Myonecrosis of Behcet’s disease

Behcet’s disease is an inflammatory disease of unknown cause characterized by intermittent episodes of acute inflammation manifested by oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. We report a rare case of myonecrosis associated with Behcet’s disease. Myonecrosis of Behcet’s disease can mimic soft tissue abscess and therefore awareness of this entity in the appropriate clinical setting is important for initiation of appropriate and timely treatment.     

Role of DWI and MRS in diagnosis of Alzheimer’s and pre-Alzheimer’s disease

Background and purpose

Alzheimer’s disease (AD) is a major cause of dementia in elderly affecting about 30% above the age of 85 years, while mild cognitive impairment (MCI) is the impairment in cognitive functions with intact daily life activities which is described as the preclinical phase of AD.

MRI of Hoffa’s fat pad

The infrapatellar fat pad of Hoffa is commonly injured but rarely discussed in the radiological literature. Abnormalities within it most commonly are the consequences of trauma and degeneration, but inflammatory and neoplastic diseases of the synovium can be confined to the fat pad. The commonest traumatic lesions follow arthroscopy, but intrinsic signal abnormalities can also be due to posterior and superior impingements syndromes and following patellar dislocation. Infrapatellar plica syndrome may also be traumatic in aetiology. The precise aetiology of ganglion cysts is not understood; the principal differential diagnosis is a meniscal or cruciate cyst. Hoffas fat pad contains residual synovial tissue, meaning that primary neoplastic conditions of synovium may originate and be confined to the fat pad. Inflammatory changes along the posterior border of the pad may also be used to help differentiate effusion from acute synovitis on unenhanced MR examinations.     

Kimura’s disease of the elbows

Kimuras disease rarely involves a location outside the head and neck. We report a case of Kimuras disease in a young Asian man involving both elbows. Magnetic resonance imaging showed a soft-tissue mass of irregularly infiltrative strands in the subcutaneous fat accompanied with medial epitrochlear lymphadenopathy. The MRI appearance is described and the entity is briefly reviewed.     

Ewing’s sarcoma of the patella

Ewing’s sarcoma is a relatively rare malignancy, occurring mainly between 4 and 25 years of age. It usually arises from the pelvis, followed by the femur, tibia, and remainder of both the long bones of the extremities and flat bones of the axial skeleton. To the best of our knowledge, Ewing’s sarcoma of the patella has never been reported previously. Patellar tumors occur infrequently and represent an uncommon etiology of anterior knee pain. We describe the rare case of a 41-year-old man who presented with a 3–4 month history of escalating right anterior knee pain and swelling. Imaging demonstrated an aggressive patellar tumor with an adjacent soft tissue mass. The diagnosis of Ewing’s sarcoma was confirmed by pathology. Physicians should be aware of atypical locations for Ewing’s sarcoma and, conversely, of rare tumors arising in the patella and accounting for anterior knee pain. Early recognition of such malignancies allows prompt initiation of treatment, hence improving prognosis.     

Ultrasonographic evaluation of peyronie’s disease

High-resolution ultrasonography was performed on 58 patients with Peyronie’s disease and on 6 healthy men; in 3 patients the examination was repeated during medical treatment for a follow-up period of 4 months. Peyronie’s plaques always corresponded to abnormal echographic findings. In 54/58 cases (93%) they appeared as hyperechoic lesions. In 4 cases (7%) the plaques were hypoechoic and corresponded to a localized widening of the pericavernous tissues: this condition was observed more frequently in the earliest stages of the disease. There was good agreement between the palpable size of the plaques and their size measured by ultrasonography, with some degree of clinical overestimation of the smallest lesions. Calcified mature plaques corresponded to dense hyperechoic lesions with acoustical shadowing. High-resolution ultrasonography is proposed as a first-line diagnostic approach and as a reliable follow-up examination for Peyronie’s disease. The possibility of differentiating calcified plaques from the more recent ones is helpful to allow a correct choice of medical or surgical treatment.     

Ball-thrower’s fracture of the humerus

A relatively rare case of ball-throwers fracture of the humerus is presented. Severe muscular action is an uncommon cause of humeral fractures but has been well documented in the orthopedic literature. To our knowledge, this fracture has not been described in the radiology literature, and awareness of this entity could preclude further unnecessary workup. The mechanism of injury and its typical radiographic appearance is described.     

Endovascular Treatment of Veno-Occlusive Behcet’s Disease

Purpose

To retrospectively evaluate the outcome of endovascular treatments for patients with chronic veno-occlusive disease in different vascular beds secondary to Behcet’s disease (BD). There are few case reports on the subject, and this is the largest study to date.

