Xeroradiography in β-thalassaemia

Xeroradiographic investigations of the skull, hand, and elbow were performed on 27 patients with homozygous -thalassaemia. The results were compared with plain radiographic examinations. Xeroradiography, because of its technical properties (i.e. edge contrast enhancement and wide latitude), was shown to demonstrate cortical thinning of long bones, swelling of the diploic space in the skull, and reticulated patterns in the elbow better than standard radiography. Moreover, the use of positive mode imaging was shown to have advantages in the study of the skull and extremities.     

The role of imaging in skull base osteomyelitis — Reviewed

PurposeSkull base osteomyelitis (SBO) is difficult to diagnose due to a wide array of clinical presentations. It can be life threatening if not treated promptly.The objective of this study is to identify the various neck spaces involved in skull base osteomyelitis, correlate them with the possible source of infection and identify the related complications.MethodsEighty nine consecutive either culture proven cases of skull base osteomyelitis, or culture negative cases with inflammation on histopathology responding to antibiotic therapy, presenting at a single non-government hospital in south India between January 2016 and December 2018 were included in this study. Images were reviewed by two radiologists and imaging findings were documented by consensus.ResultsInvolvement of the parotid space, retromastoid space and (temporomandibular) TM joint was associated with otogenic source of infection (p value < 0.05); while, retropharyngeal/prevertebral involvement was associated with sphenoid and nasopharyngeal sources (p value < 0.05). Complications such as cavernous sinus thrombosis (p value = 0.023) and ICA involvement (p value = 0.014) were more commonly seen with central skull base osteomyelitis. Abscess formation was seen in all three groups of patients without a significant difference between the groups.ConclusionImaging plays an important role in determining the possible source of infection by identifying the involved neck spaces and this in turn can guide the clinician to a site for biopsy. Complications related to SBO can also be identified on imaging and can guide appropriate management.     

The “sickle-sign” in bone scintigraphy

A side-effect of an intensive cytotoxic treatment on bone scanning will be reported: the socalled sickle sign, a diffuse activity arlund the calvarium seen only in patients at cytotoxic therapy. The differentiation between this harmless side-effect and abnormalities caused by the cancer could be done in our patients by a vertex view. All patients with skull metastases or meningeal carcinosis and this sign in the frontal and lateral view had an inhomogenous uptake in the vertex view. This view should therefore be added to the standard views in all patients with the sickle sign.     

The “Mellanby effect” in alcoholised e-scooter drivers

International Journal of Legal Medicine - Several studies tried to discuss and clarify the so-called Mellanby effect: Similar blood alcohol concentrations (BACs) supposedly lead to more signs of...     

Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of “minor” sutures

Introduction

This study aims to identify the premature synostosis of “major” and “minor” sutures of the four “sutural arches” of the skull and to perform a morphometric analysis in children with syndromic craniosynostosis in order to evaluate changes in the skull base linked with premature suture synostosis.

Methods

We reviewed multiplanar high-resolution CT images, implemented with 3D reconstructions, from 18 patients with complex syndromic craniosynostosis and compared them with 18 age-matched healthy subjects. We assessed the calvarial sutures and their extension to the skull base, and then we correlated specific types of synostosis with the size, shape and symmetry of the cranial fossae.

Results

We found a marked asymmetry of the skull base growth in all patients. The synostotic involvement around the coronal ring caused a reduction in the growth of the anterior and middle fossae. The size of the posterior cranial fossa was related not only to “major” but also to “minor” suture synostosis of the lambdoid and parieto-squamosal arches.

Conclusion

Changes in the skull base and craniofacial axis symmetry are due to structural and functional relationships between “major” and “minor” skull sutures, suggesting a structural and functional relationship between the neurocranium and basicranium. The early recognition of prematurely closed skull base sutures may help clinicians and neurosurgeons to establish correct therapeutic approaches.     

The use of β-TCP in the surgical treatment of tibial plateau fractures

The objective of this study was to evaluate the outcome of using β-TCP in the treatment of depression tibial plateau fractures. A total of 124 patients with depression tibial fractures were included in this study and followed for a minimum of 12 months. All the cases were treated with open reduction and internal fixation, and grafted with β-TCP ceramic. The clinical and radiological outcomes were assessed using Hospital for Special Surgery (HSS) score of knee and Rasmussen score during the follow-up. No obvious redisplacement was found at the follow-up assessment. Most of the patients had excellent HSS score and Rasmussen clinical score. Bone healing was noted in all fractures and Schatzker II-type fractures had the best functional outcome. The results suggested that using β-TCP combined with open reduction and rigid internal fixation was an effective treatment for depression fractures of the tibial plateau.     

