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Objective: To test the anecdotal observation that isolated navicular collapse is associated with diabetes mellitus, we quantified the size of the tarsal navicular bone in subjects with and without diabetes and tested for association of size with age, height, weight, body mass index (BMI), gender, smoking, bone mineral density (BMD), duration, and level of control of diabetes. Materials and Methods: Ankle radiographs of 200 patients (122 female; 78 male; mean age 58 years [27-89]), 100 with type II diabetes and 100 age- and gender-matched controls were selected and reviewed. The anteroposterior (AP) dimension of the mid-navicular bone was measured from lateral radiographs. For standardization, the supero-inferior (SI) dimension of the calcaneal was measured and the navicular-calcaneus ratio calculated. Statistical evaluation included independent sample t tests and linear regression analyses. Results: Diabetic subjects had a significantly smaller navicular AP dimension and navicular-calcaneus ratio compared with controls ( p = 0.02 and p = 0.0001 respectively). Age, gender, height and duration of diabetes had no association with the navicular-calcaneus ratio. The navicular-calcaneus ratio was inversely correlated with weight ( p = 0.01) and BMI ( p < 0.001) and directly correlated with smoking ( p = 0.04). Reliability of the radiographic measurements was excellent (ICC 0.80-0.97; SEM 0.3-1.7 mm). Conclusion: The anteroposterior dimension of the navicular is smaller in type II diabetic subjects than in age- and gender-matched controls. We hypothesize that this might be due to navicular collapse of multifactorial causes. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of the hip (DDH) is associated with chronic pain and limping which especially has a negative impact on the patients’ daily activities, body image, and self‑esteem. Although total hip arthroplasty remains the first choice for treatment of DDH in adults, minimally invasive alternative approaches are being increasingly favored both by the surgeon and the patients with severe DDH. This study aimed to evaluate the outcome of these patients treated with a mono‑lateral external fixator‑based tibial lengthening procedure. Materials and Methods: During the period of month between June 1999 and January 2006, 13 (mean ages 20.8 years) adult patients with unilateral Crowe type‑IV DDH were treated by tibial lengthening using a mono‑lateral external fixator over an intramedullary nail. Bone healing, infection, gait correction and improvement in body image were assessed during postoperative followup. Patients’ overall health status at the end of followup was assessed using the short form‑36 (SF‑36) health survey. Results: Patients were followed up for an average of 7.3 years. Successful bone healing was observed in all 13 patients and no further surgeries were indicated. A mean external fixation index of 12.4 days/cm was achieved. Bone formation fell in good to excellent categories with a mean consolidation index of 50.1 days/cm. Pin‑tract infections were observed in two patients. The degree of limping was reduced from severe or moderate preoperatively to mild postoperatively. Neither equinus deformity nor painful degenerative osteoarthritis and hip dysfunction were observed in any of the patients studied. The SF‑36 questionnaire survey showed that all patients were satisfied with their outcomes. Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type‑IV DDH. Mono‑lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator‑related complications. [ABSTRACT FROM AUTHOR]

Background. The incidence of infantile Blount disease is rising in parallel to the increasing obesity in children. Material and methods. Seven children (3 female) between the ages of 17 and 30 months (21.8 ± 4.3 months) were included in the study. Results. All patients had complaints of inward bowing of the legs and excess weight gain. The biochemical and hormonal assessments of all patients yielded normal results. Patients were diagnosed with infantile Blount disease based on clinical, laboratory, and radiological findings. Conclusion. This disease should be differentiated from physiological genu varum, and the potential psychosocial and physical complications are prevented with early diagnosis and treatment. [ABSTRACT FROM PUBLISHER]

Currently, radiography is the only imaging technique used to diagnose bone pathology in wild animals situated under “field conditions”. Nevertheless, while chronic foot disease in captive mega-herbivores is widely reported, foot radiographic imaging is confronted with scarcity of studies. Numerous hindrances lead to such limited numbers and it became very clear that the traditional perspective on bone imaging in domestic animals based on extensive studies and elaborated statistical evaluations cannot be extrapolated to their non-domestic relatives. For these reasons, the authors initiated a multi-modality imaging study and established a pioneering approach of synchronized computed tomography (CT) and digital radiography (DR), based on X-ray projections derived from three-dimensional CT reconstructed images. Whereas this approach can be applied in any clinical field, as a case of outstanding importance and great concern for zoological institutions, we selected foot bone pathologies in captive rhinoceroses to demonstrate the manifold applications of the method. Several advances were achieved, endowing the wildlife clinician with all-important tools: prototype DR exposure protocols and a modus operandi for foot positioning, advancing both traditional projections and, for the first-time, species-related radiographic views; assessment of radiographic diagnostic value for the whole foot and, in premiere, for each autopodial bone; together with additional insights into radiographic appearance of bone anatomy and pathology with a unique, simultaneous CT-DR correlation. Based on its main advantages in availing a wide range of keystone data in wildlife imaging from a limited number of examined subjects and combining advantages of CT as the golden standard method for bone diseases' diagnostic with DR's clinical feasibility under field conditions, synchronized CT-DR presents a new perspective on wildlife's health management. With this we hope to provide veterinary clinicians with concrete imaging techniques and substantial diagnostic tools, which facilitate straightforward attainment and interpretation of field radiography images taken worldwide. [ABSTRACT FROM AUTHOR]

