Dysplasia epiphysealis hemimelica of the proximal tibia showing epiphyseal osteochondroma in an adult.

A 33-year-old woman was referred to our hospital complaining of pain and a tumorous lesion in her left knee joint in the absence of any history of trauma. Radiological examinations demonstrated an osseous mass originating from the epiphysis of the proximal tibia, with a continuous osteoblastic lesion involving the lateral half of the epiphysis. The pathological diagnosis of these lesions was compatible with that of osteochondroma. The clinical and pathological features of this case were considered to be identical with those of dysplasia epiphysealis hemimelica, although this patient was older than patients described in previous reports, and demonstrated no other symptoms such as valgus or varus deformity or limb-length discrepancy.     

Spontaneous resolution of solitary osteochondroma in the young adult

Spontaneous resolution of a solitary osteochondroma is rare. Such a case is presented in a patient nearing skeletal maturity. Based on a search of the English literature this is the first such report in a patient of this age..     

1例成人单纯Tillaux骨折病例报告

正Tillaux骨折为胫骨远端外侧关节面骨折,Paul Tillaux于1892年第一次在尸体解剖中定义了该骨折~([1])。此骨折临床较少见,多发生于12~14岁青少年的胫骨远端骨骺闭合前~([2]),属于骨骺损伤Salter-HarrisⅢ型,Lauge-Hansen分型中旋后外旋Ⅰ度,而成年人的单纯Tillaux骨折更不多见。临床资料患者女性,65岁,因"扭伤致左踝关节疼痛伴活动受限     

Acute bowing fracture of the fibula in an adult.

Acute traumatic bowing of bone has only recently been recognized. Although most of these unusual fractures have been described in the pediatric forearm, bowing fractures of other juvenile long bones have also been reported. The authors describe a case of an acute bowing fracture of the fibula in a young adult.     

Stress fracture of the olecranon in an adult baseball player

Stress fractures of the olecranon caused by repetitive stress force have infrequently been reported as a cause of elbow pain in adult athletes, engaged in throwing and pitching sports. We diagnosed as a stress fracture of the olecranon by clinical and radiographic findings and treated surgically. The patient returned to playing baseball at a competitive level and was asymptomatic 4 months after the first operation. However, the patient re-injured the olecranon and a second surgical treatment was performed almost 1 year after the first operation. After the second surgery, the patient returned to playing baseball at a competitive level and was free from elbow symptoms. We presented a stress fracture of the olecranon in a semi-professional adult baseball player and suggested that surgical treatment is necessary.     

Simultaneously detected parosteal osteoma and osteochondroma in the distal femur of a single patient

Parosteal osteoma arising from long tubular bone is an extremely rare bone tumor and should be distinguished from parosteal osteosarcoma, whereas osteochondroma is a common benign bone tumor showing an outgrowth of medullary and cortical bone with a cartilaginous cap. This report describes simultaneously detected parosteal osteoma and osteochondroma arising from the distal femur in a single patient.     

Misplaced pulmonary arteries in an adult patient with pulmonary hypertension

Misalignment of pulmonary vessels, with or without alveolar capillary dysplasia, is a rare cause of persistent pulmonary hypertension in the newborn. The prognosis is poor, with virtually all patients succumbing to unremitting hypoxaemic respiratory failure and death during the newborn period. We report the CT and histological findings of misplaced pulmonary arteries in a previously healthy young adult patient who presented with pulmonary arterial hypertension. Contiguous high-resolution spiral CT angiography showed small pulmonary arteries coursing within the interlobular septa and enlarged central pulmonary arteries. Surgical lung biopsy demonstrated anomalous muscularised pulmonary arteries in the interlobular septa. This is, to our knowledge, the first report of misplaced pulmonary arteries presenting in an adult patient and may represent a forme fruste of the neonatal vascular anomaly. A possible association with pulmonary arterial hypertension is also suggested in this case.Misalignment of pulmonary vessels, with or without alveolar capillary dysplasia (ACD), is a rare cause of persistent pulmonary hypertension in the newborn [1–5]. The prognosis is poor, with patients usually succumbing to unremitting hypoxaemic respiratory failure and death in early infancy [3–7]. We report the CT and histological findings of misplaced pulmonary arteries in a previously healthy young adult patient who presented with symptoms of pulmonary arterial hypertension. CT of the chest confirmed the findings of pulmonary arterial hypertension and demonstrated small anomalous pulmonary arteries within many interlobular septa. Surgical lung biopsy confirmed the presence of anomalous muscularised small pulmonary arteries in the interlobular septa. To our knowledge, this is the first reported adult patient with a histological diagnosis of misplaced pulmonary arteries in the literature and may represent a variant of misalignment of pulmonary vessels seen in neonates. This finding lends credence to earlier assertions that the distribution of the vascular misalignment, be it patchy or diffuse, may correlate with the phenotypic expression of disease [3, 6, 7]. The finding in an adult without associated ACD would seem to validate previous hypotheses that the anomalies may co-exist or present as mutually exclusive entities [2–5].     

Calcific discitis in an adult patient with intravertebral migration and spontaneous remission

Symptomatic disc calcifications have been reported, especially in the pediatric population, and remain of unknown etiology. Such a condition has been very rarely reported in adults. The aim of this paper is to present a case report of calcific discitis in an adult patient with intravertebral migration and spontaneous calcification resorption. The clinical presentation was that of back pain with an abrupt onset, not related to trauma or to physical activity. No fever or neurological deficits were present. Blood count, erythrocyte sedimentation rate, routine urine, and urine culture were negative. The pain regressed in 20 days with analgesic therapy. Findings of thoracic calcific discitis are illustrated with X-rays, CT, MRI, and bone scintigraphy.     

