[Aneurysmal bone cyst: diagnostic role of computerized tomography and magnetic resonance]. / Cisti ossea aneurismatica: ruolo diagnostico della Tomografia Computerizzata e della Risonanza Magnetica.

Aneurysmal bone cysts (ABC) are relatively uncommon benign expansile osteolytic lesions characterized by multiple cavities with serum-blood levels and delimited by a thin periosteal external border. The differential diagnosis is difficult to make with conventional radiography, while CT and MRI are elective techniques. Ten patients with ABC (7 central and 3 eccentric lesions) were examined with CT and MRI. Four cysts were localized at the proximal femur, 2 in calcaneal, 2 in vertebral (cervical and dorsal), 1 in tibial and 1 in iliac sites. Diagnostic criteria were the presence of fluid-fluid levels and a thin hyperdense peripheral border at CT, while hyperintense cavities on T2-weighted sequences, fluid-fluid levels, pseudodiverticular features and a low-signal border were found at MRI. Intralesional levels were detected in 9 patients at CT and in 10 at MRI; the 3 peripheral cysts exhibited a hyperdense extraosseous border at CT, corresponding to the periosteal shell, considered a benignity sign. To conclude, CT and MRI, thanks to their high resolution, clearly depict the anatomopathologic features of ABC, thus allowing this type of lesion to be differentiated from other benign and malignant osteolytic lesions.

[Densitometry analysis with quantitative computerized tomography in 530 subjects from Southern Italy]. / Analisi densitometrica con tomografia Computerizzata Quantitativa di 530 soggetti dell'Italia meridionale.

Quantitative measure of bone mineral content (BMC) loss is an important diagnostic indicator for determining the risk of fracture and in following the course of patients undergoing therapy for osteoporosis. Several techniques have been used to evaluate this parameter. Quantitative Computed Tomography (QCT) is the most precise and accurate method allowing selective measurement of trabecular compartment of the vertebrae. Age, sex, ethnic heritage and geographic factors influence BMC variability. The aim of this study is to describe the normal cross-section pattern of age-related spinal bone loss in a Southern Italy population (530 healthy subjects: 450 women, 80 men) and to provide a local data-base for better interpretation of the BMC values. The BMC of lumbar spine was measured by single energy QCT, using a reference phantom with five tubes containing known amounts of CaCO3, placed approximately at the vertebral bodies L2-L4. Results indicate an age-related bone loss with the lowest values at 55-70 years, particularly in women, while no major further decrease was observed in subjects over 65 years. Normal linear BMC decrease rate can be derived from this data.

Another triangle: mother, doctor, and fetus.

Advances in medical technology and drug development have given physicians immense power to save lives. But with these capabilities come moral responsibilities that give rise to serious ethical questions. At the University of Nevada School of Medicine, University Medical Center, patient cases posing moral dilemmas in treatment are discussed in bimonthly meetings. The objective of these meetings, which originated three years ago, is to give residents and staff physicians the principles and skills to address such dilemmas. From time to time we will publish these reports to illustrate how one hospital faced and resolved specific ethical problems on a case-by-case basis.

Intraglomerular fibrin, platelet aggregation, and subendothelial deposits in lipoid nephrosis.

We have investigated the formation of fibrin, platelet aggregates, and subendothelial deposits in lipoid nephrosis. Fibrin formation was found in 10 cases of active lipoid nephrosis. Platelet aggregates were found in eight cases and subendothelial deposits in nine. Fibrin and platelets were also found in cases of nephrotic syndrome due to other causes, and in glomerulonephritis. Fibrin was generally absent in lipoid nephrosis in remission and in benign recurrent hematuria. It is suggested that what seems to be a lower incidence in females is more apparent than real and that fibrin or related material may be present in a less easily identifiable form. Steroid therapy apparently had no effect on the presence or absence of fibrin. Most instances were associated with elevated serum cholesterol and alpha(2)-globulin. It is suggested that elevated serum lipids as well as the disease process in the kidney play a role in this phenomenon. It is further suggested that intraglomerular fibrin formation could lead to irreversible renal damage in lipoid nephrosis.