Background/Aim. Autogenous bone grafting has been the gold standard in clinical cases when bone grafts are required for bone defects in dentistry. The study was undertaken to evaluate multilevel designed carbonated hydroxyapatite (CHA) obtained by hydrothermal method, as a bone substitute in healing bone defects with or without corticosteroid treatment in rats as assessed by histo-pathologic methods. Methods. Bone defects were created in the alveolar bone by teeth extraction in 12 rats. The animals were initially divided into two groups. The experimental group was pretreated with corticosteroids: methylprednisolone and dexamethasone, intramuscularly, while the control group was without therapy. Posterior teeth extraction had been performed after the corticosteroid therapy. The extraction defects were fulfilled with hydroxyapatite with bimodal particle sizes in the range of 50250 µm and the sample from postextocactional defect of the alveolar bone was analyzed pathohystologically. Results. The histopatological investigations confirmed the biologic properties of the applied material. The evident growth of new bone in the alveolar ridge was clearly noticed in both groups of rats. Carbonated HA obtained by hydrothermal method promoted bone formation in the preformed defects, confirming its efficacy for usage in bone defects. Complete resorption of the material's particles took place after 25 weeks. Conclusion. Hydroxyapatite completely meets the clinical requirements for a bone substitute material. Due to its microstructure, complete resorption took place during the observation period of the study. Corticosteroid treatment did not significantly affect new bone formation in the region of postextractional defects. [ABSTRACT FROM AUTHOR]

Objective: To identify and investigate the susceptibility genes of Kashin–Beck disease (KBD) in Chinese population. Methods: Whole-exome capturing and sequencing technology was used for the detection of genetic variations in 19 individuals from six families with high incidence of KBD. A total of 44 polymorphisms from 41 genes were genotyped from a total of 144 cases and 144 controls by using MassARRAY under the standard protocol from Sequenom. Association was applied on the data by using PLINK1.07. Results: In the sequencing stage, each sample showed approximately 70-fold coverage, thus covering more than 99% of the target regions. Among the single nucleotide polymorphisms (SNPs) used in the transmission disequilibrium test, 108 had a p-value of <0.01, whereas 1056 had a p-value of <0.05. Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway analysis indicates that these SNPs focus on three major pathways: regulation of actin cytoskeleton, focal adhesion, and metabolic pathways. In the validation stage, single locus effects revealed that two of these polymorphisms (rs7745040 and rs9275295) in the human leukocyte antigen (HLA)-DRB1 gene and one polymorphism (rs9473132) in CD2-associated protein (CD2AP) gene have a significant statistical association with KBD. Conclusions: HLA-DRB1 and CD2AP gene were identified to be among the susceptibility genes of KBD, thus supporting the role of the autoimmune response in KBD and the possibility of shared etiology between osteoarthritis, rheumatoid arthritis, and KBD. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to investigate the characteristics of power Doppler (PD) subclinical synovitis in patients with RA who achieve clinical remission free from physical synovitis.Methods. Twenty-nine RA patients were consecutively enrolled. All of the patients had achieved clinical remission [simplified disease activity index (SDAI) 3.3] for at least 6 months at the musculoskeletal ultrasound (MSKUS) examination. Additionally, none of the patients exhibited tender joints at 68 sites or swollen joints at 66 sites. MSKUS of bilateral wrist and finger joints, including the first to fifth MCP joints, the first IP joint and the second to fifth PIP joints, was performed and the findings obtained by grey scale (GS) and PD were graded on a semi-quantitative scale from 0 to 3.Results. The median disease duration upon the introduction of DMARDs was 3 months and that at MSKUS examination was 21 months. The percentages of patients with PD synovitis in at least one joint were PD grade 1, 58.6%; PD grade 2, 31.0% and PD grade 3, 6.9%. The use of biological agents was low in patients with PD synovitis grade 2 (P < 0.05). The presence of US bone erosion was high by patient (P < 0.05) and by joint (P < 0.0001) with PD synovitis as compared with those without PD synovitis. However, no correlations were found between PD synovitis measures and serum biomarkers, including angiogenesis factors.Conclusion. PD subclinical synovitis correlates with several clinical characteristics, whereas conventional serum biomarkers are not useful for indicating the presence of subclinical PD synovitis. [ABSTRACT FROM AUTHOR]

Purpose: To differentiate between the MRI findings for benign bone lesion and metastasis detected by breast MRI in patients with breast cancer and to evaluate the conspicuity of bone lesions according to MR sequences. Materials and Methods: In 14 patients with 15 bone lesions, the MRI fin dings were statistically analyzed to differentiate between benign bone lesion and metastasis. We considered margin, signal intensity on T2-weighted image (T2WI) with spectral attenuated inversion recovery (SPAIR), enhancement, and patterns of bone lesions (focal mass, diffuse infiltration, and extraosseous soft tissue change), as well as the conspicuity of bone lesions in each MR sequence. Results: There was a statistically significant difference in the frequency of a solitary focal mass pattern between benign bone lesion and metastasis (p=0.044). The margin, signal intensity on T2WI with SPAIR, and enhancement were not significantly different between benign bone lesion and metastasis. Both T2WI with SPAIR and delayed phase of contrast enhanced MRI were superior to other sequences in terms of lesion conspicuity. Conclusion: A solitary focal mass pattern indicates a high probability of benign bone lesion on breast MRI in patients with breast cancer. Bone lesions tend to have greater conspicuity on T2WI with SPAIR and delayed phase image of contrast enhanced MRI, compared to results for other MR sequences. [ABSTRACT FROM AUTHOR]

