively without autogeneic bone graft. Except in one patient who sustained pathologic fracture at the femoral diaphysis, HA was packed with a fibula strut graft. Each case had an uneventful postoperative course and was followed, on average, two years. Complete healing without cyst recurrence occurred in 18 cases (78%). In three cases--all rapidly growing children--a new cyst appeared between the epiphyseal plate and the HA packing, but the original cysts did not recur. In two multiloculated cysts, the cavities were not filled fully and healing was incomplete, yet there was no cyst recurrence. In the entire group, new bone surrounding HA was roentgenographically evident within an average of 2.3 months. Thus, the result of packing high-porosity HA for simple bone cysts compares favorably with the cure rates reported either with autogeneic bone graft, or topical steroid injection.

[Aneurysmal bone cyst or giant cell tumor. The value of x-ray diagnosis for differential diagnosis]

Depending on analysis of radiographic morphology, location and patient's age of 72 aneurysmal bone cysts (ABC) and 47 giant cell tumours (GCT), the following criteria suggest an ABC with a high positive predictive value: location in the diaphysis (100%), in the shaft (92%), in the metaphysis or metadiaphysis (86%), patient younger than 17 years (97%) and growth rate grade Lodwick-IA (88%). GCT were selected via the following criteria: epimetaphyseal location (82%) and growth rate grade Lodwick-II (100%). In 14% of the cases, differential diagnosis between both entities is radiologically impossible.

Aneurysmal bone cyst of the maxilla: case report and review of the literature

Aneurysmal bone cyst (ABC) is a rare benign lesion of the head and neck. A case of an ABC in a 12-year-old female is presented, the twentieth reported such case in the maxilla. Literature review shows ABC are common in the long bones; only 2% are in the head and neck. Of the 77 lesions in the head and neck found in the literature, 31 (40%) are in the mandible, 20 (26%) are in the maxilla (including this case) and the remainder mainly in the skull. Current recommended treatment is curettage with enucleation first if technically possible.

Benign tumors of the cervical spine

Benign tumors of the cervical spine are relatively infrequent but have a number of common characteristics that aid in the evaluation and treatment of these lesions. The tumors are most common in the first and second decades of life, presenting as pain, neck stiffness and torticollis. In approximately 70%, the lesions are visible on plain roentgenograms and the remainder are well visualized on bone scan and computed tomographic scan. The majority are present in the posterior elements and may be treated adequately with excisional biopsy by curettage. Stage 3 lesions are best treated by marginal excisional techniques and may require adjunctive techniques such as embolization or radiation therapy. The location of the lesion and extent of excision determine the necessity for fusion.

Dialysis-associated arthropathy: a multicentre survey of 171 patients receiving haemodialysis for over 10 years. The Co-operative Group on Dialysis-associated Arthropathy

In order to determine the prevalence of dialysis-associated arthropathy (DAA) and what factors favour its development, we conducted a survey in 19 centres in northeastern France, of all patients receiving haemodialysis for over 10 years (171). A diagnosis of DAA was made in 84 patients (49%) by two investigators, using as criteria single or combined presence of carpal tunnel syndrome (32%), erosions and bone cysts of the large limb joints (33%) and destructive spondylarthropathy (14%). The 84 patients with DAA were compared with the 87 dialysis patients free of these clinical or radiological abnormalities. The affected patients were significantly older at the start of dialysis than unaffected patients. The risk of developing carpal tunnel syndrome increased with the duration of dialysis. Amyloid deposits were found in carpal tunnel tissue obtained from 24 of the 39 operated patients (62%) during surgery. Destructive spondylarthropathy was significantly associated with the presence of disc calcifications and more frequent in AN 69-treated patients in whom secondary hyperparathyroidism appeared to be more severe. The use of an AN 69 membrane for at least 90% of the dialysis period (in 15 patients) was not associated with a lower prevalence of DAA. We found that after 10 years of haemodialysis DAA occurred whatever type of membrane was used and the prevalence increased with the patient's age and the duration of dialysis.

[Incidence of primary benign and malignant neoplasms and bone pseudotumoral lesions. An epidemiologic analysis of 585 cases diagnosed at the Faculdade de Medicina of the Universidade Federal de Minas Gerais]

The authors present an epidemiological study of 585 primary bone neoplasms and tumor-like lesions in order to investigate their incidence and distribution according to age, sex and skeletal location. A statistical agreement between the pertinent literature and the collected data was found. In this series, the most common benign neoplasms were the osteochondroma (45.3%) followed by chondroma (19.6%). Among the intermediate and malignant neoplasms, osteosarcoma was the most frequent (30.0%) followed by myeloma (16.0%). Fibrous dysplasia accounted for 46.6% of all tumor-like lesions, followed by solitary bone cyst (18.6%).

