[Spinal stiffness. Differential imaging diagnosis with reference to acquired hyperostosis syndrome and spinal loading disease]. / Die versteifte Wirbelsäule. Bildgebende Differentialdiagnose unter Berücksichtigung des Akquirierten Hyperostose-Syndroms und der Lastenträgerkrankheit.

There are numerous diseases which can irreversibly stiffen the whole spine or parts of the axial skeleton. Due to didactic reasons one can distinguish 3 groups of such disorders: Paradigmatic diseases of the spine with an inherent proneness to stiffness. Rare diseases which involve a certain danger of stiffening the spine. Rigidity of the spine due to scientifically unrecognised morphologic phenomena.

Dense bone around the sacroiliac joint: a radiological review of the differential diagnosis.

Solitary osteosclerotic bone lesions around the sacroiliac (SI) joints are described as seen on plain radiographs or conventional tomography, with the descriptive attributes ranging from round to ovoid over square and triangular to multiform. The etiology of the solitary osteosclerotic lesions around the SI joint can often be concluded from the radiographic appearance, sometimes complemented by the presentation on CT and/or scintigraphy.

[Osteoclastic finger arthrosis--a subtype of hand polyarthrosis]. / Osteoklastische Fingerarthrose--Subtyp der Handpolyarthrose.

AIM: Description of a subtype of arthrosis deformans of the hand which is characterised as osteoclastic arthrosis. PATIENTS AND METHODS: Retrospective analysis of radiographs of the hands of 150 women and 100 men with radiological findings of arthrosis deformans. RESULTS: 5% of women and 2% of men showed at least one digital joint with subchondral osteolysis of one or both articulating bones involving at least a third of the phalanx. This subchondral osteolysis far exceeds the cysts which are situated in the epiphyseal part of the articular region. It may develop within a year. CONCLUSION: Osteoclastic arthrosis of the finger is a subtype of polyarthrosis of the hand. Serial observations suggest that an osteoclast stimulating substance is produced by the cysts or arises directly from the synovial fluid; this enters the subchondral part of the bone through clefts which may or may not be visible radiologically and that this produces osteoclastic activity. The most important differential diagnoses are chronic tophaceous gout and a benign tumor.

Acquired hyperostosis syndrome--AHYS--(sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, SAPHO-syndrome): bone scintigraphy of the anterior chest wall.

The objective of this report is to provide a description of diagnostically significant scintigraphically recognizable sites and patterns of acquired hyperostosis syndrome (AHYS) on the anterior chest wall (ACW), which is involved in 82% of AHYS patients. In 49/90 of our own AHYS patients, planar bone scans of the ACW were performed with the gamma camera, applying an average of 650 MBq of 99mTc-phosphate complexes. In addition, 53 atraumatic patients with extrathoracic cancer were available for routine whole-body scintigraphy. None of these patients had increased uptake identifiable as metastasis clinically or by imaging modalities in either the ACW or the rest of the skeleton. The scintigraphic involvement of the various morphological ACW structures is described in AHYS. Moreover, attention is called to the diagnostic significance of focal hyperactivities at the anterior end of the 2nd-8th rib of adults, which are in the 5th place with respect to their frequency in AHYS. The diagnostic significance of sternocostal-joint involvement in AHYS can likewise be recognized by bone-scan scintigraphy and will be discussed. Bone scintigraphy is more sensitive than radiomorphological imaging in AHYS. This, however, only applies under three conditions. 1. The increased radiotracer uptake in the upper sternocostoclavicular region must be assessed on both the anterior and the posterior view of the ACW scan. 2. In addition to the anterior view of the routine scintiscan, further anterior scans with reduced scan time of the gamma camera are usually necessary. This ensures better visibility of the involvement of certain morphological structures that are important for AHYS diagnosis. Moreover, a statement can be made about the inflammatory ossifying activity/inactivity of the AHYS on ACW.3. Increased radionuclide uptake in the manubrium sterni and corpus sterni on the anterior scan should be verified by additional lateral or oblique scans of the thorax (sternum).

[Comparative roentgenometry of the hand in aging]. / Vergleichende Röntgenometrie der Hand im Senium.

