Deformation across the zone of callotasis during loading. radiostereometric analysis in a patient with achondroplasia.

The present study demonstrates that high-resolution radiostereometric analysis (RSA) can be used to assess global longitudinal compressive deformation across the callotasis zone during loading. In an achondroplastic patient operated with bifocal lengthening of the tibia by use of the Ilizarov external fixator, the axial compressive intersegmental strain in the proximal lengthening zone under a load of 71% of body weight was 7.7 mm. The proximal lengthening zone was 51.0 mm, and accordingly the overall linear strain across the callotasis was 15.1%. This large strain value found in distraction osteogenesis 6 weeks after end of distraction is not consistent with classical theory of the magnitude of micromotion needed for adequate stimulation of bone formation in fracture healing. The increased axial displacement did not stimulate bone healing and delayed union was observed. This one single observation does not allow for any conclusions to be drawn about the relationship of strain to fracture healing, but further and refined use of the RSA method will certainly improve our understanding of the role of axial strains in distraction osteogenesis.

Osseous manifestations of 'handball goalie's elbow'.

The radiographic manifestations of musculoskeletal stress at the elbow associated with European team handball are reported in 46 amateur handball players with 74 elbows injured by blocking shots. All the 92 elbows were evaluated by clinical and radiological examinations using the 18 asymptotic elbows as a control. Lateral and anterioposterior radiographs were obtained of both elbows in addition to stress radiographs with manual valgus force. The mean age of the athletes was 23.0 (range 16-44) years. The players had an athletic experience of 11.6 years (range 3.5-34). Their elbow pain had at inclusion lasted for 43 +/- 42) (range 2-252) months. Their symptoms were located in all four parts of the elbow and in different combinations: anterior (6), posterior (23), medial (38), lateral (17), and in the whole elbow (3). No major bony lesions were found. Minor abnormalities were observed (21%), including loose bodies (7), traction spur formation (1), and minor arthritic changes (7) in addition to medial instability (12). Manual instability stress test was not useful and should be performed with a stress device. 'Handball goalie's elbow' does not lead to major osseous manifestations.

Follow-up of breast cancer patients stage I-II: a baseline strategy.

In 430 stage I-II breast cancer patients the cost-benefit of investigations during follow-up have been studied. Median follow-up time was 8 years and 128 patients had relapsed, 91 with metastatic disease. High costs of routine chest X-ray, limited skeletal X-ray and bone scan examinations were associated with low incidence of diagnosed relapses not suspected otherwise. In the eight blood analyses examined, increases of more than 10 mm/h in erythrocyte sedimentation rate (ESR), 20 U/l in gamma-glutamyltransferase (GT) or 60 U/l in alkaline phosphatase (ALP) resulted in a combined sensitivity of 55% and specificity of 91% for relapses with distant metastases. Elevation of at least two blood tests gave a combined sensitivity of 31% and a specificity of 98%. The importance of using individual reference values in screening for recurrences is emphasised. Symptomatic relapse or relapse detected at interval visits were not independent prognostic factors. The blood tests ALP, ESR and GT were strong predictors of survival measured from relapse which increase their legitimacy in follow-up. A more frequent follow-up for patients with 4+ involved nodes is proposed: three visits annually the first 5 years vs. two visits annually for the others. We conclude that history, clinical examination, ALP, ESR and GT are sufficient as a baseline screening for relapse in breast cancer patients.

Orofaciodigital syndrome type I in a girl with unilateral tibial pseudarthrosis.

The orofaciodigital syndromes are a group of possibly seven different malformation syndromes including oral, facial, and digital malformations. Type I has X linked dominant inheritance whereas the other types show autosomal recessive inheritance. An exact diagnosis is therefore important for genetic counselling. We here report a girl with orofaciodigital syndrome type I. She had cystic kidney disease at the age of 8 months which has not previously been reported in an infant with orofaciodigital syndrome. In addition she had unilateral tibial pseudarthrosis which has only rarely been reported in the orofaciodigital syndromes and in type II only.

High-dose methotrexate in the treatment of malignant mesothelioma of the pleura. A phase II study.

From 1984 to 1989, 63 patients with diffuse, malignant mesothelioma of the pleura were treated with 4-8 courses of high-dose methotrexate (HDMTX, 3 g total dose) and citrovorum factor rescue. There were 61 male and two female patients of median age 60 years. CT scan was performed before and after treatment and used for response evaluation. Of 60 patients evaluable for response, 37% showed partial or complete remission, 32% showed no change and 32% showed progressive disease. Median survival from start of treatment for all patients was 11 months, for 42 patients with the epithelial type 12 months, and for 20 patients with sarcomatous or mixed types only 5 months. Toxicity was acceptable, with only five patients (8%) terminating therapy due to toxicity. One toxic death occurred. We conclude that HDMTX is an active regimen in malignant pleural mesothelioma. The significantly shorter survival for patients with the sarcomatous or mixed subtypes indicates that further investigations on the activity of HDMTX in mesothelioma should be limited to patients with the epithelial subtype.

Postrenal segment aneurysm and infrahepatic interruption of the inferior vena cava. A case report.

Infrahepatic interruption of the inferior vena cava (IVC) with azygos and hemiazygos continuation is a well known anomaly. An aneurysm of the IVC has to our knowledge never been reported. A patient is described in whom a postrenal segmental aneurysm of the IVC in association with infrahepatic interruption was evaluated by cavography, ultrasound, and computed tomography. The different modes of evaluation are discussed with emphasis on the embryogenesis of the IVC.

Postmenopausal osteoporosis: no effect of three years treatment with 1,25-dihydroxycholecalciferol.

The therapeutic effect of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) in postmenopausal osteoporosis was tested in a single blind, randomized prospective study. Thirty-nine women, 50-65 years of age, were treated for three years with 0.5 microgram 1,25(OH)2D3 daily. In a control group, 37 women were given 400 IU vitamin D3 daily. There was no significant difference in annual bone loss from the distal or proximal forearm between the groups. New vertebral fractures were evaluated, and in the treatment group, the annual increase in vertebral fractures was 0.18 +/- 0.387 and in the control group 0.13 +/- 0.330. New long bone fractures were 7 and 5, respectively. None of the observed differences were statistically significant. In the 1,25(OH)2D3 group, 28% had to reduce the dose because of slight hypercalcaemia. We conclude that 1,25(OH)2D3 as used in this study is not effective in the treatment of osteoporosis.

Radiologic evaluation of urolithiasis.

Interobserver variations between three radiologists with different backgrounds (duration of practice, and departments) were studied in connection with the diagnosing of urolithiasis. Films from 152 consecutive patients (examined with conventional abdominal films, urography/tomography) were analyzed independently. With respect to the number of patients with or without calculi there was agreement between the three observers in 129 of the 152 cases, which was taken to represent very good agreement beyond chance. The total number of stones was interpreted as 832, 460 and 570 respectively, and the median stone size as 6, 9 and 11 mm2. There was a fair interobserver agreement rate regarding whether stones were localized to the renal parenchyma or calyces, and whether stenosis/stricture or hydronephrosis was present. Tomography appeared to reduce the interobserver variability significantly. Adequate bowel cleaning, oblique projections, and lack of clinical information apparently did not influence the agreement rate. It was concluded that such interobserver variations are factors of importance in the reliability of the radiologic evaluation of urolithiasis.