Hypertrophic osteoarthropathy in cystic fibrosis

Seven adult patients with cystic fibrosis who had radiological evidence of hypertrophic osteoarthropathy were reviewed. In five of the patients symptoms were particularly pronounced at times of acute infective exacerbations; appropriate treatment of the infective episodes resulted in reduction or resolution of the bone pain and joint effusions. Despite this symptomatic relief periosteal changes persisted radiologically and their chronic nature was indicated by changes in the midshafts of long bones. Four of the seven patients had transient gynaecomastia or mastalgia related to infective exacerbations. It is hypothesised that a neuroendocrine mechanism--namely, release of vasoactive intestinal polypeptide--might account for the osteoarthropathy.     

Hypertrophic pulmonary osteoarthropathy complicating Celestin tube insertion.

A case is reported in which hypertrophic pulmonary osteoarthropathy (HPOA) developed following the insertion of a Celestin tube for a benign oesophageal stricture. The HPOA resolved completely following removal of the tube. It is believed that the Celestin tube was the major factor causing the HPOA, a complication of Celestin tube insertion not previously reported.     

Hypertrophic osteoarthropathy without radiographic evidence of new bone formation.

A 70-year-old man with florid symptoms of hypertrophic osteoarthropathy for over a year presented without radiographic evidence of new bone formation. His symptoms improved after exploratory thoracotomy, but recurred with lesser severity a year later with tumour recurrence on the chest wall. Absence of new bone formation was again demonstrated radiologically as well as by isotope scan.     

Hypertrophic osteoarthropathy associated with Fallot's tetralogy��a case report

A case of Fallot''s tetralogy associated with hypertrophic osteoarthropathy in a young Nigerian female is described. The clinical spectrum of hypertrophic osteoarthropathy is reviewed. The rarity of this syndrome is stressed. Some other aspects of the clinical manifestation of cyanotic congenital heart disease which may mimic the skeletal syndrome are mentioned.     

Hypertrophic osteoarthropathy, spider naevi and oestrogen hyperexcretion associated with adenocarcinoma

We describe two patients with hypertrophic osteoarthropathy, spider naevi and elevated 24 h urinary oestrogen excretion associated with an adenocarcinoma. In one of the patients, the spider naevi and the clinical signs of hypertrophic osteoarthropathy disappeared and the 24 h urinary oestrogen returned to normal following removal of the tumour.     

Hypertrophic colonic tuberculosis.

A patient who has suffered from hypertrophic colonic tuberculosis caused by the human strain of tubercule bacillus is presented. Despite being an uncommon presentation of tuberculosis, it is of more than academic interest to surgeons practising in tropical countries.