Magnetic resonance imaging of calcaneal aneurysmal bone cyst

A 7-year-old black male presented with a lytic, expansile lesion of the calcaneus. This lesion was studied with conventional x-rays as well as MRI. The MR examination demonstrated a multiloculated lesion with material of a high- and low-signal intensity appreciated within each loculation. Pathologic review of the lesion demonstrated an aneurysmal bone cyst.     

Neuropsychological changes after surgery for anterior communicating artery aneurysm

Neuropsychological disturbances following surgery for anterior communicating artery aneurysms were analyzed in 26 patients (11 males, 15 females) using the Hasegawa dementia scale-revised (HDS-R) over a 3-year period. The patients were aged from 34 to 76 years (mean 54.1 years). Lesions in the frontal lobe were evaluated using computed tomography (CT). Twenty-three patients had symptoms over the course. Four patients had basal forebrain lesion, five had ventral frontal lesion, and 12 had no lesion. Patients with basal forebrain lesion and no lesion tended to show disorientation. The mean HDS-R score was 10.2 points in the patients with ventral frontal lesion, and 13.5 points in the patients with no lesion. These scores are within the range for dementia. The mean HDS-R score in patients with basal forebrain and striate lesions was over 25 points and beyond the range for dementia. Significant differences were observed in the HDS-R score between patients with ventral frontal lesion and basal forebrain lesion, and between patients with no lesion and basal forebrain lesion (p < 0.05). Recovery from neuropsychological disturbances was poorer in patients with ventral frontal lesion and no lesion compared to those with basal forebrain and striate lesions, and their symptoms tended to persist.     

Traumatic delayed intracerebral hematoma--clinical aspects

In order to seek the occasion and the management of traumatic delayed intracerebral hematoma, we selected 17 cases (4.2%) of traumatic delayed intracerebral hematoma (secondary lesion) from 401 cases of head injury, and compared them with other 11 acute traumatic intracranial multiple lesion (immediate lesion). The age ranged from 15 to 78 (except for a newborn hit on the cranium by his mother) and the average was 49 in secondary lesion and 58 in immediate lesion. Sex distribution, 15 males and 2 females in secondary lesion, and 10 males and 1 female in immediate lesion. Though both lesions were supposed to be resulted from almost same severe loads, secondary lesion took worse prognosis than the other: misery outcome (poor and fatal) of secondary lesion was 59% and that of immediate lesion 27%. Of 8 hypertensive cases who were all fatal, 7 were of secondary lesion. Secondary lesion could be expected in only 59% (10/17) by the initial X-CT performed 5.4 +/- 6.2 hr. after trauma. The predicted secondary lesion were classified into three types: salt and pepper like high density lesion (Lanksh's II type), low density lesion (Lanksh's I type) and isodensity mass lesion. The shortest interval between injury and the X-CT detection of secondary lesions was 10 hours and the longest interval was 69 hours (40 hours mean) in conservatively treated patients. In operated patients, the shortest and longest intervals were 8 and 84 hours, respectively (33 hours mean, except for one case who was not examined for 10 days after operation).(ABSTRACT TRUNCATED AT 250 WORDS)     

肩袖间隙分裂症的X线诊断及治疗

目的：肩袖间隙分裂症是肩痛的主要原因之一，诊断较为困难，为提高对本病的认识，讨论诊断和治疗方法。方法：采用肩关节动态造影，注入造影剂后，通过内外旋上肢，改变关节内压力，使分裂的间隙显现。７例肩袖间隙分裂症的患者采用手术直接修复。结果：Ｘ线动态肩关节造影的上肢不同位置，肩关节的内压发生变化，可使分裂处明显显示。手术修复损伤的肩袖间隙，７例患者全部解除疼痛，恢复肩关节功能。结论；Ｘ线动态肩关节造影可明     

Localized fibrocystic disease of the femur: A report of three patients treated by curettage and bone graft