Context In health professions education, tests have traditionally been used to assess the skills and knowledge of learners. More recently, research in psychology and education has shown that tests can also be used to enhance student memory; a phenomenon called the 'testing effect'. Much of the research in this domain has focused on enhancing rote memory of simple facts, and not on the deeper comprehension and application of complex theoretical knowledge necessary to diagnose and manage patients. The purpose of this study was to examine the effects of testing on students' comprehension of the basic science mechanisms and diagnostic accuracy. Methods Undergraduate dental and dental hygiene students ( n = 112) were taught the radiographic features and pathophysiology underlying four intrabony abnormalities. Participants were divided into two groups: the test-enhanced ( TE) condition and the study ( ST) condition. Following the learning phase, the TE condition group completed an interventional test that tested the basic science mechanisms and the ST condition group was given additional study passages without being tested. Participants in both groups then completed a diagnostic test and a memory test immediately after the learning phase and 1 week later. Results A main effect of testing condition was found. The participants in the TE condition group outperformed those in the ST condition group on immediate and delayed testing. Unlike the diagnostic test, the memory test showed no difference between the groups. Conclusion The inclusion of the basic science test appears to have improved the students' understanding of the underlying disease mechanisms learned and also improved their performance on a test of diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Besides the overall mass density, strength of trabecular bone depends significantly on its microstructure. However, due to dose constraints in medical CT imaging, it is impossible to gain sufficient information about very fine bone structures in vivo on the micrometer scale. Here we show that a recently developed method of X-ray vector radiography (XVR), an imaging method which uses X-ray scattering information to form an image, allows predictions on the bone microstructure without the explicit need to spatially resolve even individual trabeculae in the bone. We investigated thick human femoral bone samples and compared state-of-the-art μCT data with XVR imaging. A model is presented which proves that XVR imaging yields information directly correlated with the trabecular microstructure. This opens up possibilities of usingXVR as a tool to help early diagnosis of bone diseases, such as osteoporosis. [ABSTRACT FROM AUTHOR]

The article presents research which determines the independent predictors of total hip replacement in patients with systemic lupus erythematosus (SLE) and symptomatic osteonecrosis (ON) in Korea. Results of the study show the independent risk factors for symptomatic ON in SLE patients including the administration of immunodepressants and Cushingoid body habitus. The likeliness of the patients to undergo total hip replacement following their ON diagnosis is also noted.

A letter to the editor is presented about the role of histopathology in diagnosing osteomyelitis in the feet of patients with diabetes.

Abstract: Purpose: To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). Materials and methods: A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50–81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120kV; tube current time product 40mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2mSv. Every patient gave personal informed consent, as required by our institution guidelines. Results: The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. Conclusion: WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients. [Copyright &y& Elsevier]

Abstract: Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss. [Copyright &y& Elsevier]

Background: Open Bone Measurement (OBM) and Bone Sounding (BS) are most reliable but invasive clinical methods for Alveolar Bone Level (ABL) assessment, causing discomfort to the patient. Routinely, IOPAs & OPGs are the commonest radiographic techniques used, which tend to underestimate bone loss and obscure buccal/lingual defects. Novel technique like dentascan (CBCT) eliminates this limitation by giving images in 3 planes – sagittal, coronal and axial. Aim: To compare & correlate non-invasive 3D radiographic technique of Dentascan with BS & OBM, and IOPA and OPG, in assessing the ABL. Settings and Design: Cross-sectional diagnostic study. Material and Methods: Two hundred and five sites were subjected to clinical and radiographic diagnostic techniques. Relative distance between the alveolar bone crest and reference wire was measured. All the measurements were compared and tested against the OBM. Statistical Analysis: Student’s t-test, ANOVA, Pearson correlation coefficient. Results: There is statistically significant difference between dentascan and OBM, only BS showed agreement with OBM (p < 0.05). Dentascan weakly correlated with OBM & BS lingually.Rest all techniques showed statistically significant difference between them (p= 0.00). Conclusion: Within the limitations of this study, only BS seems to be comparable with OBM with no superior result of Dentascan over the conventional techniques, except for lingual measurements. [ABSTRACT FROM AUTHOR]

Abstract: Sonography has been used successfully to evaluate a number of musculoskeletal disorders. The method is operator dependent and familiarity with sonographic pitfalls greatly improves diagnostic accuracy and helps to optimize management. In this article, we discuss ten common pitfalls which can become a source of confusion and misdiagnosis in musculoskeletal sonography. [Copyright &y& Elsevier]

F-fluoride positron emission tomography (F-PET) allows the assessment of regional bone formation and could have a role in the diagnosis of adynamic bone disease (ABD) in patients with chronic kidney disease (CKD). The purpose of this study was to examine bone formation at multiple sites of the skeleton in hemodialysis patients (CKD5D) and assess the correlation with bone biopsy. Seven CKD5D patients with suspected ABD and 12 osteoporotic postmenopausal women underwent an F-PET scan, and bone plasma clearance, K, was measured at ten skeletal regions of interest (ROI). Fifteen subjects had a transiliac bone biopsy following double tetracycline labeling. Two CKD5D patients had ABD confirmed by biopsy. There was significant heterogeneity in K between skeletal sites, ranging from 0.008 at the forearm to 0.028 mL/min/mL at the spine in the CKD5D group. There were no significant differences in K between the two study groups or between the two subjects with ABD and the other CKD5D subjects at any skeletal ROI. Five biopsies from the CKD5D patients had single tetracycline labels only, including the two with ABD. Using an imputed value of 0.3 μm/day for mineral apposition rate (MAR) for biopsies with single labels, no significant correlations were observed between lumbar spine K corrected for BMAD ( K) and bone formation rate (BFR/BS), or MAR. When biopsies with single labels were excluded, a significant correlation was observed between K and MAR ( r = 0.81, p = 0.008) but not BFR/BS. Further studies are required to establish the sensitivity of F-PET as a diagnostic tool for identifying CKD patients with ABD. [ABSTRACT FROM AUTHOR]