Surgical treatment of Arnold-Chiari malformation type I in an adult patient

BACKGROUND: Herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal with obliteration of the cerebellomedullary cistern is the primary feature of Arnold-Chiari type I malformation (ACM I). It is considered to be congenital malformation, although there have been reported cases of an acquired form. CASE REPORT: We presented a female patient, 45-year old, with ACM I without syringomyelia as a rare and unusual clinical image, as well as the effect of decompressive surgery in the treatment of this malformation. The patient was admitted to the Department of Neurosurgery with clinical signs of truncal ataxia worsening during the last six years. Moderate quadriparesis with predominant lower extremity involvement and the signs of the cranial nerves damages occured during the last seven months before admission, with progressive clinical course up to the date of admission. Neurosurgical treatment that included suboccipital medial craniectomy with resection of posterior arch C1 vertebrae and C2 laminectomy resulted in a significant clinical improvement and a much better quality of life. CONCLUSION: Posterior craniovertebral decompression with microsurgical reduction of the cerebellar tonsils and placement of an artificial dural graft is a treatment of choice in severe forms of ACM I without syringomyelia.     

Cerebral aneurysmal arteriopathy in an adult patient with acquired immunodeficiency syndrome

In adult patients with acquired immunodeficiency syndrome (AIDS), cerebral arteritis usually takes the form of arterial wall thickening, stenosis, and occlusion, leading to cerebral ischemia and infarction. Aneurysms and intracranial hemorrhage are much less commonly associated with cerebral vasculitis. For reasons not entirely clear, this form is seen more often in pediatric patients infected with human immunodeficiency virus. We report an adult patient with cerebral aneurysmal arteriopathy who presented shortly after his AIDS-defining illness in a setting of severe immune suppression and high viral load.     

Malignant degeneration of an osteochondroma with unusual intra-bursal invasion

Multiple hereditary osteochondromatosis is an uncommon autosomal dominant condition in which patients are predisposed to the development of chondrosarcoma. We report a case of a patient who developed a secondary low-grade chondrosarcoma in this setting. The tumor was associated with an unusual multinodular invasive growth pattern into a pre-existing bursa that was present overlying the osteochondroma. Received: 1 March 1999 Revision requested: 6 April 1999 Revision received: 7 May 1999 Accepted: 10 May 1999     

Jejunoduodenogastric intussusception secondary to percutaneous gastrostomy tube in an adult patient

Intussusception is the most common abdominal emergency in early childhood, but it is rare entity in adults. Jejenoduodenogastric intussusception is an exceedingly rare retrograde small-bowel intussusception. Percutaneous endoscopic gastrostomy (PEG) has become the preferred procedure for establishing enteral feeding in most clinical situations. Despite the fact that it is relatively safe, a number of complications can occur following PEG placement; jejenoduodenogastric intussusception is one of them, but it is a very rare entity. Here, we report a case of jejenoduodenogastric intussusception secondary to placement of a PEG tube in an adult patient. To our knowledge, this is the third case of isolated duodenogastric intussusception being reported.     

Sudden unexpected death in an adult patient with endocardial cushion defect

A 50-year-old male died following a road traffic accident. Postmortem examination revealed that the injuries caused by the accident did not seem to have caused his death. A large ostium primum defect was found, with bridging leaflets attached to the interventricular septum. In this article, we present a case of sudden death with partial endocardial cushion defect and discuss the mechanism of death. We believe that this is the first report of sudden death caused by endocardial cushion defect.     

Malrotation of the midgut: a rare complication in an adult patient

Complications caused by a congenital anomaly of the midgut usually occur in the first 4 weeks of life; later such complications are rare. We present an adult patient with extrinsic duodenal compression caused by malrotation. The embryology, symptoms and complications in the adult and the radiological diagnosis are discussed. The literature on this subject is reviewed.     

罕见骨软骨瘤并蒂部骨折1例

女．49岁。因左大腿下段肿块40年疼痛1d就诊。40年前无意中发现左大腿下端内后侧有一硬性包块，膝部活动时稍有不适感，未予治疗。1d前不慎撞伤左膝内后侧．遂觉疼痛．尤以膝部活动时为甚。查体：左膝内上方软组织肿胀、压痛，皮下触及2cm×1．5cm质硬肿块，边界清，不活动。     

Developing an action plan for patient radiation safety in adult cardiovascular medicine

Technological advances and increased utilization of medical testing and procedures have prompted greater attention to ensuring the patient safety of radiation use in the practice of adult cardiovascular medicine. In response, representatives from cardiovascular imaging societies, private payers, government and nongovernmental agencies, industry, medical physicists, and patient representatives met to develop goals and strategies toward this end; this report provides an overview of the discussions. This expert “think tank” reached consensus on several broad directions including: the need for broad collaboration across a large number of diverse stakeholders; clarification of the relationship between medical radiation and stochastic events; required education of ordering and providing physicians, and creation of a culture of safety; development of infrastructure to support robust dose assessment and longitudinal tracking; continued close attention to patient selection by balancing the benefit of cardiovascular testing and procedures against carefully minimized radiation exposures; collation, dissemination, and implementation of best practices; and robust education, not only across the healthcare community but also to patients, the public, and media. Finally, because patient radiation safety in cardiovascular imaging is complex, any proposed actions need to be carefully vetted (and monitored) for possible unintended consequences.