We have presented three cases of fibrocystic disease of the femur. Two of these patients had a purely cystic lesion, while the third had a solid fibrous lesion. In each of the three cases, the lesion described was the only such bone lesion present, and there was no evidence of any endocrine or hormonal disturbance. Although the gross and microscopic appearance of the solid lesion differs from that of the cystic lesion, it is probably true that both have as their pathogenic basis some localized congenital abnormahty in bone development. The clinical picture in both types of fibrocystic disease is very similar, and the surgical treatment in both types is the same. Each of these three patients was treated by curettement of the fibrocystic lesion followed by insertion of multiple bone grafts. This type of operation resulted in complete obliteration of the two purely cystic lesions and almost complete obliteration of the solid lesion.     

Instability of the hindfoot after lesion of the lateral ankle ligaments: investigations of the anterior drawer and adduction maneuvers in autopsy specimens

The mobility patterns in the tibiotalocalcaneal joint complex with a solitary lesion of the anterior talofibular ligament (ATL) and a combined lesion of the ATL and calcaneofibular ligament (CFL) were studied in 22 human lower-extremity autopsy specimens mounted in a kinesiologic testing device. A solitary lesion of the ATL increased the anteroposterior (AP) laxity in the ankle joint in the entire range of flexion, with a maximum median of 3.1 mm in neutral flexion. Further cutting of the CFL increased AP laxity most obviously in dorsiflexion. A solitary lesion of the ATL resulted in a minor instability in adduction, whereas further lesion to the CFL increased adduction in the entire range of flexion, with a maximum median of 14.2 degrees in dorsiflexion. The anterior drawer maneuver can reveal a combined lesion of the ATL and CFL if performed with the tibiotalocalcaneal joint complex in dorsiflexion. Significant clinical instability in adduction will only take place when a combined lesion of the ATL and CFL is present.     

Regeneration of the rat sciatic nerve after different conditioning lesions: effects of the conditioning interval

Regeneration of the rat sciatic nerve was studied after a crush lesion (test lesion) on nerves previously subjected to a conditioning lesion. The test lesion was made approximately 30 mm proximal to the conditioning lesion. The period between the conditioning lesion and the test lesion was varied. Regeneration was measured by the pinch test. The conditioning procedure increased the rate of axonal elongation and decreased the initial delay. Conditioning intervals between 14 hours and 4 days were sufficient to increase the regeneration distance significantly, but only until day 4. If the conditioning interval was prolonged to 7 or 14 days, the conditioning effect persisted until day 6. A conditioning effect also was produced by transection of the sciatic nerve and by local compression produced with a silicone tube. The results of this study demonstrate that the type of injury and the conditioning intervals are important determinants in producing the conditioning effect in the rat.     

Dieulafoy lesion in the ileum of a child: a case report

A 14-year-old girl had massive bleeding from a Dieulafoy lesion of the ileum. A preoperative dynamic computed tomography scan detected the point of bleeding. Selective arteriography with embolization using microcoils could not stop the bleeding, but the microcoils were useful as markers of the location of the bleeding point. The position of the microcoils was confirmed by intraoperative fluoroscopy. A partial resection of the ileum that included the lesion was performed. The pathologic finding was Dieulafoy lesion of the ileum. Dieulafoy lesion is a rare condition that usually presents in the stomach. Dieulafoy lesion of the ileum is extraordinarily rare, and to our knowledge, this is only the second case report of an ileal lesion in a child.     

