Differential diagnosis between osteomyelitis and bone tumors.

BACKGROUND: Hematogenous osteomyelitis is often difficult to distinguish from a bone tumor because clinical findings are noncontributory and radiological features can mimic a bone tumor. Recently, the penumbra sign, a higher signal intensity feature of the thin layer of granulation tissue which lines the abscess cavity on T1-weighted magnetic resonance (MR) images, has been reported to be helpful for discriminating subacute osteomyelitis. PURPOSE: To determine helpful findings for distinguishing osteomyelitis from bone tumors. MATERIAL AND METHODS: The laboratory and imaging findings of a consecutive series of 244 patients referred to our institution with a suspected bone tumor were reviewed. There were 15 cases of osteomyelitis, 160 bone tumors, and 69 tumor-like lesions. RESULTS: In osteomyelitis, the C-reactive protein (CRP) level increased in nine patients and the penumbra sign was seen in 11 patients. In bone tumors and tumor-like lesions, a high CRP level was observed in 21 patients and the penumbra sign was seen in two patients. The sensitivity of the penumbra sign for osteomyelitis was 73.3%, with a specificity of 99.1%. CONCLUSION: The penumbra sign and a high CRP level support the diagnosis of osteomyelitis and may help to exclude the presence of a tumor.

Major-nerve schwannomas versus intramuscular schwannomas.

BACKGROUND: A schwannoma is a benign peripheral nerve tumor. Predicting the involvement of a nerve on symptoms or magnetic resonance (MR) findings is crucial to the diagnostic process. PURPOSE: To compare symptoms, MR findings, and histological findings between major-nerve schwannomas and intramuscular schwannomas. MATERIAL AND METHODS: Thirty-four patients with 36 palpable schwannomas (29 major-nerve schwannomas and seven intramuscular schwannomas) surgically excised and proven histologically were retrospectively reviewed. RESULTS: Frequencies of the Tinel-like sign, split-fat sign, entering and exiting nerve, and low-signal margin indicate the presence of a nerve, and were significantly higher in major-nerve schwannomas than in intramuscular schwannomas. In tumor morphological patterns (target sign, inhomogeneous and homogeneous pattern), there were no significant differences between major-nerve schwannomas and intramuscular schwannomas. Schwannomas showing the target sign histologically tended to be less degenerative. All major-nerve schwannomas and five of the intramuscular schwannomas produced some characteristic symptoms and/or MR findings, but two intramuscular schwannomas did not have any characteristic symptoms and findings. CONCLUSION: In major-nerve schwannomas, the Tinel-like sign, split-fat sign, entering and exiting nerve, and low-signal margin are commonly observed and useful for diagnosis. In intramuscular schwannomas, these characteristic findings are less common, which makes diagnosis difficult.

Hemispatial sunglasses: effect on unilateral spatial neglect.

OBJECTIVE: To investigate whether using glasses shaded on the non-neglected side would lead to less unilateral neglect during pencil-and-paper activities. DESIGN: Descriptive study of ten patients. One remarkable case is described in detail. SETTING: Rehabilitation medicine department in an urban general hospital. PATIENTS: Ten hemiplegic patients showing left unilateral neglect during pencil-and-paper activities. INTERVENTION: Use of glasses in which the right half of each lens was shaded by a darker lens like those used in sunglasses. MAIN OUTCOME MEASURES: For unilateral neglect: (1) deviation from marking the middle of a 20-cm horizontal line; (2) number of lines left unmarked on the left hand portion of a page of 40 randomly oriented lines; (3) degree of failure to copy a representation of a cube. RESULTS: Among the ten patients, improvement was mixed for each of the three outcome measures. One patient, however, demonstrated dramatic and lasting improvement in functional activities by wearing the hemispatial sunglasses. CONCLUSION: Hemispatial sunglasses appear to have a potentially specific effect on visual neglect in certain patients with right hemispheric lesions. Further investigation is necessary to determine the nature of this effect and its scope of applicability.