Jaw enlargement complicating secondary hyperparathyroidism in three hemodialysis patients.

Over a period of two years we saw three patients with longstanding chronic renal failure in whom the size and shape of the jaws had gradually changed. Clinical, metabolic, and radiologic observations suggested that secondary hyperparathyroidism had caused the disfigurement, and bone histology supported this conclusion in each case. The appearance of our subjects resembled that of patients morbidly afflicted with osteitis fibrosa before its association with hyperparathyroidism was widely known. Jaw enlargement is a potential consequence of secondary hyperparathyroidism in dialysis patients.

Abnormalities of carbohydrate and lipid metabolism in Dahl rats.

Plasma glucose, insulin, and triglyceride concentration, blood pressure, and insulin action on isolated adipocytes were determined in weight-matched Sprague-Dawley, Dahl salt-resistant, and Dahl salt-sensitive rats. Blood pressure and plasma glucose concentrations were not significantly different in the three groups. However, Dahl salt-sensitive rats had significantly higher plasma insulin (39 +/- 2 microunits/ml) and triglyceride (213 +/- 11 mg/dl) concentrations than did Sprague-Dawley rats (27 +/- 2 microunits/ml and 101 +/- 6 mg/dl, respectively). Values for insulin (34 +/- 4 microunits/ml) and triglyceride (159 +/- 11 mg/dl) were intermediate in Dahl salt-resistant rats. In contrast, maximal insulin-stimulated glucose transport was significantly lower in adipocytes isolated from Dahl salt-sensitive as compared with Sprague-Dawley rats (400 +/- 16 versus 523 +/- 14 fl/cell/sec), with Dahl salt-resistant rats again having intermediate values. However, the ability of insulin to maximally inhibit catecholamine-stimulated lipolysis was similar in all three groups, averaging approximately 20% of the activity present in the absence of insulin. All of these differences were seen when the rats were eating conventional chow and did not change in Dahl rats after 2 weeks of an 8% NaCl diet. On the other hand, the predicted rise in blood pressure took place in Dahl salt-sensitive rats, increasing from 147 +/- 4 to 181 +/- 6 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-associated differences in beta adrenergic-stimulated lipolysis in adipocytes from Sprague-Dawley and Fischer 344 rats.

We compared the ability of adipocytes isolated from the epididymal fat pads of Sprague-Dawley and Fischer 344 rats of different ages and weights to release glycerol in response to beta-adrenergic stimulation. Twelve-month-old Sprague-Dawley rats weighed approximately three times more than did 2-month-old rats of the same strain (761 +/- 61 g vs 223 +/- 8 g, p less than .001). Basal glycerol release was increased in the adipocytes of the 12-month-old rats (128 +/- 8 nmol/10(5) cells/L compared to the 2-month-old rats 51 +/- 3 nmol/10(5) cells/L). However, the ability of isoproterenol to stimulate glycerol release above basal was markedly decreased in the older and fatter Sprague-Dawley rats (178 +/- 15 nmol/10(5) cells/L vs 482 +/- 20 nmol/10(5) cells/L, p less than .001), and significant correlation coefficients between isoproterenol-stimulated glycerol release and both total body (r = .76, p less than .001) and fat pad (r = .83, p less than .001) weight were seen in Sprague-Dawley rats. Total body weights of 2-month (188 +/- 16 g), 12-month (393 +/- 15 g), and 27-month-old (402 +/- 36 g) Fischer 344 rats were less disparate. Isoproterenol-stimulated glycerol release was similar in the three groups of Fischer 344 rats, and there was no correlation between either total body or fat pad weight and lipolysis in these rats.

CT appearance of large sternoclavicular calcific masses in a teenager with chronic renal disease and secondary hyperparathyroidism, on hemodialysis maintenance.

The case of a 14-year-old teenager is reported who had large sternoclavicular masses. The young man had chronic renal disease due to chronic glomerulonephritis and had been on hemodialysis maintenance for many years. CT showed the masses to be lobulated with low attenuation septa. Metastatic calcification occurs in various systemic diseases.

Lead arthropathy: arthritis caused by retained intra-articular bullets.