Unicameral bone cyst of the talus

The authors present a rare case of a talar unicameral bone cyst in a 9-year-old boy. This is the first such case presented in podiatric literature; the lesion has been cited infrequently in world literature. A brief review of the literature is discussed, along with the diagnostic tests, possible complications, and proper therapy for this lesion.

Aneurysmal bone cyst of the mandible

Aneurysmal bone cyst is an uncommon benign lesion that rarely presents in the craniofacial region. No prior reports of this entity involving the mandible could be found in the otolaryngologic literature, and it has been reported only infrequently in the maxilla. Two previously unreported cases originating in the mandible are presented with a review of the literature, pathology, and diagnosis of this lesion. Treatment of this lesion consists of complete surgical removal and immediate bone grafting for reconstruction.

Lunate implant arthroplasty. Evaluation of 19 patients

The results of lunate implant arthroplasty are unpredictable and many untoward postoperative problems are encountered. A retrospective review of 19 patients operated on for lunatomalacia (Kienböck's disease) by Silastic (HP) implant arthroplasty suggests that prevention of postoperative scapholunate dissociation seems to be the key to successful results. Knowledge of the predominant role played by the palmar ulnolunate and radiolunate ligaments is important to the understanding of this mechanism. The intrinsic stability accomplished by the geometry of the carpal bones requires adequate ligamentous support. This restraint, however, may be weakened by pre-existing absence of certain palmar fibres, by the disease process or by the surgery. In the present study three operative methods have been assessed: dorsal approach and implant stem fixation; dorsal approach, removal of implant stem and Kirschner-wire fixation; volar approach, removal of implant stem, no internal fixation but palmar capsuloligamentous reinforcement. Consistently good results have been obtained using the latter technique. It seems as if most of the usual postoperative problems of lunate implant arthroplasty can be avoided by this method which warrants continued trial.

Comparison of diving experience factors between divers classified as positive and negative for bone cysts

Official U.S. Navy diving records for enlisted divers who were 35 years of age and older were examined for differences in diving experience between those who were classified as positive or negative for bone cysts. One-third of the divers (n = 31) were classified as positive, and two-thirds (n = 62) as negative, for bone cysts. Diving experience factors included total years of diving experience, frequency of dives between 15 and 31 m, frequency of dives deeper than 31 m, number of saturation dives, number of dives involving decompression, and number of cases of decompression sickness. None of these factors differed significantly between the two groups. While previous findings showed that bone cysts are twice as prevalent among divers as among a comparison group of Navy enlisted men matched to divers for age, rank, and occupational specialty, these results indicate that this high prevalence rate does not appear to be related to specific types of diving exposure. Other environmental factors such as long-bone injury, disease, or exposure to hazardous or toxic substances may account for differences in the prevalence of bone cysts between the two groups.

Aneurysmal bone cyst of the jaws. Report of a case associated with fibrous dysplasia and review of the literature

A case of aneurysmal bone cyst (ABC) of the mandible, recurring for the third time and arising in conjunction with fibrous dysplasia, is reported. A comprehensive review of the literature and analysis of over 50 cases of ABC of the jaws yielded the following results: ABCs of the jaws constitute 1.5 % of all non-odontogenic and non-epithelial cysts of the jaws, and 1.9 % of all ABCs of the skeleton. The mandible was affected in 55 % of the cases, the maxilla in 45 % of the patients. Females represented 53 % of the patients and males the remaining 47 %. Seventy-four percent of the ABCs occurred in patients 20 years old and younger. This lesion is regarded as non-neoplastic and as most likely secondary to a pre-existing bone lesion. Our review established that 21 % of the reported cases in the jaws had developed in association with various primary lesions of bone, including fibro-osseous lesions. The primary bone lesion initiates an osseous, arteriovenous fistula which, through its hemodynamic forces, creates a secondary reactive lesion, that is an aneurysmal bone cyst. We also established a recurrence rate of 26 %, based upon previously reported cases as well as our own. The treatment of choice is surgical curettage with cryosurgery and immediate packing with bone chips.

Clinical significance of hyperparathyroidism in familial multiple endocrine adenomatosis type I (MEA I)

In order to investigate the suggestion that hyperparathyroidism in patients with familial MEA I has a mild and nonprogressive clinical course, we have compared clinical, biochemical, roentgenologic and histologic features of 29 patients with hyperparathyrodism originating from six families with the MEA I syndrome with those of 28 unselected patients with isolated nonfamilial hyperparathyroidism. The patients from the families with MEA I were significantly younger, had lower serum calcium and inorganic phosphate concentrations and a lower incidence of elevated alkaline phosphatase levels. Furthermore, they had multiple enlarged parathyroid glands and recurrence of the disease significantly more often. There was, however, no significant difference in the incidence of renal impairment, urolithiasis, subperiosteal resorption or large bone cysts on roentgenograms, histologic changes in bone biopsy specimens or mortality due to hyperparathyroidism. Therefore, the suggestion that this type of hyperparathyroidism has a milder clinical course is not confirmed in the present study.