Growth hormone secretion and bone histomorphometric study in thalassaemic patients with acquired skeletal dysplasia secondary to desferrioxamine.

An auxological and endocrinological study was performed in 21 thalassaemic patients with growth retardation and skeletal dysplasia secondary to desferrioxamine. Bone metaphyseal proximal tibial or iliac crest biopsy was performed in six patients with severe genu valgum or non-traumatic vertebral compression. GH insufficiency/deficiency (GH deficiency: peak after stimulation test below 6 ng/ml) was found in 72% of our thalassaemic patients with skeletal dysplasia, but in only 41% of patients without skeletal dysplasia. Bone histology showed abnormal chondrocytes, alteration of staining pattern of cartilage, irregular columnar cartilage and lacunae in the cartilaginous tissue. The behaviour of bone tissue was unpredictable (presence of thick or thin osteoid layer). Bone microfractures were sometimes present. The bone microstructure showed scarce mineralization, which was evenly or irregularly distributed. The bone tissue apatitic phase was quantitatively reduced. The hardness of bone tissue was remarkably lower than that of normal bone in three out of six patients. In conclusion, iron chelation therapy in patients with acquired skeletal dysplasia seems to interfere with GH secretion. The early identification of clinical and radiological abnormalities of skeletal dysplasia is of paramount importance in preventing severe bone destruction.

Fractures of the posterior apophyseal ring of the lumbar vertebral body in young patients. Three cases.

Three cases of posterior apophyseal fracture of a lumbosacral vertebral body are described. This disco-apophyseal lesion is typical of adolescents and sports-related trauma. Like all acute and chronic apophysiolyses it is probably enhanced by a constitutional weakness of the apophyseal area, closely fused with the anulus fibrosus of the disc.

A rare case of solitary exostosis of the cervical spine.

The authors report a rare case of solitary exostosis (osteochondroma) of the spinous process of the 6th cervical vertebra. They also re-examine the embryology and bone growth in this region.

[Selective arteriography in fractures of the femur head]. / L'arteriografia selettiva nelle fratture della testa femorale.

The choice between conservative and radical operation in case of femoral neck fractures is very important because it is the determining factor for a successful therapy. In case of epiphysial necrosis, an endoprosthesis as well as an osteosynthesis will be carried out. Selective arteriography of the medial circumflex artery represents the most reliable study to establish, immediately after the fracture, the possible presence of a post-traumatic ischemic necrosis. Angiography, as a reliable diagnostic tool, has to be carried out in the most selective way and needs the image subtraction technique. The authors report their preliminary results on the reliability of angiography in the femoral epiphyseal ischemic necrosis diagnosed by comparing the results of angiography with the Wood light test carried out on the surgically removed femoral head.