Highlights: [•] Bone turnover was detected in epilepsy patients treated with oxcarbazepine or valproate. [•] Oxcarbazepine treatment led to an increase of bone turnover markers within 2 weeks. [•] Valproate-induced alterations occurred later and less pronounced. [•] Distinct mechanisms of increased bone turnover may require individual treatment. [Copyright &y& Elsevier]

Eosinophilic necrotizing granulomas in the liver, known as visceral larva migrans (VLM), are a rare cause of liver abscesses. The term VLM refers to infections in human tissues caused by the larval stages of ascarid worms of dogs and cats. We report two cases of VLM which presented with high grade fever and abdominal pain for 3-4 months. Marked peripheral eosinophilia, multiple confluent perivenous lesions in the right lobe of liver with characteristic migratory tracts on imaging and biopsy evidence of necrotizing eosinophilic granulomas led to the diagnosis. Complete recovery was achieved with repeated courses of a combination of anthelmintics. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hallux valgus is a common but aetiologically not perfectly understood condition. Imaging in hallux valgus is based on weight bearing plain radiographs or in exceptional cases on non-weight bearing computerized tomography (CT)-studies. Methods: A portable extremity CT was used to study the forefoot with focus on first metatarsal bone in ten hallux valgus patients and five asymptomatic controls at rest and at weight bearing. Two-dimensional (2D) or three-dimensional (3D) hallux valgus angles, intermetatarsal angles and various other parameters were measured on CT data and the measurements between study groups were compared. The measured angles were also compared to angles measured on plain radiographs. Results: 2D or 3D angles from CT data sets can be used to evaluate hallux valgus. In hallux valgus, when compared with normal asymptomatic foot, the first metatarsal bone is medially deviated (intermetatarsal angle is wider), the width of the forefoot is increased and the proximal phalanx pronates. Between the study groups there was a statistically significant difference of the measured 3D hallux valgus angles at weight bearing but not at rest suggesting the importance of weight bearing CT studies when evaluating hallux valgus. Conclusions: To our knowledge, this is the first time weight bearing CT data is presented when evaluating hallux valgus, offering a true alternative to plain radiographs. The relationships of bones of the forefoot, including rotational changes, can be reliably measured using this imaging method. [Copyright &y& Elsevier]

Primary bone lymphangiomatosis is a disease of unknown etiology that can cause lytic lesions in long bones, the pelvis, the spinal column and the cranium. We are presenting the case of a woman with localized bone lymphangiomatosis in the left knee. The authors believe this is the first case in which percutaneous osteoplasty was used in long bones for the treatment of bone lesions resulting from this disease showing good clinical results. [ABSTRACT FROM AUTHOR]

Abstract: Traditional arthroscopic examination is subjective and poorly reproducible. Recently, we introduced an arthroscopic ultrasound method for quantitative diagnostics of cartilage lesions. Here we describe our investigation of the feasibility of ultrasound arthroscopy for simultaneous measurements of articular cartilage and subchondral bone. Human osteochondral samples (n = 13) were imaged using a clinical 9-MHz ultrasound system. Ultrasound reflection coefficients (R, IRC), the ultrasound roughness index (URI) and the apparent integrated backscattering coefficient (AIB) were determined for both tissues. Mechanical testing, histologic analyses and micro-scale computed tomography imaging were the reference methods. Ultrasound arthroscopies were conducted on two patients. The ultrasound reflection coefficient correlated with the Mankin score and Young's modulus of cartilage (|r| > 0.56, p < 0.05). Ultrasound parameters (R, IRC, AIB) for subchondral bone correlated with the bone surface/volume ratio (|r| > 0.70, p < 0.05) and trabecular thickness (|r| > 0.59, p < 0.05). Furthermore, R and subchondral bone mineral density were significantly correlated (|r| > 0.65, p < 0.05). Arthroscopic ultrasound examination provided diagnostically valuable information on cartilage and subchondral bone in vivo. [Copyright &y& Elsevier]

Extraction of bone contours from radiographs plays an important role in disease diagnosis, preoperative planning, and treatment analysis. We present a fully automatic method to accurately segment the proximal femur in anteroposterior pelvic radiographs. A number of candidate positions are produced by a global search with a detector. Each is then refined using a statistical shape model together with local detectors for each model point. Both global and local models use Random Forest regression to vote for the optimal positions, leading to robust and accurate results. The performance of the system is evaluated using a set of 839 images of mixed quality. We show that the local search significantly outperforms a range of alternative matching techniques, and that the fully automated system is able to achieve a mean point-to-curve error of less than 0.9 mm for 99% of all 839 images. To the best of our knowledge, this is the most accurate automatic method for segmenting the proximal femur in radiographs yet reported. [ABSTRACT FROM AUTHOR]

The article discusses the use of the combination of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and 18F-fluoride PET to detect metastatic bone disease. A study found that the combined diagnostic procedures were more accurate than 18F-FDG PET/computed tomography alone. Results also demonstrated the high sensitivity of 18F-fluoride PET for osteoblastic lesions.