Increasing age is a risk factor for the development of osteoarthrosis of the joints of the hand in adults between 21 and 60 years of age. Only in the very old (> or = 80 years) is osteoarthrosis of the hand part of the age related degeneration. The literature contains different parameters and indices correlating the amounts of minerals and ashes of metacarpal bones. Our results speak in favour of the presumptions published by Exton-Smith et al. (1969 b) that bone mass belongs among the biological characteristics of old age. Our investigations of hand roentgenograms reveal that remodeling of the joint socket as described by pathologists is not a general but an elective phenomenon. With age the wrist shows only an increasing angle of the radial joint surface (males, right hand) and there is a variation of form in the medial sesamoid bone at the first metacarpus (males, left hand).

[Technique and economics of first worldwide roentgen conference via public phone lines with the Medical Desktop-Conference and Integrated Services Digital Network]. / Technik und Okonomie der weltweit ersten Röntgenbesprechung über das öffentliche Fernsprechnetz mittels medizinischer Desktop-Konferenz und ISDN.

The introduction of the world's first Medical Desktop-Conference via public phone lines (ISDN-S2M) in spring 1994 for the weekly discussion of radiological findings with 25 orthopedic surgeons has proved the effectiveness of this system developed by the project BERMED. The use of standard hard- and software as well as ISDN are the most important factors to keep the system costs low. Technical advantages can be seen in the immediate, loss-free transmission of image and other patient-related data and in the integration of digital archives. Medical advantages are the 24-hour-availability of the radiologist and quality-control of the radiologists work. Practitioners and external hospitals can be tied closely to radiological service centers by using ISDNetwork.

The supercilium acetabuli score: an additional criterion for estimating the biomechanics of the hip joint.

There are significant correlations between the surface of the acetabular roof sclerosis (supercilium acetabuli) in the hip joint on a normal a.p. radiograph and the corresponding surface of cartilage. This correlation can be defined through mathematical formulas and scaled afterwards. These scales are determined on the basis of our clinical experience with the new supercilium acetabuli score. The score is related to the biomechanical situation of the hip joint and describes 3 classes: Class I = optimum, class II = balance, class III = imbalanced correlation between the supercilium acetabuli and the corresponding part of the joint space. For simple measurement of both surfaces, we developed a measuring instrument, the superciliometer, with which it is possible to obtain standardized conclusions describing the functional morphology of the cartilage in the pressure distribution zone of the hip joint, irrespective of whether there are already any visible radiological signs of coxarthrosis or not.

[Side effects and efficiency of 15 mg and 25 mg methotrexate per week in chronic polyarthritis]. / Nebenwirkungen und Wirksamkeit von 15 mg und 25 mg Methotrexat pro Woche bei der chronischen Polyarthritis.

To examine the rate of side effects and the dose dependence of side effects 185 consecutive patients with active rheumatoid arthritis were randomized to receive 15 mg (group A) or 25 mg (group B) methotrexate (MTX) per week and studied prospectively over 12 months. Dose adjustments were performed according to tolerability and efficacy. With 168 patients eligible for evaluation the rate of withdrawal for any reason was 26% in group A and 27% in B. Withdrawal due to side effects occurred in 16% versus 18%, dose reduction due to side effects in 10% versus 9%. The higher dose was associated with a significantly higher rate of gastrointestinal side effects (28% vs. 17%, p < 0.05) and a tendency for more frequent elevations of transaminases. Other side effects were not dose dependent. A significantly higher rate of dose reduction due to improvement (35% versus 10%, p < 0.001), a more rapid decline of morning stiffness, and a higher number of patients reporting marked improvement are evidence in favour of higher therapeutic efficacy of the higher dose. In conclusion, an initial dose of 25 mg MTX/week is not associated with a higher rate of limiting side effects as compared with 15 mg/week. The efficacy of doses up to 25 mg/week should be examined in more detail.

The acquired hyperostosis syndrome: a little known skeletal disorder with distinctive radiological and clinical features.

The acquired hyperostosis syndrome (AHS) is a chronic inflammatory disorder of bone of unknown etiology. It is accompanied by circumscribed hyperostosis which can be associated with ossifying lesions at sites of tendinous and ligamentary insertions and erosive or non-erosive arthritis. The predominant location of lesions is the sternocostoclavicular region (approximately 80% of patients), less frequent are involvement of the spine, pelvis, and appendicular skeleton. In 20%-60% of cases AHS is associated with palmoplantar pustulosis, psoriasis, or severe acne (acne fulminans or conglobata). The X-ray appearance of AHS is a more or less homogeneous increase in density with blurred margins, which on scintiscan with labeled phosphate compounds is associated with intense accretion of tracer. These features are associated with a variable increase in the acute phase reactants and a conspicuously low increase, if any, in serum alkaline phosphatase. The therapeutic modalities which have been used so far are entirely symptomatic. Long-lasting improvement has been reported following percutaneous anti-inflammatory radiation therapy.

