Progressive and regressive changes in the nucleus pulposus. Part II. The adult

The spines of 28 cadavers were studied with magnetic resonance (MR) imaging, correlated with anatomic sections, to characterize the progressive and regressive changes in the nucleus pulposus. Four additional types of nucleus pulposus were identified in this study. The transitional type (type II) of childhood had fibrous tissue that developed near the anulus fibrosus anteriorly or posteriorly. MR images showed a notch of reduced signal intensity in the nucleus pulposus where the fiber was developing. The adult type (type III), which is predominant after age 30 years, had an indistinct boundary between the nucleus pulposus and anulus fibrosus. MR images showed the fibrocartilage in the nucleus pulposus and inner anulus fibrosus as areas of high signal intensity. Adult disks with a tear of the anulus fibrosus (type IIIB) had a lower signal intensity on MR images and slightly reduced disk heights. This type may represent an early stage of degeneration. Degenerated intervertebral disks (type IV) had either dense disorganized fibrous tissue or fluid replacing the normal fibrocartilaginous structure of the nucleus pulposus. MR images showed narrow intervertebral disk spaces with either reduced signal intensity if collagen was present or increased signal intensity if fluid was present. This study suggests that the nucleus pulposus may progress normally through types I, II, and III.     

The marrow heterotopia in thalassemia

The subject of marrow heterotopia has been reviewed on the basis of 15 cases suffering from thalassemia. Other cases reported in the literature were also reviewed. Using conventional radiography, scintigraphy, computerized tomography and myelography, 17% of the cases admitted into the hospital with the diagnosis of Thalassemia, were found to have macroscopic masses of marrow heterotopia. The most common site of development of these masses was the costovertebral gutter, followed by the anterior end of the ribs and the extradural space of the spinal canal. In one case, masses were located in the maxillary antra. The clinical implications, the pathogenesis of the masses and the differential diagnosis from other tumour-like entities are discussed. Three patients presented with symptoms and signs of spinal cord compression. All three patients were treated satisfactorily with small doses of radiotherapy.     

Keep your eyes on the ribs: the spectrum of normal variants and diseases that involve the ribs.

A variety of normal variants or pathologic conditions of the ribs may be overlooked at chest radiography if the ribs are not evaluated carefully. Rib lesions may simulate pulmonary disease as well. Normal rib variants include cervical, intrathoracic, and pelvic ribs; forked rib; fusion and bridging; and pseudarthrosis of the first rib. Trauma-related lesions are common and usually occur in isolation but can alert the radiologist to other injuries. Metastases may appear as vague areas of increased opacity overlying the lung if seen en face and typically have a smooth interface with the lung on oblique images. Chondroid lesions nearly always arise at or near the anterior end of the rib. Osteochondroma (exostosis) typically manifests as a deformity or expansion of the rib with calcification of the cartilaginous cap. Acute rib infections are seen as focal areas of bone destruction, whereas chronic infections may manifest as periosteal reaction or a bone sequestrum. Inferior rib notching may be seen in a wide variety of pathologic conditions. Rib abnormalities may also be seen in fibrous dysplasia, Langerhans cell histiocytosis, Paget disease, and various hemoglobinopathies. In most cases, radiography is sufficient for the identification and diagnosis of normal variants and pathologic conditions of the ribs.     

Seasonal changes in cyclists' performance. Part II. The British Olympic track squad.

In Part II of the study, the British Olympic track (sprint) squad cyclists demonstrated reductions in body fat index, % body fat and endomorphy (p greater than .05), increased Hb and PCV % (p greater than .05), and lowered HR at rest and in warm-up exercise (p greater than .05), but no change in leg power. Repeated interval sprints of short duration, maximal exercise on an "ergowheel" ergometer, at standardised power output, showed increased anaerobic index (p greater than .05) and acceleratory power (p greater than .01) but no change in sustained power output. Compared with "non-select" riders, a case study of the single "select" rider showed anthropometric differences in terms of lower height, weight, body fat index, % body fat and endomorphy, but enhanced mesomorphy and FEV %. Furthermore, the "select" rider demonstrated temporarily latent functional performance capabilities, in that increased anaerobic index, acceleratory and sustained power indices, as well as enhanced relative power output, were not identified until late in the competitive season.     

Plastic bowing of the ribs in children

Four cases of plastic bowing of the ribs are presented. In three patients with Werdnig-Hoffman disease, plastic curvatures were associated with chronic pneumonia and atelectasis. We postulate that intrapulmonary retractive forces can deform ribs thinned by muscular atrophy. In turn, thoracic collapse can perpetuate lobar and segmental atelectasis. In one case of osteogenesis imperfecta without pneumonia, we believe normal muscle forces bent ribs weakened by deficiency of normal cortical architecture.     

Pediatric ribs: a spectrum of abnormalities.