A 44-year-old man with well-controlled HIV presented with low-grade fever, pharyngitis, frontal headache, abdominal and shin pain, and abnormal liver function tests 8 weeks after switching from zidovudine to abacavir (while continuing nevirapine and lamivudine). An abacavir reaction was the working diagnosis and thus his antiretroviral regimen was returned to the previously tolerated combination and he received 10 days of oral penicillin (500mg twice daily) for presumptive tonsillitis with significant improvement. A whole-body bone scan demonstrated multiple foci of increased patchy osteoblastic activity of the long bones and skull. Six months later during routine screening, a syphilis rapid plasma reagin (RPR) titre of 128 was detected. Retrospective testing on stored samples demonstrated a first positive RPR at the time of symptomatic presentation. He received three injections of 1.8 g benzathine penicillin on a weekly basis with a subsequent decrease in RPR titre and normalisation of the bone scan. Although syphilitic osteitis is rare, this case reemphasises the importance of considering syphilis when HIV-infected patients present with unusual symptoms. The use of bone scan in this setting and treatment options are discussed. [ABSTRACT FROM AUTHOR]

Intraosseal epithelial cysts in the hand are rare. In a typical clinical scenario the patient presents with progressive pain and tenderness of the affected area. Radiologically they present as a unilocular well-defined osteolytic lesion with thinned or severed cortex on radiographs. When diagnosed correctly, treatment -- surgical excochleation -- is usually straightforward and successful. However, differential diagnosis of these lesions may be difficult, as they can mimic a number of conditions. Radiological imaging (radiographs, MRI, ultrasound), laboratory findings, fine needle aspiration cytology, histology samples, intra-operative swabs may be useful in establishing a correct diagnosis. In this paper we would like to give an overview of the literature on intraosseal epithelial cysts of the hand and report the case of a 63 year old male patient with an epithelial cyst in the thumb. The patient presented with progressive pain and tenderness of the distal phalanx of the right thumb. Based on clinical symptoms and radiological findings initial diagnosis was chronic osteomyelitis. During surgical exploration, the lesion was not typical of osteomyelitis, so both swabs and histology samples were taken. The patient made an uneventful recovery. The histology report found the sample to contain squamous epithelial cells with no sign of malignancy, and discreet signs of chronic inflammation, it was diagnosed as non-malignant keratinocyte proliferation. We conclude, that with a high level of suspicion under the appropriate clinical circumstances, and the suitable application of the appropriate diagnostic tools, epithelial cysts may be treated with a high level of success, if the diagnosis is established. [ABSTRACT FROM AUTHOR]

This systematic review of studies compared magnetic resonance imaging ( MRI), 18 F-fluorodeoxyglucose positron emission tomography ( FDG- PET), FDG- PET with computerized tomography ( PET- CT) and CT with whole body X-Ray ( WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies ( QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12-1·82) CT (1·04-1·33), PET (1·00-1·58) and PET- CT (1·27-1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity . This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed. [ABSTRACT FROM AUTHOR]

Introduction Bone marrow ( BM) assessment is an important aspect of paediatric MRI, with the marrow cavity visible on almost every clinical MR examination. In practice, however, assessment for marrow infiltration in paediatric patients can be challenging. Our aim was to review the MRI appearance of normal BM from 0 to 5 years. Methods Consecutive body MR examinations over 7 years were retrospectively reviewed in patients aged 0-5 years. Patients with anticipated BM abnormality were excluded. All patients had imaging of the spine and/or pelvis with T1-weighted ( T1) ± T2 with fat saturation, post-contrast T1-weighted, diffusion-weighted or out-of-phase sequences. Results Nineteen patients were included: nine (47%) infants, 11 (58%) boys, mean age 18.2 months (range 1 day to 3 years and 10 months). On T1 imaging, 69% infant marrow sites and 24% in children >1 year were isointense, the remainder were hyperintense. One hundred per cent BM was T2 fat saturation hyperintense. Enhancement following contrast was seen in 16% of BM sites. Restricted diffusion was seen in 100% infant BM and 50% BM in children >1 year. On out-of-phase imaging, no signal loss was seen in infants, and 21% BM in children >1 year showed signal loss. Conclusion Due to normal age-related differences in BM histology, MRI for marrow assessment in infants and young children can be misleading and may mimic marrow infiltration. [ABSTRACT FROM AUTHOR]

Bhan et al discovered low rates of testing and treatment for mineral and bone disorders in patients with chronic kidney disease (CKD) in the primary care setting. In this study, bisphosphonates were prescribed more frequently than vitamin D as treatment for CKD mineral and bone disorders. Bhan's study concluded that a lack of knowledge exists about the treatment of metabolic mineral and bone disorders related to chronic kidney failure. The purpose of this article is to increase awareness about the appropriate treatment of metabolic mineral and bone disorders related to CKD. [ABSTRACT FROM AUTHOR]

Abstract: Eosinophilic granuloma (EG) is a benign, self-limiting disorder that usually involves a single bone. However, there is a growing evidence that the clinical picture of EG is protean. We report two cases with EG that showed rare presentations. Case 1: A 14-year-old girl complained of headache in the left parietal region for several days. The initial examination was normal. During the next three weeks, her headache was progressive and she noticed a tender swelling on her head. Cranial computed tomography (CT) revealed an osteolytic lesion on the left parietal bone. On magnetic resonance imaging (MRI), the lesion corresponded to a tumor that arose from the intradiploic region, and showed both extracranial and epidural extension. She underwent tumor resection and a diagnosis of EG was made on pathological examination. An immunohistochemical study with Ki-67 suggested accelerated growth of the tumor cells. Case 2: A 1.9-year-old boy suddenly complained of a pain in the back and soon had difficulty in walking without help. Several days later, he became unable to sit or walk. On examination, he had spastic paraplegia in addition to painful swelling on the back. A myelogram showed a block just below the T2 vertebra. Chest CT scanning disclosed that a tumor lying posterior to the T2 vertebra was causing marked cord compression and destruction of the posterior elements of the spine. The tumor extended at T1–T3 vertebral levels. He underwent tumor resection and recovered neurological ability. EG should be considered as a differential diagnosis for patients with osteolytic lesions who exhibit aggressive clinical features. [Copyright &y& Elsevier]