Evaluation of olfactory ensheathing and schwann cells after implantation into a dorsal injury of adult rat spinal cord

Olfactory ensheathing cells (OECs) and Schwann cells (SCs) obtained from adult transgenic rats expressing alkaline phosphatase (AP) were studied following implantation into intact spinal cord and after dorsal column crush (DCC) injury, either within the lesion or near the lesion borders. We observed no evidence of migration of AP OECs or AP SCs after lesion site injections, with most cells remaining in or nearby the injection/lesion site. Acute injection of either cell type outside of the lesion site resulted in the presence of cells in the lesion even two hours after injection. However, after a 2-week delay between DCC injury and cell injection, only OECs injected 2.5-mm outside of a DCC lesion entered the lesion, while SCs did not pass a region of increased astroglial immunoreactivity. GFAP-immunoreactivity also revealed differences in the astroglial scar at the lesion border with openings apparent in this region only in the OEC group. SCs induced greater ingrowth of CGRP-positive axons within the lesion, two weeks post-injury. Equivalent numbers of GAP-43-positive axons grew within the lesion after SC or OEC implantation. These findings show that, although there is no active migration for either cell type, both OECs and SCs are able to support axonal regrowth and/or sprouting into the lesion. The openings in the astroglial boundary at the lesion site may give OECs a potential advantage over SCs in promoting axonal growth through the astroglial scar.     

Posterior shoulder pain in throwing athletes with a Bennett lesion: factors that influence throwing pain

A Bennett lesion is a bony spur at the posterior glenoid that is often seen in baseball players and usually asymptomatic. However, it sometimes becomes painful, but the mechanism of throwing pain is still unknown. The purposes of this study were to identify clinical characteristics associated with the Bennett lesion causing shoulder pain (painful Bennett lesion) and to try to predict which type of Bennett lesion might become painful. Several clinical factors in 51 consecutive baseball players who underwent arthroscopic surgery were investigated. Of these baseball players, 24 had a bony spur: 13 were diagnosed as having a painful Bennett lesion and 11 were diagnosed as having an asymptomatic Bennett lesion, according to our previously reported criteria. The other 27 players did not have a bony spur. Posterior joint laxity, no deficit of internal rotation, and an avulsed fragment on computed tomography scan were determined to be the characteristic clinical features in the shoulders with a painful Bennett lesion.     

Cyst-like lesions of the lunate resembling Kienböck's disease: a case report

A 33-year-old man presented with a cyst-like lesion of the lunate resembling Kienb?ck's disease. Radiographs showed collapse of the proximal portion of the lunate and a lucent lesion in the triquetrum. T1-weighted magnetic resonance images showed a low signal in the collapsed part of the lunate but not in the remaining area. During surgery the lesion of the triquetrum contained serous fluid and the lunate was partially collapsed. Histologically, the triquetrum consisted of fibrous connective tissue and the lunate consisted of a mixture of bone, cartilage, and fibrous tissue without necrosis. The lunate lesion was diagnosed as a collapsed cyst-like lesion, although radiographs resembled Kienb?ck's disease. The lesion was successfully treated surgically with curettage, bone grafting, and external skeletal fixation. The patient is asymptomatic 3.5 years after surgery with some recovery of the trabecular pattern of the lunate.     

Stimulation of regeneration of the sciatic nerve by experimentally induced inflammation in rats.

The effects of application of a chromic catgut suture (conditioning lesion) placed close to the sciatic or tibial nerves on regeneration of the sciatic nerve after a crush lesion (test lesion), that had been induced after an appropriate conditioning interval (two or four weeks) were assessed. The catgut suture induced an inflammatory reaction around the nerve during the four weeks after application of the catgut suture (conditioning interval) but no signs of degeneration of nerve fibres were seen. There was a significant increase in length of outgrowth of sensory nerve fibres as measured by the pinch reflex test when the test lesion was applied after two and four weeks' exposure to the catgut suture. The rate of regeneration was increased by about 11% when the catgut suture had been applied for four weeks before the test lesion was made. The findings indicate that an inflammatory reaction around a peripheral nerve may act as a conditioning lesion, thereby stimulating regeneration of the nerve.     