The “Empty Merchant Sign” in acute patellar tendon ruptures

IntroductionWe introduce a new sign on a Merchant view present in acute patellar tendon ruptures (APTR). We aim to determine the accuracy, sensitivity, and specificity of this new radiographic sign and measure the effect of a tutorial on these measures between trainees and non-trainees.MethodsLateral and Merchant radiographs (22 images) of knees with four conditions (patellar instability, APTR, quadriceps tendon rupture, and controls) were randomly shown to 50 trainees and non-trainees who were asked to make a diagnosis based on radiographs. A brief tutorial was administered describing the “Empty Merchant Sign” and the same 22 images were randomly shown after the tutorial. Accuracy, sensitivity, specificity, and positive predictive value were calculated between the two image types and the effect of tutorial on these measures was assessed.ResultsAfter the tutorial: 1. the “Empty Merchant Sign” had a higher specificity (100%) and positive predictive value (99%) compared to the lateral radiograph (81% and 64% respectively, P < 0.001), 2. There was significant improvement (from 56% to 95.3%; P < 0.001) in the accuracy of the Merchant view, making it as accurate as the lateral view (95.3% vs. 90.7%, respectively; P = 0.113). There was no difference in the accuracy of the Merchant view between trainees (97.2%) and non-trainees (90.5%) (P = 0.079).ConclusionThe “Empty Merchant Sign” is a highly sensitive and specific diagnostic sign in cases of APTR. With very little training, physicians can identify this sign to diagnose APTRs on a Merchant view.     

The β-ray gauge as an evaporimeter

Diurnal variations of the net count rate through a turgid tobacco leaf measured by β-ray gauge system corresponded with the stomatal movement. Three distinct stages of evaporation rates were observed through a porous medium. Use of the instrument to study stomatal dynamics and transpiration non-destructively is suggested.     

The “mini brain” appearance of plasmacytoma in the appendicular skeleton

We report on the case of a 70-year-old woman presenting with right hip pain. Radiographs of the right hip demonstrated a well-defined large lytic lesion in the proximal right femur, with prominent trabeculae situated peripherally and extending into the lesion in a "spoke-wheel" pattern. Magnetic resonance imaging (MRI) demonstrated solid enhancing marrow-replacing lesion, with intervening linear nonenhancing areas of low T2 signal intensity. The MRI appearance resembled that of a small brain or "mini brain". Biopsy specimen demonstrated predominantly mature plasma cells, with occasional admixed immature forms. A diagnosis of plasmacytosis, consistent with myeloma, was made. This case illustrates a rare but seemingly characteristic "mini brain" appearance of plasmacytoma, which, to date, has only been reported in the spine and has not been observed in other bony lesions.     

Dose distribution from β-radiation in heterogeneous media: “Two-group” method of calculation

A new method is suggested for calculating distributions of absorbed energy from β-radiation in heterogeneous combinations of various media with atomic number Z in the range 7 ≲ Z ≲ 50. The method can be applied only to spectra of a certain, artificial, “quasi-equilibrium” shape. Therefore, the spectrum of β-radiation of the source in question should first be presented as the superposition of several partial quasi-equilibrium spectra. The dose distribution from a point source with this partial spectrum is then considered as the sum of two components of the dose: “directional” and “diffusion”. The first component is described by the function of the point source (FPS) of the simplest form, and the second one by solutions of the diffusion equation in each medium under certain boundary conditions. Parameters appearing in the FPS and solutions of the diffusion equation are estimated empirically.The paper reports formulae for calculating dose distributions for several of the simplest geometrical configurations for source and absorbers. Dose distributions calculated by the “two-group” method suggested are compared with data obtained in specially performed experiments. The agreement of the results is quite satisfactory.     

The “whisker sign” as an indicator of ochronosis in skeletal scintigraphy

A patient with alkaptonuria and ochronotic arthrosis was imaged twice with technetium-99m dicarboxypropane diphosphonate (^99mTc-DPD) — once during a bout of arthritic knee pain and once when symptom-free. There was a marked accumulation of radioactivity in the large joints. During the episode of arthritis the knee joints had a higher uptake than when the patient was without symptoms. The intervertebral discs showed a high uptake which extended laterally from the axial vertebral column; the finding gave an impression of whiskers, and this whisker sign may be characteristic of ochronosis.     

Expression of β-defensin-4 in “an in vivo and ex vivo model” of human osteoarthritic knee meniscus

Purpose  

To investigate, for the first time, the expression of β-defensins-4, by immunohistochemistry and western blotting, in OA meniscus versus control meniscus, thus providing new insights into the physiological processes of meniscus repairing.