Summary: Cherubism is a rare and benign bone disease affecting the bones of the face, mainly the mandible, sometimes the maxilla and exceptionally the whole skeleton. The physiopathology is briefly mentioned, especially the genetic aspect of the disease. Subsequently, we present the case of a patient suffering from cherubism, a case we have been following from the age of four and a half to the age of 22. Each step of the surgical treatment is illustrated through a wide iconography. The discussion analyses the intellectual process that leads to diagnosis. The clinical examination is fundamental, as well as the radiological check-up but the latter may not be feasible due to the young age of the patient. The definite diagnosis relies on the histological examination of the bone concerned. It will show an association of dense, abundant and highly vascularised conjunctive tissue together with giant plurinuclear cells, without any mitosis nor any cellular atypia. The other bone diseases affecting the bones of the face will have to be sought, of course, and eliminated through the clinical and radiological examinations and, above all, by the histological examination which is the basis of the definite diagnosis. The treatment of cherubism is still a controversial issue: some authors are in favour of therapeutic abstention while others support the recourse to surgery to deal with the functional and aesthetic dimensions of the disease. In conclusion, the authors insist that the diagnosis of cherubism is apparently easy. Cherubism must be envisaged in the case of a chubby-cheeked child and a sample of pathological bone should be taken in order to ascertain the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Uncommonly, Klippel–Feil syndrome (KFS) has been associated with intracranial or spinal tumors, most frequently dermoid or epidermoid cysts. Although the associated dermoid cyst (DC) is usually located in the posterior fossa, isolated upper cervical DC has been reported. Extension from the posterior fossa to the upper cervical spine (C2) has been reported once. We report a rare case of KFS in association with a posterior fossa DC that extended down to the upper thoracic spine and review the current literature. Case Description: A 47-year-old female with presented cervical myelopathy related to a cranio-cervico-thoracic DC in association with KPS-related cervicothoracic fusion (C2-T6) and thoracic kyphosis. The patient underwent complete tumor resection following sub-occipital craniectomy and C1-C4 cervical laminectomy. The patient exhibited complete resolution of symptoms with no tumor recurrence and no deformity at 6-year follow-up. Conclusion: DC should be added to the list of congenital central nervous system abnormalities, which should be sought in patients with KFS. Therefore, the presence of a cystic lesion in the posterior fossa, the craniocervical junction or the anterior cervical spine should suggest the possibility of a DC in patients with KFS. In cases of cranio-cervical DC, the tumor may extend quite far down the spinal column (reaching the thoracic spine), as demonstrated in the present case. [ABSTRACT FROM AUTHOR]

Trevor's disease, an intra-articular variant of osteochondroma, has been reported previously in various unusual forms. The present article describes acutely presenting, intra-articular kissing lesions in a 4-year-old girl. A high index of suspicion and elaborate awareness on the part of the treating surgeon are essential to diagnose as well as manage such cases. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the utility of sequentially acquired, post hoc fused, magnetic resonance imaging (MRI) and multi-pinhole single photon emission computed tomography (MPH-SPECT) with technetium-99m-labeled disphosphonates (Tc99m-DPD) for the identification of finger joints with later erosive progression in early rheumatoid arthritis (ERA) patients. Methods: Ten consecutive ERA patients prospectively underwent MPH-SPECT and MRI of metacarpophalangeal (MCP) joints prior to and after 6 months methotrexate therapy. Tc99m-DPD uptake was measured at proximal and distal MCP sites using regional analysis. The course of joint pathologies was scored according to the Rheumatoid Arthritis MRI Score (RAMRIS) criteria. Results: The frequency of increased Tc99m-DPD uptake, synovitis and bone marrow edemadecreased under MTX therapy; but the number of bone erosions increased. Joints with progressive and new erosions on follow-up had a higher baseline Tc99m-DPD uptake (2.64±1.23 vs. 1.43±0.91) (p =0.02). Conclusions: Joints with erosive progression are characterized by an early increased Tc99m-DPD uptake, even in absence of MRI bone pathologies. Tc99m-DPD MPH-SPECT might thus be of additional value to morphological MRI for the identification of RA patients with a high risk for erosive progression. [Copyright &y& Elsevier]

Abstract: Adequate blood supply and circulation to the bones is required to maintain a healthy skeleton. Inadequate blood perfusion is associated with numerous bone pathologies and a decrease in bone mineral density, yet bone hemodynamics remains poorly understood. This study aims to 1) quantify bone hemodynamic responses to changes in external pressure, and 2) identify the predominant mechanisms regulating bone hemodynamic responses to pressure changes. Photoplethysmography was used to measure bone and skin perfusion in response to changes in external pressure. Single-limb pressure chamber experiments were performed over a pressure range of −50 to +50mmHg. Bone perfusion is decreased at all negative pressures, and larger decrements in perfusion are observed at the more extreme pressure differences. At positive pressures we observed an initial increase in perfusion followed by activation of intramuscular pressure receptors at +30mmHg, which overrides the initial response and results in decreased perfusion at the highest positive pressure levels. The myogenic effect is observed and is shown to be the predominant control mechanism in bone over a wide range of pressure exposures. Greater understanding of these hemodynamic mechanisms may be important in developing new drugs and therapies to treat various bone disorders. [Copyright &y& Elsevier]