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) in the hand

PURPOSE: The purpose of this study was to review our experience with a benign surface bone lesion referred to as bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, named for the pathologist who described it in 1983. The lesion may be confused with a variety of tumors, particularly solitary osteochondromas, which are rare. METHODS: The files in the Department of Pathology at the Hospital for Joint Diseases were reviewed over a 21-year period for all surface bone lesions involving the tubular bones in the hand. There were a total of 10 cases of BPOP compared with only a single case of an osteochondroma. RESULTS: Radiographs generally showed a well-marginated uniformly dense mass arising from the surface of the affected bone without any disruption in its bony architecture. Surgical excision is the definitive treatment and included the fibrous pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and any area of the cortex of the host bone that appeared abnormal. Although in the medical literature the recurrence rate for BPOP is high, we had only one recurrence in our series. CONCLUSIONS: BPOP is a benign surface bone lesion that may be confused with benign and malignant tumors. Although there is a cleavage plane between the lesion and host bone, we recommend excising the pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and decorticating any abnormal-appearing areas in the underlying host bone. This may explain the low recurrence rate in our series.     

Merkel Cell Carcinoma Arising from the Subcutaneous Fat of the Arm with Intact Skin

BACKGROUND: Merkel cell carcinoma is a rare malignant neuroendocrine neoplasm characteristically arising from the dermis of sunlight-exposed skin. It rarely arises outside the skin. OBJECTIVE: We present a patient with primary Merkel cell carcinoma arising from subcutaneous fat, with no involvement of the overlying skin. We describe the clinical manifestations and magnetic resonance imaging (MRI) findings. METHODS: We report a 63-year-old woman with a primary lesion of Merkel cell carcinoma that arose from the subcutaneous fat layer of the left arm. The lesion presented as a subcutaneous nodule with intact overlying skin. MRI showed that the nodular lesion was located entirely in the subcutaneous fat layer, with no involvement of the dermis. Peritumoral infiltration around the lesion and enlarged lymph nodes deep to the lesion were noted. The patient received wide excision of the lesion with dissection of the regional lymph nodes and adjuvant radiotherapy and chemotherapy. RESULTS: Histopathologic examination confirmed the diagnosis of Merkel cell carcinoma with local lymphatic metastasis, and the lesion was completely located in the subcutaneous fat, with no involvement of the dermis. These findings were well correlated with MRI findings. CONCLUSION: Primary Merkel cell carcinoma may arise from the subcutaneous fat and present as an entirely subcutaneous lesion with intact skin. MRI is helpful to evaluate the local extension of the lesion and regional lymphatic metastasis.     

Dieulafoy's lesion of esophagus

Dieulafoy's lesion is a rare arterial malformation that can cause massive gastrointestinal hemorrhage. The lesion occurs most commonly in the proximal stomach. The esophagus is not a common location for this lesion. We present the case of a 25-year-old woman who was admitted to our emergency unit with the findings of hematemesis and melena. Early upper gastrointestinal endoscopic examination revealed a Dieulafoy's lesion, which was located in the distal esophagus. Endoscopic band ligation stopped the bleeding successfully. The patient was discharged 3 days after the band ligation without any complications. Dieulafoy's lesion may cause severe, life-threatening bleeding. Endoscopic diagnosis can be difficult because of the small size and obscure location of the lesion. An abnormally dilated artery that penetrates through the mucosa constitutes the etiology. Endoscopy plays an important role in the diagnosis and treatment of this pathology. Despite widespread awareness of this entity, it may present a real challenge for the endoscopist due to the small size and hidden location of the lesion. The endoscopic approach to occult gastrointestinal bleeding for the diagnosis of vascular malformations is accepted as a quick and safe diagnostic method.     

Anterior shoulder instability with humeral avulsion of the glenohumeral ligament lesion

Humeral avulsion of the glenohumeral ligament (HAGL) is a rare lesion. The purpose of this study was to analyze the clinical manifestations of HAGL lesions in patients who underwent operative treatment for anterior shoulder instability. Six patients with HAGL lesions were studied. Four patients had an HAGL lesion associated with a Bankart lesion, and two had an isolated HAGL lesion. The range of motion at final follow-up showed a loss of 1 degree in forward flexion and of 15 degrees in external rotation. During an operation to treat anterior shoulder instability, a thorough examination for not only Bankart lesions but also other associated lesions, including an HAGL lesion, should be considered to lower the risk of redislocation. In repairing an HAGL lesion, the surgeon should keep in mind the possibility of a postoperative loss of external rotation and follow an active rehabilitation protocol to obtain successful results.     

Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants

The histopathologic diagnosis of primary focal segmental glomerulosclerosis (FSGS) has come to include a number of histologic lesions (variants), but the prognostic significance of these discrete lesions is controversial because published information regarding the presentation, course, and response to treatment is limited. A retrospective analysis was conducted of 87 nephrotic adult patients with biopsy-proven primary FSGS. Patients were categorized on the basis of histologic criteria into those with a classic scar (36 patients), the cellular or collapsing lesion (40 patients), or the tip lesion (11 patients) of FSGS to evaluate differences in presentation, response to therapy, and clinical outcomes. The clinical features at biopsy were similar among the three groups with the exception that patients with the tip lesion were older and patients with the collapsing lesion had more severe proteinuria. Over the course of follow-up, 63% of patients treated attained remission and the response to steroid therapy was similar among the groups (classic scar 53% versus collapsing lesion 64% versus tip lesion 78%; P = 0.45). The overall renal survival was significantly better for patients who entered remission compared with patients who did not enter remission (92% versus 33% at 10 yr; P < 0.0001). The renal survival at 10 yr for patients who entered remission was similar among the three groups (classic scar 100% versus tip lesion 100% versus collapsing lesion 80%; P = 0.61). In patients who did not enter remission, the renal survival at 10 yr was significantly worse for patients with collapsing lesion and tip lesion (classic scar 49% versus tip lesion 25% versus collapsing lesion 21%; P = 0.002). In conclusion, the prognosis for nephrotic FSGS patients who enter remission is excellent regardless of the histologic lesion. Because the remission rate after treatment is similar among patients with the histologic variants, response to therapy cannot be predicted on the basis of histology alone. Thus, nephrotic patients with primary FSGS should receive a trial of therapy irrespective of the histologic lesion when not contraindicated.     

胸腰椎骨纤维结构不良的影像学诊断

[目的]总结胸腰椎骨纤维结构不良的影像学特征,提高对本病的影像学诊断水平。[方法]回顾性分析5例胸腰椎骨纤维结构不良的X线、CT与MR I资料,总结其影像学特征。[结果]胸腰椎骨纤维结构不良X线表现为圆形或椭圆形囊状低密度影,有清晰的硬化带与周围正常骨组织间隔。CT表现为类圆形低密度影,边界清晰,边缘有完整骨质硬化带,骨皮质略微变薄但连续性未有破坏。MR I表现为T1W I中均匀长T1信号,T2W I中病灶呈混杂偏低信号,在T1W I、T2W I及质子像中病灶周围均有较完整的低或极低信号环状带;增强扫描时病灶信号明显强化。[结论]胸腰椎骨纤维结构不良具有独特的影像学特征,完全不同于骨纤维结构不良发生在脊柱以外的影像学表现,掌握这些特征是正确地做出影像学诊断的关键。     

Development of a de novo tumorous necrotic lesion in the liver after transcatheter arterial embolization combined with iodized oil infusion: Report of a case

We report herein the case of a 69-year-old woman in whom a hepatic tumorous necrotic lesion was discovered following transcatheter arterial embolization combined with iodized oil infusion (Lp-TAE) for a hepatoma. The lesion, which had not been evident prior to the Lp-TAE, was resected and analyzed pathologically. The portal area distribution in the necrotic lesion was the same as that in the surrounding hepatic tissue, suggesting that the lesion was derived from the nonneoplastic hepatic tissue. Moreover, extensive wall thickening and obstruction were observed in the intrahepatic portal vein and hepatic artery. These findings suggest that the lesion was a focus of hepatic infarction triggered by Lp-TAE.