Materials and Methods

From January 2001 through October 2009, chronic venous occlusions were treated in 10 patients (all male [age range 18–76?years]) with BD using percutaneous transluminal angioplasty and/or stent placement. All patients were symptomatic and had chronic iliofemoral deep venous thrombosis (DVT; n?=?5), central venous occlusion (n?=?3), or Budd–Chiari syndrome (BCS; n?=?2). All patients met criteria of the International Study Group on Behcet’s Disease.

Results

Two of five patients with DVT had unsuccessful recanalization attempts. Three patients had successful recanalization with stent placement. All three veins were occluded within 1?month with unsuccessful reinterventions. Three patients with chronic central venous occlusion had successful recanalization with percutaneous transluminal angioplasty (n?=?1) and stent placement (n?=?2). Two patients had reocclusion with successful reintervention. Two BCS patients had successful treatment with stent placements. Overall technical success was 69%, and no procedural complications were encountered. None of the patients with chronic DVT had patent veins; however, all patients with central venous occlusion or BCS had patent veins on color Doppler ultrasonography at follow-up ranging from 3 to 48?months after intervention.

Conclusion

Endovenous treatment for chronic iliofemoral DVT due to BD had a poor outcome. However, long-term outcome after endovenous treatment for upper-extremity central venous occlusion and BCS syndrome was good.     

Magnetic resonance imaging of Alzheimer’s disease

A modern challenge for neuroimaging techniques is to contribute to the early diagnosis of neurodegenerative diseases, such as Alzheimer’s disease (AD). Early diagnosis includes recognition of pre-demented conditions, such as mild cognitive impairment (MCI) or having a high risk of developing AD. The role of neuroimaging therefore extends beyond its traditional role of excluding other conditions such as neurosurgical lesions. In addition, early diagnosis would allow early treatment using currently available therapies or new therapies in the future. Structural imaging can detect and follow the time course of subtle brain atrophy as a surrogate marker for pathological processes. New MR techniques and image analysis software can detect subtle brain microstructural, perfusion or metabolic changes that provide new tools to study the pathological processes and detect pre-demented conditions. This review focuses on markers of macro- and microstructural, perfusion, diffusion and metabolic MR imaging and spectroscopy in AD.     

’Cable-maker’s clavicle’: stress fracture of the medial clavicle

A 50-year-old man presented with a non-traumatic painful swelling over the medial clavicle. Radiographs showed a poorly defined fracture and the possibility of an underlying pathology was raised. Computed tomography suggested a stress fracture. This prompted a further, more detailed occupational history to be obtained from the patient, which revealed a hitherto undescribed cause of clavicular stress fracture and obviated the need for further imaging or biopsy. Received: 27 December 1999 Revision requested: 17 January 2000 Revision received: 24 February 2000 Accepted: 29 February 2000     

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

We report the case of a 31-year-old woman with mediastinal Castleman’s disease of the hyaline vascular type. This large tumor was safely resected after arterial embolization. We describe the steps of this interventional procedure and discuss related necessary precautions.     

Primary Ewing’s sarcoma of the vertebral column

Objective To determine the demographics, imaging findings, clinical symptoms, and prognosis of primary vertebral Ewings sarcoma (PVES).Design A retrospective review of medical records and radiological studies of patients diagnosed with PVES from 1936 through 2001 in our institution and Department of Pathology consultation files was undertaken. Metastatic and soft tissue Ewings sarcoma cases were excluded.Results From a total of 1,277 cases of Ewings sarcoma, 125 (9.8%) had a primary vertebral origin. There were 48 females and 76 males. Patient ages ranged from 4 to 54 (mean 19.3, standard deviation 10.7, median 16) years. Vertebral column distribution was four cervical (3.2%), 13 thoracic (10.5%), 31 lumbar (25%), and 67 sacrum (53.2%). More than one vertebral segment was involved in ten cases (8%). Satisfactory imaging studies were available in 51 patients: 49 radiographs, 27 computerized tomography (CT), and 23 magnetic resonance imaging (MRI) studies. The majority of tumors were lytic (93%). Three cases were mixed lytic and sclerotic (6%) and one sclerotic. In the nonsacral spine, the majority of lesions (12/20) involved the posterior elements with extension into the vertebral body. Five cases were centered in the vertebral body with extension into the posterior elements. Two cases were limited to the posterior elements, and one case solely involved the vertebral body. Ala was the most frequently affected site in the sacrum (18/26). Spinal canal invasion was frequent (91%). Detailed clinical information was available in 53 patients. Duration of symptoms ranged from 1 to 30 (mean 7) months. Local pain was the first symptom and seen in all cases. Neurological deficits were present in 21 (40%) cases. All patients received radiation in various dosages; 70% additionally received chemotherapy. Twenty-five patients had surgery, and two patients received bone marrow transplantation. Forty-five patients had follow-up; the five-year disease-free survival probability is 0.53. Disease-free survival probabilities are 0.60 for sacral tumors and 0.45 for nonsacral tumors.Conclusion PVES is an uncommon tumor, usually seen in the second decade of life (mean age 19.3 years) with a male predilection (62%). An aggressive osteolytic lesion, particularly in the sacrum, should raise suspicion for this tumor in adolescents. Prognosis was similar in sacral and nonsacral tumors.     

