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

[Evaluation of meniscal fluenceincidence and other menisco-ligamentous injuries in the knee MRIs of patients reffering to Imam Reza MRI center in Mashhad]

Background and Aim: Meniscal flounceis a rare, wavy shaped folding along the free edge of the meniscus that observed in .MRI images. This is a feature of transient distortion of a normal meniscus but it can be regarded as a pseudo- meniscal tear. The aim of the current study was to evaluate the incidence of this normal variant

Materials and Methods: A total number of1001 knee MRI images were prospectively studied to check meniscal flounce and meniscoligamentous injuries in patients referred to. Kosar MRI center of Imam Reza hospital in Mashhad [2009-2011]

Results: In this study the most common meniscoligamentousinjury was diagnosed in the right medial meniscus [17.8%]. The most common accompanying injuries were the right medial meniscal tear and the right anterior cruciate ligament. The incidence of meniscal fluencewas 1%

Conclusion: The meniscal flounce observed in MRI images should be carefully interpreted because it can simulatea meniscal tear. This underscores the importance of correlating diagnostic images with clinical signs and symptoms and also avoidance of unnecessary MRI requisition inpatients whom some low probable diagnostic doubt exists

effect of surveillance on the outcome of breast cancer patients

The beginning of metastasis poorly affects the prognosis of breast cancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray [CXR] could play a role for early detection of lung metastasis, during the prognosis of these patients. The files of the breast cancer patients between 1996 to 2006 [1739 patients] have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method. Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy [LAP] was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in 77.4% and patients' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients [50%], other sites of metastasis [bone, liver, and brain] have discovered. The most frequent pattern of lung recurrence was pulmonary nodule [44.6%], followed by pleural effusion [28.6%]. Median survival was 27.5; median survival from pulmonary metastasis was 8 m; Early detection of pulmonary metastasis by CXR did not affect patients' endpoints. None of the probable prognostic factors have shown a significant effect on patients' outcome. Despite systemic treatment, survival after metastasis is low

Can gallbladder ejection fraction measured by fatty meal cholescitigraphy diagnose chronic cholecystitis?

Despite presence of a body of evidence in support of high accuracy of cholecystokinin cholescintigraphy [CCK-CS], for diagnosis of chronic cholecystitis[CC], some authors have claimed that gallbladder ejection fraction [GBEF] has poor predictive diagnostic values. The purpose of this study was to determine if there is any difference in GBEF between normal individuals and patients with CC. In a prospective case-control study, we studied 36 subjects as control group who did not have any abdominal symptoms, or history of abdominal disease or gallstone. Patients group were 42 with established choronic calcalous cholecystitis[CCC] who complaining of chronic biliary-like pain and had gallstone on ultrasonography. All subjects underwent gallbladder scintigraphy and GBEF was calculated at 30 and 60 minutes after fatty meal [FM] ingestion. In control group GBEF at 30-minute and at 60-minute after FM ingestion were 69.54% +/- 21.04% and 84.26% +/- 11.41% respectively while in patients group GBEF at 30-minute was 61.21% +/- 16.01% and at 60-minute was 80.22% +/- 12.57%. No significant difference was noticed between control and patient groups. GBEF didn't show significant difference between different groups based on the number of gallbladder stone, severity of chronic inflammatory [lymphoplasma] cell infiltration, wall thickness and evidence of fibrosis in the gallbladder wall. Our data are against the diagnostic value of the GBEF as measured by FM-CS in the workup of patients with CC. Thus, interpretation of GBEF should take the proper clinical context into consideration