Benign osteoblastoma. Report of a case and review of the literature.

Benign osteoblastoma is a rare lesion of bone, usually confined to the long bones and the vertebrae. There have been 16 cases reported in the calvarium and only four in the frontal bone. We treated a patient with benign osteoblastoma of the frontal bone (supraorbital ridge and roof of orbit), and we review the literature. The histologic and radiologic characteristics are described and the treatment modalities are reviewed.

Retro-orbital hematoma and proptosis associated with chronic sinus disease.

Sudden unilateral proptosis occurred in a patient with a history of chronic sinusitis. The radiologic description of chronic sinusitis associated with the computerized tomography scan picture of a retro-orbital mass justified surgical exploration and evacuation of a hematoma. The proximity of the orbital cavity and the sinuses, plus their common venous drainage system, can account for this disease.

Osteolysis of the ribs in progressive systemic sclerosis.

In a patient with progressive systemic sclerosis (PSS), osteolysis of the posterior portion of the rib cage developed in an insidious fashion, without symptoms or preceding trauma. Six previous examples of rib resorption in PSS are reviewed. The destructive mechanism is unknown but may be related to endarteritis and ischemia.

Hereditary osteodysplasia with acro-osteolysis. (The Hajdu-Cheney syndrome).

A mother and son with acro-osteolysis (Hajdu-Cheney syndrome) are described. In addition to osteolysis of the distal phalanges, these patients have a generalized osseous dysplasia with osteoporosis, premature loss of teeth, short stature and a distinctive facial appearance. In one of the cases an enlarged sella turcica was associated with no abnormality of endocrine function. A biopsy specimen taken from an area of active osteolysis in a phalanx was studied by light and electron microscopy. There was active replacement of central medullary bone by a fibrous and angiomatous process characterized by the presence of small, thick-walled vessels and an unusual number of interspersed nerve fibers and mast cells. A neurovascular dysfunction with local release of osteolytic mediators may be involved in the pathogenesis of the disorder, but the nature of the osteolytic factor is unknown.

Bone changes induced by diphenylhydantoin in chicks on a controlled vitamin D intake.

Florid rickets developed in chicks receiving doses of diphenylhydantoin analogous to doses used in humans as anticonvulsants, vitamin D3 being given in amounts sufficient for normal bone mineralization in controls. The changes in the bones were directly related to the dose of diphenylhydantoin and inversely related to the dose of vitamin D3. Bone mineralization was assessed by roentgenography, histological examination, microradiography, and measurement of bone ash. Of these methods, roentgenography was the least sensitive. Rachitic changes were detectable by light microscopy and microradiography in chicks whose skeletons appeared normal roentgenographically. Roentgenographic evidence of rickets became detectable only when the rickets was far advanced. Rickets developed at serum levels of diphenylhydantoin similar to those found in patients taking anticonvulsant medication.

Use of computerized axial tomography of the head and neck region.

The use of the computerized axial tomography has been well received in the field of otolaryngology. Five cases are presented illustrating the capability of the total body scanner (Delta scanner) to contribute to radiologic diagnosis below the level of the base of the skull. The advantages of non-invasibility and three dimensionality are compared to the disadvantages of added cost, added radiation exposure, comparatively long exposure time and relatively poor detail. Because of the overall usefulness of this diagnostic tool, evolution of rapid scanning devices with greater detail is awaited with interest.

Fiber-optic video study of the post-laryngectomized voice.

Simultaneous video-fluoroscopy and fiber-optic video laryngoscopy was carried out on a series of eight laryngectomees. Previous concepts supported by an earlier report1 indicated that the folds of the rebuilt cricopharyngeal sphincter were seen to represent the primary source of sound vibration for voice production. Fold vibration was envisioned as an essential for sound production. Present findings present a challenge to the older concept. The fluoroscopic studies showed a considerable variation in the vertical thickness of the sphincteric area--from several millimeters to as many as 10 centimeters. Mucus bubbles in rapid motion were easily visible immediately above the narrowest portion of the reconstructed cervical esophagus. Ingestion of barium only enhanced the visualization of this bubbling. Vibration of a long vertical area of the thin anterior and thicker posterior esophageal walls well above and well below this point was regularly noted. Fiber-optic visualization failed to show actual fold vibration at any time. Momentary opening of the food tract during air injection or intake, immediately prior to the onset of phonation, was seen on many occasions. During phonation, routinely, the anticipated pseudoglottic opening was obscured by bubbles of mucus or barium. These findings suggest that the air, when accumulated below the narrowest spot in the hypopharyngeal-esophageal tract and when forced upward through a narrow opening, sets the accumulated mucus, not the mucous membrane, into vibration; further, that this vibration is of sufficient amplitude to transmit itself to both the anterior wall and the posterior wall of an extensive vertical portion of the neck.

Diphenylhydantoin: effects on calcium metabolism in the chick.

Rickets, hypocalcemia, decreased duodenal calcium transport, and reduction of calcium binding protein have been produced in chicks treated with diphenylhydantoin. These effects are directly related to diphenylhydantoin dose and inversely related to the intake of vitamin D(3) (cholecalciferol).