Early diagnosis of stress fracture of the lumbar spine in athletes

Thirty-three athletes complaining of back pain of more than 1 months’ duration and with normal radiography of the lower spine were all studied by scintigraphy and in 24 of them with single photon emission computerized tomography. A stress fracture was considered present if localized increased uptake was seen at a vertebral level. Scintigraphy showed increased uptake in 17 of 33 patients and single photon emission computerized tomography in 16 of 24 patients.

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Résumé 33 athlèes se plaignant de lombalgies depuis plus d’un mois avec des radiographies normales de la colonne lombaire ont étéétudiés. Tous ont eu une scintigraphie, et 24 un scanner. A été retenu comme signe de fracture de fatigue, l’existence d’une augmentation de densitéà un niveau vertébral. La scintigraphie montrait une telle augmentation chez 17 des 33 patients et le scanner chez 16 des 24 patients. On conclut que même si la scintigraphie est normale, on ne peut pas rejeter le diagnostic de fracture de fatigue.

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Accepted: 22 October 1997     

The prognostic significance of DNA cytophotometry and proliferation index (Ki-67) in giant cell tumors of bone

We studied DNA ploidy by smear cytophotometry and proliferation activity by Ki-67 MIB immunohistochemistry in 69 primary and recurrent giant cell tumors (GCT) from 50 randomly selected patients. The obtained results were evaluated with comparisons made to the available clinical data. From the 46 primary tumors 63% showed diploidy and 37% aneuploidy. A significantly (P=0.026) higher recurrence rate (64%) was observed in aneuploid than in diploid tumors (31%). In the course of the recurrences, both the ratio of aneuploid tumors as well as the proliferation index of the tumors increased, though the degree of the latter was non-significant. Aneuploidy did not mean an unambiguous tendency towards malignant transformation; however, a close follow-up of recurrent aneuploid tumors, and wide excision of the recurrence instead of intralesional curettage are the recommended procedures. The DNA cytophotometry and proliferation index of GCTs – as compared to other histologic examinations – are of prognostic value in the evaluation of the recurrence potential of the GCTs.

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Résumé  Les auteurs ont examiné 1’anomalie chromosomique de DNA á 1’aide de cytophotometrie de frottis; et 1’activité de proliferation par le moyen de 1’immuno- histochimie Ki-67 MIB dans 69 tumeurs de cellules géantes de 50 patients choisis accidentellement. lls ont évalué les résultats en les comparant aux données cliniques disponibles. Parmi les 46 tumeurs primaires 63% ont manifesté un caractère diploide et 37% un caractère aneuploide. On a observé une proportion de recidive significativement plus élevée (P=0.026) dans les tumeurs aneuploides (64%) que dans les tumeurs diploides (31%). Au cours des récidives on a remarquè une augmentation tant dans la proportion des tumeurs aneuploides que dans 1’indice de proliferation mais en ce dernier 1’augmentation n’était pas significative. Le caractère aneuploide ne signifie pas forcément une tendance univoque á la transformation maligne cependant dans les tumeurs aneuploides récidivantes il est nécessaire de suivre la maladie avec beaucoup de soin et comme intervention chirurgicale on conseille une excision large au lieu du curettage intralésionel.

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Accepted: 20 October1999     

Intradural cervical chordoma. Case report

We describe a rare case of an intradural spinal chordoma. Only two cases have been previously reported and it is the second case diagnosed with MRI. A 65-year-old man presented with progressive disturbance of gait and weakness in the lower extremities. MRI revealed a intradural C6-C7 isointense mass, on T1- and T2-weighted images. The lesion enhanced after injection of gadolinium. The lesion was totally removed without difficulty by a C6-D1 laminectomy. Microscopic examination of the tumor revealed a chordoma. This is the third case in the literature of an intradural spinal chordoma. The appearance of this tumor with MRI may be similar to the chordomas of other locations.     

Meckel's diverticulum: ten years experience

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of MD cases are asymptomatic although they can, occasionally, cause complications such as bleeding, intestinal obstruction and/or inflammatory process. The diagnosis is difficult and it is usually made at surgery. The treatment of choice in the patients with symptomatic MD is surgical resection while difference of opinion there are about the treatment of asymptomatic MD. The present study concerns 9 cases of MD, 7 symptomatic and 2 incidentally found during surgical abdominal operations. Six patients was males and 3 females with 2:1 male: female ratio. The mean age was 14.7 years. The most common complication was the diverticulitis with the perforation of MD in 1 patient. All patients, symptomatic and asymptomatic, was operated. The diverticulectomy was made in 7 patients while in 2 cases we had to perform an intestinal resection. There was not operative mortality, while there were 2 cases of postoperative complications which occurred only in the patients with symptomatic MD. The Authors believe that there is no factor predictive of the development of diverticular complications. They recommend, in light of the low postoperative mortality and morbidity, the surgical treatment also in the cases of asymptomatic MD, in the absence of absolute contraindications.