[Acquired hyperostosis syndrome (so-called pustular arthro-osteitis). Review of the literature including 73 personal cases]. / Akquiriertes Hyperostose-Syndrom (sogenannte pustulöse Arthroosteitis). Literaturübersicht einschliesslich 73 eigener Beobachtungen.

The acquired hyperostosis syndrome (AHS) (best known synonym: pustulotic arthro-osteitis) is a system disease of the supporting and gliding tissue with sites of predilection characterized by inflammation-induced bony reconstruction of positive balance. This syndrome is affiliated with the seronegative spondylarthropathies. The main finding is the sternocostoclavicular hyperostosis in about 80% of patients. Focal hyperostoses also occur on the skeleton of truncus and extremities and joints. AHS is accompanied by psoriasiform and acneform dermatoses. Overlapping findings with spondylitis ankylosans are reported. Terminology, aetiology, nosology, pathogenesis, histomorphology, clinical and laboratory findings, complications, imaging diagnostic, differential diagnosis and therapy of AHS are discussed. Knowing AHS helps to prevent misdiagnoses (as especially bacterial osteomyelitis, spondylitis, osteoplastic tumor and metastases) and interventional diagnostic procedures.

[Adhesive (retractile) capsulitis of the hip joint in diabetes mellitus. An x-ray histomorphological synopsis]. / Adhäsive (retraktile) Kapsulitis des Hüftgelenkes bei Diabetes mellitus. Röntgenologisch-histomorphologische Synopsis.

Adhesive (retractile) capsulitis of the hip joint is a rare complication (association) of (juvenile) diabetes mellitus. The clinical features, plain radiographic and CT findings and histomorphological appearances of this condition are described and attention is drawn to changes in the elastic tissue in the fibrosed capsule. Three diagnostic radiological features have been defined; in their presence, arthrography or diagnostic arthroscopy need not be performed.

[Pericoxal fat stripes and the capsule of the hip joint. The anatomical-radiological correlations]. / Perikoxale Fettstreifen und Hüftgelenkkapsel. Anatomisch-radiologische Korrelation.

The capsule of the hip joint can always be demonstrated on antero-posterior radiographs provided two conditions are met: 1. the so-called gluteus minimus fat stripe is shown and 2. the exposure is made in maximal external rotation which can be either active or, better still, passive. Under these conditions the joint capsule appears as a soft tissue band stretched between the margin ot the acetabulum and the upper end of the greater trochanter. Effusions or oedemas of the hip joint cause lateral displacement of the gluteus minimus fat stripe. Anatomical and radiological comparisons, including computed tomography, confirm that the joint capsule of the hip can be demonstrated in this way.

[Pelvic roentgenometry of the third kind: age- and sex-related measurement results in adulthood]. / Pelvine Röntgenometrie der dritten Art: alters- und geschlechtsbezogene Messergebnisse im Erwachsenenalter.

Normal values in adults for the hip joint (3.5-6 mm), the sacro-iliac joint (1-3.5 mm) and the symphysis (up to 7.5 mm) were obtained by measurements of a.p. views of the pelvis. Contrary to the literature there was no sex difference as regards the CCD. The roentgenometric features of the female and male pelvis depend on the pubic angle, the transverse diameter of the pelvic inlet and the sulcus paraglenoidalis. In females there are age-related changes consisting of a reduction of the pubic angle, increasing height of the symphysis components of the pubis and an increase in the transverse diameter of the pelvis. In the male, age changes consist of an increase of the symphysis component of the pubis and the transverse diameter of the pelvis.

[Alloarthroplasty of the hip joint. Radiologic diagnosis of loosening and infection in cemented total endoprostheses]. / Alloarthroplastik des Hüftgelenks. Radiologische Diagnostik der Lockerung und Infektion bei zementierten Totalendoprothesen.

Patients with problems following implantation of cemented total hip prostheses must be clinically examined. This examination is followed by a series of diagnostic imaging procedures. These include X-ray diagnosis, 3-phase 99mTc-MDP bone scans, scintigraphy for inflammation, and arthrography, performed singly or as sequential studies. X-ray findings and scintigraphic patterns arousing or confirming a suspicion of aseptic (mechanical) or septic (infectious) loosening of the prosthesis are evaluated and discussed.