Magnetic resonance imaging of aneurysms of the abdominal aorta.

Experience with magnetic resonance imaging (MRI) of 10 normal control patients and 13 patients with known abdominal aortic aneurysms is presented. The aorta, renal artery origins, and iliac arteries were clearly identified in all control patients. Ten out of 13 aneurysms were optimally visualized. Three cases early in the experience were poorly seen and permitted less confident measurements. Renal artery origins were identified in 12 cases and judged to be uninvolved by the aneurysm in 11. Iliac arteries were identified in 11 cases and judged to be definitely aneurysmal in three. Sonography clearly depicted all 13 aneurysms. Correlation of the actual anteroposterior (AP) and transverse diameter aneurysm measurements with both techniques was excellent. Sonography failed to identify the renal artery origins in all cases, but could infer noninvolvement in two cases. Iliac arteries were seen in eight cases and judged definitely aneurysmal in three. According to these preliminary results, both MRI and sonography provide accurate AP and transverse outer wall measurements. MRI is superior in determining the presence of renal and/or iliac involvement. The authors recommend, however, that sonography continue to be the preliminary screening method.

Widespread marrow necrosis during pregnancy.

Recently, a 22-year-old Caucasian female was referred to our Hospital two days post-partum. She had been feeling unwell during the last few days of her pregnancy and complained of multiple aches and pains, worst in the abdomen and lower back. Her admission platelet count was severely depressed and a bone biopsy showed extensive marrow necrosis with viable bony trabeculae. There was no evidence of vasculitis, vascular thrombosis, or malignancy. Widespread marrow necrosis in pregnancy followed by recovery, to our knowledge, has not been previously reported.

Dialysis encephalopathy and osteomalacic bone disease: a case-controlled study.

Nine patients on long-term hemodialysis with dialysis encephalopathy were studied, with sex matched control subjects for eight of the patients. Each patient with dialysis encephalopathy and control subject were contemporaries in a similar dialysis environment. Rib and other fractures were found in excess in the patients with dialysis encephalopathy (p less than 0.005 and p less than 0.01). These patients had less radiographic hyperparathyroid bone disease, and no more osteopenia as measured by metacarpal thickness than did their control counterparts. Severe osteomalacia was documented by bone biopsy in four of te patients. In a retrospective review of clinical, biochemical and pharmacologic differences, the patients with dialysis encephalopathy were significantly older at the start of dialysis (45.6 years versus 38.6 years, p less than 0.02) and had higher mean concentrations of blood urea nitrogen (BUN) and lower serum hemoglobin in the first year of dialysis than the control subjects. Blood pressure weight, creatinine, calcium, phosphate, alkaline phosphatase and a number of transfusions did not differ significantly. There was no difference in prescribed vitamin D and elemental aluminum in phosphate binders. This study demonstrates that patients with dialysis encephalopathy had more rib fractures without more parathyroid or osteopenic bone disease than did the control subjects and suggests that the etiology of dialysis encephalopathy and osteomalacia is multifactorial.

Peri-articular erosions in the hands and wrists in haemodialysis patients.

Peri-articular erosions have been described in primary and secondary hyperparathyroidism. Seventy-two patients with chronic renal failure were reviewed for the presence of erosions. These were found in 15 patients while another 20 patients showed other evidence of secondary hyperparathyroidism. The distribution of erosions was unlike that of other erosive arthropathies, and there were no relevant clinical symptoms. Previous reports of peri-articular erosions in hyperparathyroidism are reviewed. It is concluded that peri-articular erosion is a common finding in secondary hyperparathyroidism and may be the major radiographic feature of this condition.

Gray scale ultrasound in the evaluation of rheumatoid arthritis of the knee.

Gray scale ultrasound at a frequency of 5.0 MHz was used as part of a study to evaluate the results of yttrium-90 injection as therapy for rheumatoid arthritis of the knee. Popliteal cysts, suprapatellar effusions and synovial thickening in the suprapatellar pouch were demonstrated and ultrasound studies were correlated with the clinical and arthrographic findings. Gray scale ultrasound can be a useful adjunct in the evaluation and follow-up of rheumatoid arthritis of the knee.

A study of ankle instability utilizing ankle arthrography.

A preclinical and clinical study of ankle arthrography for chronic ankle instability was performed. In the first study, ankle arthrograms were done on 50 cadaver ankles to demonstrate the limits of the normal ankle joint, and it was demonstrated that contrast in tendon sheaths is not a sign of a torn ankle ligament. The second study consisted of investigating ten cases of chronic ankle instability utilizing ankle arthrography. It was concluded that ankle arthrography is helpful in diagnosing torn ankle ligaments if all remaining investigative procedures are negative. A positive ankle arthrogram is proof that a torn capsule and ligament has occurred. However, in this small series a negative a negative arthrogram and a normal talar tilt was still associated with a torn ligament of the ankle.

Osteoid osteoma and osteoblastoma: reclassification of 43 cases using Schajowicz's classification.

Forty-three cases of benign osteoblastic tumour of bone from the University of British Columbia bone tumour registry have been reviewed and reclassified according to the classification of Schajowicz and Lemos. Their classification has the advantage that the relationship of the two lesions is recognized and overlap, both radiologically and microscopically, is allowed for. The terminology used in the new classification, however, is cumbersome and confusing and appears to be of no great advantage. We therefore recommend instead the terminology modified from that of Dias and Frost, which incorporates the observations put forth by Schajowicz and Lemos: (a) cortical osteoblastoma, (b) medullary osteoblastoma, (c) periosteal osteoblastoma and (d) multifocal osteoblastoma.