Bilateral multiple malignant transformation of Ollier’s disease

We treated a 26-year-old man with a 19-year history of Olliers disease. Secondary chondrosarcomas developed metachronously at four separate locations: both femora, left proximal tibia and fibular head. All four lesions were surgically excised, and each specimen was histologically identified as grade 1 or 2 chondrosarcoma. Clinical follow-up for 20 years beginning at the time of first tumor surgery has shown no evidence of local recurrence or metastasis. This is the first report of multiple bilateral metachronous malignant transformation of multiple chondromatoses in a patient with Olliers disease.     

Patterns of head impact exposure in men’s and women’s collegiate club water polo

ObjectivesRecent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo.DesignProspective cohort study.MethodsHead impact sensors (SIM-G, Triax Technologies) were worn by men’s (n = 16) and women’s (n = 15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts.ResultsMen’s players sustained 52 verified head impacts of magnitude 39.7 ± 16.3 g PLA and 5.2 ± 3.2 krad/s² PRA, and women’s players sustained 43 verified head impacts of magnitude 33.7 ± 12.6 g PLA and 4.0 ± 2.8 krad/s² PRA. Impacts sustained by men had greater PLA than those sustained by women (p = .045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent’s torso or limb.ConclusionsOur cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data.     

A comparative study of the accuracy of Ranawat’s and Pierchon’s methods to determine the centre of rotation in bilateral coxopathy

Objective. The objective of the study was to compare two methods (Ranawat’s and Pierchon’s) used to determine the centre of rotation of the hip and establish which method calculates a position nearer to the real centre of rotation. Patients and design. We selected 24 patients with unilateral osteoarthritis of the hip. The centre of rotation of the healthy hip was determined in two consecutive radiographic studies by superimposing a template of circles and using two axes as the reference lines (X-axis=teardrop line; Y-axis=a line perpendicular to the X-axis, drawn from the intersection of the ilio-ischiatic line and the teardrop line). After ensuring the stability of these references, both methods were applied to the same radiograph to determine which one established a centre of rotation nearer to the anatomical centre identified by the template of circles. Results. When the values for the healthy hip are compared with those obtained using Ranawat’s method, highly significant differences are observed for both X (P<0.0001) and Y (P<0.0001). When the results for the healthy hip are compared with the values obtained using Pierchon’s method, neither the X (P=0.722 ) nor the Y values (P=0.112) show any significant differences. It would be advisable to use Pierchon’s method to determine the centre of rotation during the preoperative planning for a total hip arthroplasty when the anatomical alteration is bilateral. Received: 16 March 2000 Revision requested: 16 June 2000 Revision received: 31 July 2000 Accepted: 10 August 2000     

A comprehensive Y-STR portrait of Yousafzai’s population

In the current study, 17 Y-Chromosomal short tandem repeats (Y-STRs) included in theAmpFlSTR Y-Filer amplification kit (Applied Biosystems, Foster City, USA) were investigated in 146 unrelated Yousafzai males residing in the Khyber Pakhtunkhwa Province of Pakistan. A total of 94 (89.52%) unique haplotypes were observed. Discrimination capacity was 71.92%. Haplotype diversity ranged from 0.354 (DYS456) to 0.663 (DYS458). Both Rst pairwise analysis and multidimensional scaling plot showed that the genetic structure of the Yousafzais is significantly different from neighbouring populations.

     

Synchronous Paget’s sarcoma of tibiae in which Paget’s disease was limited to these bones

A 51-year-old native of Rio de Janeiro presented with bilateral synchronous Paget’s sarcomas in the tibiae, which developed in the upper right tibia and in the distal third of the left tibia. There were no other areas of Paget’s disease. The largest tumor spread to the right inguinal nodes and also soft tissue. The tumor in the left tibia spread dramatically in the soft tissues up the leg and only involved the medullary cavity in its inferior portion. The patient died, but there was no autopsy. Comments are made about the prevalence of Paget’s disease in Rio de Janeiro. Received: 8 April 1999 Revision requested: 10 May 1999 Revision received: 23 June 1999 Accepted: 1 July 1999