The cases of 14 patients seen 6 weeks to 7 years after gunshot wounds with painful, restrictive joint disease and retained intra-articular bullets were reviewed. Twelve patients had radiographic findings characteristic of lead synovitis. The earliest finding was a fine, punctate deposition of radiopaque lead on the articular cartilage that resembled chondrocalcinosis but was of greater density. This was followed by more discrete lead speckling of hypertrophied synovium. The opacities became larger, coarser, and more confluent over time, ultimately outlining the synovium, articular cartilage, and joint capsule. Synovial hypertrophy and diffuse chronic inflammation and fibrosis were seen in seven patients on gross pathologic examination. The lead was deposited extracellularly in the subsynovial layer and within the marrow spaces of subarticular and periarticular bone. Electron-microscopic study suggests that lead is initially incorporated within cells and secondarily deposited extracellularly after cell death. Bullets in joints are not physiologically inert and should be removed when encountered.

The sonographic appearance of the hemorrhagic ovarian cyst in adolescents.

Pelvic sonography was performed on ten teenaged girls who were proven by surgery to have hemorrhagic ovarian cysts. Pathologically, four were follicular ovarian cysts, while three were corpus luteal cysts, and the exact nature of three was undetermined. At sonography, these masses had variable appearances, ranging from anechoic to moderately echoic with septa and thick walls. All these features are nonspecific and can be encountered in other adnexal masses. The changing sonographic appearance of the hemorrhagic ovarian cyst due to clot lysis is helpful in establishing the diagnosis, and was demonstrated in two cases. These ten cases are discussed, the varied sonographic appearances are described and a review of pertinent literature is included.

Further observations on pulmonary venous varix.

Pulmonary venous varix is a well known radiographic entity. Case reports are presented to illustrate the following unusual aspects of this lesion. 1. Hypoplasia of a major pulmonary vein results in increased pulmonary blood flow through the remaining normal ipsilateral pulmonary vein. This may result in variceal enlargement of the normal vein. 2. A pulmonary venous varix may be visualized during angiocardiography but not in a routine chest radiograph. This is most common in children. 3. Elevated pulmonary venous pressure causes dilatation of the central pulmonary veins. Sudden formation of a pulmonary venous varix in a patient with mitral valvular disease may be evidence of a sudden elevation of left atrial pressure.

Peripelvic extravasation, urinoma formation and tumor obstruction of the ureter.

We report 4 cases of peripelvic extravasation caused by tumor obstruction of the ureter. A urinoma developed in 3 of the 4 cases. Review of the literature reveals only 5 previously reported cases of peripelvic extravasation secondary to tumor obstruction of the urinary tract. We discuss the mechanics of peripelvic extravasation and urinoma formation, and conclude that tumor obstruction of the ureter must be considered in all cases of peripelvic extravasation.

Right colonic adhesions.

Adhesive bands may cause narrowing of the colon. The radiographic appearance may show evidence of a sharp, localized narrowing and smooth mucosal contour. Adhesions involving the ascending colon may also precipitate acute colonic obstruction due to formation of a cecal bascule. The nature of the adhesive bands and their relationship to prior surgery, to anomalies of mesenteric fixation, and to appendices epiploicae are discussed.

Scleroderma and carcinoma of the lung.

Two cases of scleroderma and carcinoma of the lung are reported. The 16 previously reported cases in the English literature are reviewed and tabulated in an attempt to determine the pathological and clinical presentation of carcinoma of the lung superimposed on the sclerodermal lung. When patients with scleroderma develop a change in pulmonary symptoms, a superimposed cancer of the lung should be suspected. The relationship between interstitial pulmonary inflammatory disease and cancer of the lung is discussed.

Metastatic melanoma of the adrenal: an unusual cause of adrenal calcification.

A case of metastatic malignant melanoma to the adrenal gland is presented. The radiographic appearance mimicked a benign cystic adrenal lesion because of the presence of curvilinear calcification of its border.

Joint changes in idiopathic hemochromatosis.

Two patients with idiopathic hemochromatosis and a distinctive arthropathy are presented. The joint findings are characterized by joint narrowing, prominent osteophytes, subcondral sclerosis and multiple lucent subchondral cysts, and chondrocalcinosis. The etiology of this arthropathy and its relationship to chondrocalcinosis are discussed. Occasionally, patients may present with this arthropathy before the onset of the classical signs of idiopathic hemochromatosis.