The manifestations of many congenital and acquired conditions can be seen in the ribs of children. Normal variants are usually clinically insignificant; they are occasionally palpated at clinical examination or detected incidentally at chest radiography. Signs of abnormality can appear in the ribs as variations in number, size, mineralization, and shape. These changes can be focal or generalized. Abnormalities detected in the ribs may be the initial indication of previously unsuspected systemic disease. The ribs can yield important diagnostic clues in the work-up of patients with congenital bone dysplasias, acquired metabolic diseases, iatrogenic conditions, trauma (especially child abuse), infection, and neoplasms. Routine evaluation of the ribs on every chest radiograph is important so that valuable diagnostic data will not be overlooked. The diagnostic information obtained from evaluation of the ribs can help tailor the radiologic and laboratory studies that may be necessary to complete a patient's diagnostic work-up.     

Stress fracture of the ribs in female rowers

Stress fractures of the lower ribs related to sports are rare. Fractures of the ribs related to rowing sports have not been reported. We have documented seven cases of stress fractures of the lower ribs in female athletes; four were elite rowers and three were engaged in tennis, golf, and gymnastics. Each athlete was initially seen and treated elsewhere for muscular strain. All athletes presented with pain in the posterolateral thorax in and around the scapula. The time from onset of symptoms to diagnosis ranged from 2 to 6 months. Bone scans were used to document the fractures when roentgenograms were equivocal. Each athlete responded to a 4 to 8 week period of rest or training modification. Biomechanical analysis of the forces across the ribs demonstrates that these fractures tend to occur along the posterolateral segment where the bending stresses on the rib are greatest. The predominant muscle forces are generated by the forced couple of scapular retraction and protraction acting through the serratus anterior. We postulate that inadequate strength and resistance training background in women is the cause for the apparent increased susceptibility of women to these skeletal injuries.     

The heart of the patient with beta thalassemia major. Study with magnetic resonance

PURPOSE: The main cause of death in beta-thalassemia major patients is congestive heart failure which is traditionally referred to myocardial iron overload. Recently, some investigators have found that cardiac failure is not caused by the iron overload. In their opinion, left-sided heart failure develops years after the onset of acute myocarditis and might be related to a late autoimmune process. Right-sided heart failure is related to the combination of left ventricular diastolic restriction and pulmonary hypertension. The aim of this work is to study myocardial iron overload by MRI and to correlate the signal intensity changes of the myocardium with cardiac function. MATERIAL AND METHODS: Sixteen patients with beta-thalassemia major were examined with a .5 super-conducting unit. SE and cine-GE sequences were used in the 4 chamber and 2 chamber views. Left ventirclar ejection fraction (EF) was calculated by using the biplane area-length method. Right ventricular size was assessed by measuring the end-diastolic anteroposterior diameter (APD). Myocardial signal intensity was evaluated qualitatively and quantitatively (myocardium/subcutaneous fat) in all the beta-thalassemia patients and in 10 normal volunteers. RESULTS: Left ventricular function was decreased (EF < 55%) in 2/16 patients. The right ventricle was dilated in 5/16 patients (APD > 42 mm). The myocardium had a lower signal intensity than that of normal volunteers in 15/16 patients. No statistical correlation was found between myocardial signal intensity and serum ferritine levels or cardiac function. CONCLUSIONS: The small number of patients in our series does not allow any definitive statements. However, our results show that cardiac function is not influenced by myocardial iron overload.     

Benign primary tumours of the ribs

Benign primary tumours of the ribs are rare and may be identified during the investigation of a clinically suspected abnormality or as an incidental finding. This review describes the spectrum of benign tumours that can involve the rib and illustrates the radiographic, computed tomography (CT) and magnetic resonance (MR) imaging appearances that may facilitate diagnosis.     

Experimental study of the pathogenesis of frostbite. Part I. Pathohistologic and ultrastructural changes in tissues immediately after thawing]

Histopathologic and ultrastructural changes in the tissues of frozen extremities of Wistar rats were investigated immediately after thawing. Three experimental groups were formed: two were exposed to cryoinjuries of different intensity, while the third was the control one. Cryoinjury was caused by experimental model of local, controlled freezing of hind, right extremities. Immediately after thawing the tissue samples were taken from frozen right and unfrozen left extremities, in which histopathologic and ultrastructural changes were compared mutually and with control group, respectively. It was observed that the freezing directly caused ultrastructural and histopathologic damage of the tissues that were manifested immediately after thawing and were proportional to the intensity of freezing. Simultaneously, in the tissues existed complex circulatory disorders manifested in open arteriovenous shunts, venous congestion and microcirculatory insufficiency caused by evident spasm of arteriolae that could be considered to be very significant pathogenetic factor in ischemic damage of unfreezed tissues.