Influence of antihyperuricemic therapy on the clinical and radiographic progression of gout.

Ten years ago, we studied the clinical and radiographic manifestations of gout in 60 patients and described 3 patterns of disease. To determine the consequences of management over a 10-year period, we recently reassessed the 39 available patients of this population. We found that although reduced tophaceous deposition on physical examination correlated with normalization of the serum urate concentration, no correlation existed between radiographic changes and mean serum urate concentrations. Progression of gouty changes on radiography reflected progressive deformity on physical examination. We have described the radiographic changes that occurred in a well-characterized population of subjects with gout over 10 years and determined that serum urate concentrations alone may not provide an effective means of monitoring the progression of tophaceous disease in bone.

Septic spondylodiscitis in ankylosing spondylitis.

A patient with ankylosing spondylitis (AS) for 10 years suddenly developed localized midback pain after minimal activity. Although he sought immediate medical assistance, recognition of a septic spondylodiscitis was delayed 3 weeks. One day after admission, he developed fever and admitted to intravenous drug use. Staphylococcus aureus empyema and spondylodiscitis were subsequently diagnosed. Clinical differentiation of aseptic from septic spondylodiscitis cannot be ignored in patients with AS.

Chronic knee pain assessed by SPECT: comparison with other modalities.

Twenty-seven patients with chronic knee pain were examined prospectively using conventional radiography, radionuclide angiography, planar bone scintigraphy, and single-photon emission computed tomographic (SPECT) bone scintigraphy. When the results of subsequent arthroscopic examination of all three compartments of the knee were correlated with those of the noninvasive methods, SPECT bone scintigraphy was found to be most sensitive for evaluating the extent of osteoarthritis. Differences in detection sensitivity for articular cartilage damage and synovitis were greatest in the patellofemoral compartment. The frequency with which hyperemia was present in association with cartilage damage and synovitis indicates that osteoarthritis of the knee is capable of producing hyperemia and further implies that increased perfusion cannot be used to distinguish with confidence between osteoarthritis and septic processes involving the knee. SPECT (1.00) and planar (0.91) bone scintigraphy were highly sensitive indicators of torn menisci in a subgroup of 14 patients, each having a prearthroscopic clinical diagnosis of a torn meniscus. This result suggests that for patients with chronic knee pain and clinical suggestion of a torn meniscus, bone scintigraphy has significant potential as a high-sensitivity, prearthroscopic screening examination.

Gouty arthritis: a prospective radiographic evaluation of sixty patients.

A prospective analysis of 60 patients with gout was undertaken to evaluate the radiographic spectrum of gouty arthritis in patients treated in the era of hypouricemic therapy. Twenty-two of these patients were clinically tophaceous; 36 were considered to have radiographic findings diagnostic of gouty arthritis by strict radiographic criteria. Up to 24% of the patients denied symptoms in joints with radiographic changes of gout; 42% with no evidence of tophi on clinical examination had radiographic changes characteristic of gout. Radiographic assessment can be extremely helpful in the management of gout by documenting the degree and extent of bony involvement, particularly in patients with limited symptoms or without clinical tophi.

Arachnoiditis from myelography and laminectomy in experimental animals.

Clinical reports have suggested that myelography and laminectomy may produce more arachnoiditis than myelography alone. The effect of experimental lumbar myelography and laminectomy on arachnoiditis in monkeys was studied. Arachnoiditis was as severe after myelography alone as after myelography and laminectomy. Minimal arachnoiditis was found myelographically and histologically after myelography with metrizamide 300 mg l/ml, and severe arachnoiditis was found after myelography with iophendylate whether or not laminectomy was performed. Laminectomy alone produced insignificant arachnoid changes. Experimental myelography preceding laminectomy did not increase the risk of arachnoiditis.

Animal model for studying the chronic effects of herniated disks and spinal surgery.

A successful model to study both herniated intervertebral disks and spinal operations such as laminectomy has not been described. Two procedures were developed in nonhuman primates: One produces an elevated nerve root simulating a herniated disk; the second is a laminectomy that simulates the operation in humans. Twenty-five surgical procedures were performed with no complications. A myelographic abnormality typical of a disk herniation results from the simulated disk herniation. The chronic effects of herniated disk and spinal surgery can be studied with this model.

Crohn's disease of the duodenum with spontaneous reflux into the pancreatic duct.

A patient with Crohn's disease which involved the duodenum presented with recurrent pancreatitis. His upper gastrointestinal series demonstrated spontaneous reflux of barium into the pancreatic duct. The literature is reviewed and a probable mechanism for this very unusual occurrence is suggested.

Osteolytic and osteoblastic metastases due to carcinoid tumors.

Gastrointestinal carcinoid tumors arising from the foregut and hindgut may metastasize within the abdomen. Bone metastases are rare, but their occurrence is well established. Both osteoblastic and osteolytic metastases can occur in the same patient without any bone symptoms. Three patients with malignant carcinoid tumors had no bone symptoms but demonstrated extensive bone metastases on radionuclide bone scans. Some of these lesions were abnormal on corresponding roentgenograms and some areas were negative on roentgenograms. The use of radionuclide bone scanning in the evaluation of patients with malignant carcinoid tumor is emphasized.