Bone densitometry was originally developed to diagnose a high risk for fragility fractures in older postmenopausal women who may have primary osteoporosis. Its widespread availability, however, has led to its use in healthy peri- and premenopausal patients and the unexpected findings of low bone density in this group of patients. Their low bone density caused much uncertainty about the likelihood of fracture risk and what treatment might be needed. Conceptually, bone density reflected bone strength, and so a low density reflected increased fracture risk. Clinical experience and the results of pivotal studies of therapy for osteoporosis suggested that bone density was only partly responsible for skeletal strength. Many structural and material properties of bone, not measured by bone density, made it resist fracturing. Clinical risk factors helped determine these characteristics, albeit imperfectly, and aided clinicians decide whether and what treatment was needed. But now, new fracture risk assessment protocols (namely, FRAX, the WHO risk assessment tool) are available to help resolve this dilemma. This paper reviews some of the clinical observations that led to rethinking the concept bone density and bone strength and how it changes the clinical approach to therapy for the healthy young patient. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the geometric change of osteoporotic bone trabecular patterns using root mean square (RMS) values, first moment power spectrum (FMP) values and fractal dimension values. With the use of these methods, we attempted computerised analysis of osteoporotic bone patterns using texture parameters characterisi ng bone architecture and computer-aided diagnosis of osteoporosis. Methods: 32 patient cases from Korea University Guro Hospital were analysed. Patient ages ranged from 51 to 89 years, with a mean age of 65 years. Receiver operating characteristic curve analysis was performed with determination of the area under the curve (AUC). Results: The bone mineral density (BMD) measurement (AUC=0.78) was a better indicator of bone quantity than the RMS, FMP and fractal dimension values (AUC=0.72) for diagnosis; therefore the combination of RMS, FMP and fractal dimension values was a better indicator of bone quality. Conclusion: Measurements that combined BMD measurement and RMS values and combined FMP and fractal dimension values (AUC=0.85) together produced better results than the use of the two parameter sets separately for a diagnosis of osteoporosis. Advances in knowledge: For more effective application, additional study on more cases and data will be required. [ABSTRACT FROM AUTHOR]

Bone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected bymyeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compressionmay occur; diagnosis and treatmentmust be carried out rapidly in order to avoid a permanent sensitive ormotor defect. Although whole body skeletal X-ray is considered mandatory for multiple myeloma staging, magnetic resonance imaging is presently considered the most appropriate diagnostic technique for the evaluation of vertebral alterations, as it allows to detect not only the exact morphology of the lesions, but also the pattern of bone marrow infiltration by the disease. Multiple treatment modalities can be used to manage multiple myeloma-related vertebral lesions. Surgery or radiotherapy is mainly employed in case of spinal cord compression, impending fractures, or intractable pain. Percutaneous vertebroplasty or balloon kyphoplasty can reduce local pain in a significant fraction of treated patients, without interfering with subsequent therapeutic programs. Systemic antimyeloma therapy with conventional chemotherapy or, more appropriately, with combinations of conventional chemotherapy and compounds acting on both neoplastic plasma cells and bone marrow microenvironment must be soon initiated in order to reduce bone resorption and, possibly, promote bone formation. Bisphosphonates should also be used in combination with antimyeloma therapy as they reduce bone resorption and prolong patients survival. Amultidisciplinary approach is thus needed in order to properly manage spinal involvement in multiple myeloma. [ABSTRACT FROM AUTHOR]

The principals of classical mechanics are applied to the study of the resistance of materials to fracture when subject to a certain load. Bone has been, for a long time, the object of study in the field of mechanics in order to understand and resolve problems of fracture associated with deficient mechanical behaviour which may exist due to factors such as age or certain pathologies. The great quantity of specific vocabulary used in biomechanics, derived as it is from the terminology of mechanical engineering, makes it very difficult, on occasion, for researchers specialising in bone and mineral metabolism to interpret information available in the literature on the resistance of bone. The objective of this work is to describe as briefly and concisely as possible the main concepts and fundamental principles used in biomechanics, focused on their application to bone tissue. In addition, the main mechanical trials carried out on whole bones or on samples of trabecular or cortical bone are reviewed. [ABSTRACT FROM AUTHOR]

Previous studies have shown the electromagnetic stimulation improves bone remodeling and bone healing. However, the effect of percutaneous electrical stimulation (ES) was not directly explored. The purpose of this study was to evaluate effect of ES on improvement of bone repair. Twenty-four adult male Sprague-Dawley rats were used for cranial implantation. We used a composite comprising genipin cross-linked gelatin mixed with tricalcium phosphate (GGT). Bone defects of all rats were filled with the GGT composites, and the rats were assigned into six groups after operation. The first three groups underwent 4, 8, and 12 weeks of ES, and the anode was connected to the backward of the defect on the neck; the cathode was connected to the front of the defect on the head. Rats were under inhalation anesthesia during the stimulation. The other three groups only received inhalation anesthesia without ES, as control groups. All the rats were examined afterward at 4, 8, and 12 weeks. Radiographic examinations including X-ray and micro-CT showed the progressive bone regeneration in the both ES and non-ES groups. The amount of the newly formed bone increased with the time between implantation and examination in the ES and non-ES groups and was higher in the ES groups. Besides, the new bone growth trended on bilateral sides in ES groups and accumulated in U-shape in non-ES groups. The results indicated that ES could improve bone repair, and the effect is higher around the cathode. [ABSTRACT FROM AUTHOR]

