Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability

In a prospective study of 65 patients with bile duct obstruction, various radiologic modalities were compared for their capability to demonstrate the level and cause of obstruction and to indicate accurately tumor resectability. Ultrasound (US) was performed in 65 patients, computed tomography (CT) in 51, direct cholangiography (DC) in 57, and angiography in 35. The level of obstruction was correctly indicated by US in 95% of patients and by CT in 90%, and the cause was correctly indicated by US in 88%, by CT in 63%, and by DC in 89%. In predicting tumor resectability, US was correct in 71% of patients, compared with 42% for CT, 58% for DC, and 25% for angiography. US therefore appears to be the single most useful modality in the evaluation bile duct obstruction.     

Effectiveness of methyl-GAG (methylglyoxal-bis[guanylhydrazone]) in patients with advanced malignant lymphoma

We treated 51 patients with advanced malignant lymphoma refractory to conventional therapy with methyl-glyoxal-bis(guanylhydrazone) (methyl- GAG) at doses ranging from 400 to 800 mg/sq m. Therapy was started on a weekly schedule and was switched to every other week in responding patients at the onset of toxicity. Partial responses were observed in 6 of 13 evaluable patients with Hodgkin's disease (46%), 5 of 10 patients with diffuse poorly differentiated lymphocytic lymphoma (50%), 2 of 4 patients with nodular poorly differentiated lymphocytic lymphoma (50%), and 3 of 13 patients with diffuse histiocytic lymphoma (23%). Two of six patients with mycosis fungoides showed objective improvement in cutaneous disease. Toxicity was generally mild and included muscular weakness, myalgia, mucositis, and diarrhea; two patients developed bronchospasm following drug infusions. We conclude that methyl-GAG has major antitumor activity when administered on this schedule to patients with advanced malignant lymphoma. The low degree of toxicity, unique mechanism of action, and minimal myelosuppressive effects suggest that methyl-GAG will prove useful in future trials of combination chemotherapy regimens for the treatment of lymphoma.     

World Workshop on Oral Medicine VI: a systematic review of medication‐induced salivary gland dysfunction

The aim of this paper was to perform a systematic review of the pathogenesis of medication‐induced salivary gland dysfunction (MISGD). Review of the identified papers was based on the standards regarding the methodology for systematic reviews set forth by the World Workshop on Oral Medicine IV and the PRISMA statement. Eligible papers were assessed for both the degree and strength of relevance to the pathogenesis of MISGD as well as on the appropriateness of the study design and sample size. A total of 99 papers were retained for the final analysis. MISGD in human studies was generally reported as xerostomia (the sensation of oral dryness) without measurements of salivary secretion rate. Medications may act on the central nervous system (CNS) and/or at the neuroglandular junction on muscarinic, α‐and β‐adrenergic receptors and certain peptidergic receptors. The types of medications that were most commonly implicated for inducing salivary gland dysfunction were those acting on the nervous, cardiovascular, genitourinary, musculoskeletal, respiratory, and alimentary systems. Although many medications may affect the salivary flow rate and composition, most of the studies considered only xerostomia. Thus, further human studies are necessary to improve our understanding of the association between MISGD and the underlying pathophysiology.     

STRESS FRACTURES OF THE FEMORAL SHAFT IN MILITARY RECRUITS

Stress fractures amongst military recruits are limited to the lower extremities; yet involvement of the shaft of the femur is unusual. Seven such cases in a series of 352 stress fractures are presented. The importance of early recognition and management is emphasized with a view to prevent bony disruption in an otherwise easily treatable condition.KEY WORDS: Fractures stress, Femoral fractures     

Vertebral mineral status: assessment with single- versus multi-section CT

A volumetric approach to quantitative single-energy computed tomography (CT) of the spine for trabecular bone evaluation was compared with the accepted single-section method in 32 thoracic and lumbar vertebral bodies from six cadaveric specimens. Both 5-mm and 10-mm contiguous section sequences afforded greater sample volumes, mean mineral equivalent values, and precision than did the single midplane section technique. These findings can be explained by inhomogeneous trabecular distribution, differential bone resorption rates for various cancellous regions, and nonuniform deposition of marrow fat. Scoliosis may modify the net influence of these factors owing to altered biomechanical forces. Although the single-section method affords optimal sensitivity to early or subtle alterations in vertebral trabecular bone density, it may misrepresent the status of the total cancellous volume. Because three-dimensional histographic analysis includes structurally important peripheral trabeculae in determinations of mean mineral equivalent values, it may more accurately reflect vertebral body strength and risk of compression fracture.     

Sternocostoclavicular hyperostosis: a review and report of 11 cases

Sternocostoclavicular hyperostosis is a benign ossifying diathesis of unknown etiology characterized by hyperostosis and soft-tissue ossification between the clavicles, anterior portion of the upper ribs, and manubrium, with variable hyperostosis or ankylosis in the spine and sacroiliac joints. Our cumulative experience with 11 cases is reported, with emphasis on radiographic features of the condition. Scintigraphic results in five patients and computed tomographic findings in one patient are presented. A review of the literature and our own material indicates that sternocostoclavicular hyperostosis may be more common than has been previously recognized.     

Vertebral-body collapse in focal and diffuse disease: patterns of pathologic processes

The radiographic patterns of vertebral-body collapse and/or endplate deformity were examined in 99 autopsy specimens of the thoracolumbar spine with benign and malignant disease. Angling of endplates was found to be highly predictive of underlying malignancy, whereas concavity was more suggestive of benign disease, for both individual vertebral bodies and intact spines (P less than .001). Diffuse-concave, diffuse-angled, and focal-angled patterns were more useful (P less than .001) than the focal-concave pattern (P = .07) in distinguishing between benign and malignant disease for superior endplates, whereas all were equally useful (P less than .025) in inferior endplates. Condition of the adjacent disks, location within the spine, and position of the apex of collapse were not predictive. Although these results and subsequent blinded testing suggest that reliable distinction between benign and malignant vertebral collapse is possible, extrapolation to clinical practice may be inappropriate because of population bias in the study and differences in radiographic quality between autopsy specimens and live subjects.     

Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment

Sensitivity and specificity of lumbar spine radiography in the assessment of facet joint osteoarthritis were evaluated, with computed tomography (CT) as the standard. Two independent radiologists used a four-point scale to blindly grade facet joint osteoarthritis on oblique radiographs and transaxial CT scans obtained within an 8-month period in 50 consecutive patients with pain in the lower back. The L-3 to L-4, L-4 to L-5, and L-5 to S-1 facet joints were evaluated, and 68% appeared abnormal on CT scans, with 28% exhibiting moderate or severe disease. Interobserver agreement was high for conventional radiography (perfect agreement in 57% and agreement to within one grade in 39%) and still higher for CT (perfect in 63% and to within one grade in 35%). Receiver operating characteristic curve analysis indicated that oblique radiography was most accurate (55% sensitivity, 69% specificity) in distinguishing the presence from the absence of disease; in distinguishing absent or mild from moderate or severe disease, the specificity of oblique radiography was higher, at 94%, but its sensitivity was much lower, at 23%. Conventional radiography is a useful technique in screening for facet joint osteoarthritis but is insensitive compared with CT.