Chronic recurrent multifocal osteomyelitis; manifestation, imaging and diagnosis

Chronic recurrent multifocal osteomyelitis [CRMO] is an inflammatory bone disease usually affecting children. A 9-year old boy presented with recurrent lower extremities pain and discomfort lasting for two years. In every time, symptoms vanished after several weeks. The patient received antibiotics only in one period of bone pain. In other occasions the patient didn't received any antibiotics. In last episode of bone pain, symptoms disappeared by use of naproxen. In patient's X-rays, there were multifocal areas of sclerosis with a wide transitional zone accompanied by a fine periosteal reaction. Regarding his history and MRI, bone scan findings were more in favor of active inflammatory process in the involved regions. In needle biopsy and bone curetting of left and right tibiae, osteonecrosis, mild inflammatory fibrosis, and scattered chronic inflammatory cells consistent with chronic osteomyelitis were noticed. No malignant neoplastic tissue was identified. In 2-year follow-up, diagnosis of CRMO was confirmed by serial laboratory tests, three-phase bone scan, CT and MRI findings. This diagnosis was proved by pathology evaluation following needle bone biopsy

Comparison of clinical and sonographic prevalence of developmental dysplasia of the hip

Developmental dysplasia of the hip [DDK] is one of the most widely discussed abnormalities in neonates. The advantages of sonographic examination are well known, but its main disadvantage is that it might lead to over diagnosis, which might cause over treatment. Variations in the incidence of developmental dysplasia of the hip are well known. During six months study since September 2006 all 1300 neonates [2600 hips] were born in our hospital examined clinically and sonographically [587 hips] in the first 48 hours of life. Sonography was performed according to Grafs method, which considers mild hip sonographic abnormalities as type II a. Type IIb Graf were considered pathologic. Sonography screening of 587 hips detected 36 instances of deviation from normal indicating a sonographic DDH incidence of 12.5%. However, only 8 neonates remained abnormal and required treatment, indicating a true DDH incidence of 6 per 1000 live birth. Risk of diagnosis clinically and sonographicaly were 2.5 and 4.5 percent respectively and was significant [P<0.00001, x[2]=l 170]. In order to avoid over diagnosis in first days examination, repeated clinical and sonographic examination is required