Objective-To define scintigraphic, physical examination, and scapular ultrasonographic findings con-sistent with bone fragility syndrome (BFS) in horses; develop indices of BFS severity; and assess accuracy of physical examination, scapular ultrasonography, and serum biomarkers for BFS diagnosis Design-Prospective case-control study. Animals-48 horses (20 horses with BFS and 28 control horses). Procedures-Horses underwent forelimb scintigraphic evaluation, physical examination, scap-ular ultrasonography, and serum collection. Scintigraphy was used as a reference standard to which physical examination, scapular ultrasonography, and concentrations of serum biomarkers (carboxy-terminal telopeptide of collagen crosslinks and bone-specific alkaline phosphatase activ-ity) were compared for assessing accuracy in BFS diagnosis. Results-A diagnosis of BFS was strongly supported on scintigraphy by > 2 regions of increased ra-diopharmaceutical uptake, including 1 region in the scapular spine and 1 region in the scapular body or ribs; on physical examination by lateral bowing of the scapulae; and on ultrasonography by widen-ing of the scapular spine. None of the tests evaluated were accurate enough to replace scintigra-phy for mild disease; however, physical examination and scapular ultrasonography were accurate in horses with moderate to severe BFS. Serum biomarkers were not accurate for BFS diagnosis. Conclusions and Clinical Relevance-Scintigraphy remained the most informative diagnostic modal-ity for BFS, providing insight into disease severity and distribution; however, physical examination and scapular ultrasonographic abnormalities were diagnostic in horses with moderate to severe disease. Proposed severity indices classified the spectrum of disease manifestations. Clearly defined criteria for interpretation of diagnostic tests aid in the detection of BFS. Severity indices may be useful for assess-ing disease progression and response to treatment. [ABSTRACT FROM AUTHOR]

Objectives Equisetum arvense has long been used in traditional medicines to treat different disorders, including bone pathologies. In this study a hydromethanolic extract of E. arvense was assessed for its effects on human osteoclastogenesis. Materials and methods Osteoclast precursors were maintained in non-stimulated and stimulated (presence of M-CSF and RANKL) conditions, or in co-cultures with osteoblasts. Cell cultures were treated with 0.00016-0.5 mg/ml of a hydromethanolic E. arvense extract. Results The extract did not affect spontaneous osteoclastogenesis. In osteoclast precursors committed to osteoclastogenesis (stimulated or co-cultured with osteoblasts), E. arvense caused dose-dependent inhibitory effect that became statistically significant at concentrations ≥0.004 mg/ml. This was observed using different osteoclast differentiation and activation markers. Cell response was associated with changes in relative contribution of MEK and NFkB signalling pathways, as well as PGE2 production. As there were differences in the response of osteoclast precursors maintained in the presence of inductive factors, or co-cultured with osteoblastic cells, it seems that E. arvense extract had the ability to modulate osteoclastogenesis, either by acting directly on osteoclast precursor cells, and/or via osteoblasts. Conclusions Equisetum appeared to have a negative effect on human osteoclastogenesis, which is in line with its putative beneficial role in pathophysiological conditions associated with increased osteoclastic activity, and might suggest potential utility for treatment with bone regeneration strategies. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the osteoarchaeological evidence for leprosy in 38 skeletons excavated from the north cemetery of the hospital of St Mary Magdalen, Winchester (founded by the late 11th century) between 2009 and 2011. This cemetery, to the north of the medieval chapel, represents a discrete burial area, separate from the main, more recent cemetery to the south. The analysis indicates skeletal evidence for leprosy in over 85% (33) of the burials. This is therefore a much larger percentage than has previously been recorded for British material. The skeletal remains also provide evidence for amputation, possible palliative care as well as a pilgrim burial. Overall work at Winchester represents the most extensive excavation of an early leper hospital with accompanying cemetery to date, providing a unique opportunity for the cross-examination of skeletal and contextual data. Therefore the St Mary Magdalen cemetery is discussed in reference to such issues as the status of leper hospitals and social perceptions of hospital inmates in the medieval period. [Copyright &y& Elsevier]

A young mother presented her 19-month-old boy to the general practitioner (GP) with a 24 h history of reluctance to stand or walk and a slightly raised temperature. The GP arranged an assessment by the paediatrician, who organised an ultrasound of the hips which was normal. Approximately 1 week later the patient became constipated as well, was seen again by another GP but no cause was found. Another week later mother consulted the initial GP again as the boy had not shown any signs of improvement and had become more irritable. The GP arranged a review by the paediatrician and MRI scans of the hips and back were performed. These scans showed normal hips but lumbar spine changes suggestive of a spondylodiscitic event. The patient was treated with intravenous antibiotics, a corset and analgesia and made an excellent recovery. [ABSTRACT FROM AUTHOR]

We describe a case of lamellar ichthyosis with bilateral genu valgum. The association of genu valgum with congenital ichthyosis is rare. Our patient, a 22-year-old girl, had lamellar ichthyosis and was born with a collodion membrane. She developed progressive valgus deformity of the knees of 5 years duration associated with difficulty in walking. On evaluation, she had generalised scaly skin lesions along with bilateral genu valgum and biochemical evidence of vitamin D deficiency. Skin serves as an important site for vitamin D synthesis and thus skeletal deformities secondary to vitamin D deficiency may occur in cases of congenital ichthyosis, causing a diagnostic dilemma due to the unusual association. This case serves as a reminder that clinicians need to be aware of such an association in order to prevent, appropriately diagnose and adequately treat the rare case of congenital ichthyosis with rickets and osteomalacia. [ABSTRACT FROM AUTHOR]

The article reports on the role that bone scintigraphy plays in helping to diagnose malignant bone lesions in patients. A discussion of several types of benign bone lesions, including fibrous dysplasia, Paget disease and endochroma, which can resemble malignant lesions in staging bone scans, is presented.

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002-May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury. [ABSTRACT FROM AUTHOR]

The identification of fast and slow waves propagating through trabecular bone is a challenging task due to temporal wave overlap combined with the high attenuation of the fast wave in the presence of noise. However, it can provide valuable information about bone integrity and become a means for monitoring osteoporosis. The objective of this work is to apply different coded excitation methods for this purpose. The results for single-sine cycle pulse, Golay code, and chirp excitations are compared. It is shown that Golay code is superior to the other techniques due to its signal enhancement while exhibiting excellent resolution without the ambiguity of sidelobes. [ABSTRACT FROM AUTHOR]