Post-traumatic heterotopic ossification of distal tibiofibular syndesmosis mimicking a surface osteosarcoma.

AIM: To present the imaging features of post-traumatic heterotopic ossification (HO) of the distal tibiofibular syndesmosis initially suspected to be a surface osteosarcoma. MATERIALS AND METHODS: A retrospective review was conducted of the presenting complaint and imaging features of patients with a final diagnosis of HO referred over an 8 year period to a specialist orthopaedic oncology centre. RESULTS: Five patients with HO were identified. All were adult males with an age range of 19-41 years. There was a history of prior ankle trauma in all cases but the significance was not recognized at the time of referral to the specialist centre. There was radiographic evidence of HO arising from the inner aspects of the distal tibia and fibula approximately 3 cm proximal to the ankle joint. The HO was "kissing" in two cases and partially fused (synostosis) in two. The HO in the fifth case was arising on the inner fibular cortex alone. Magnetic resonance imaging (MRI), available in four cases, showed predominantly low signal intensity due to the dense bone formation. CONCLUSION: The history of prior ankle trauma with ossification arising from the inner aspects of both the distal tibia and fibula is typical of post-traumatic HO and distinguish this benign condition from the rare surface osteosarcoma at this site.

[Histopathology of graft-versus-host disease]. / Histopathologie der Graft-versus-Host-Erkrankung.

Graft-versus-host disease (GvHD) occurs as a major complication in 35%-50% of all patients undergoing allogeneic stem cell transplantation. A distinction is made between acute and chronic GvHD depending on the time of onset, type of clinical symptoms and histology. Both forms preferably show manifestations in the skin, mucosal membranes, gastrointestinal tract, liver and (less often) lung. As the clinical presentation is rather unspecific, particularly for the diagnosis of acute GvHD, histology is important to exclude infectious diseases or drug reactions. This review covers the diagnostic morphological criteria and differential diagnoses of GvHD in the skin, gastrointestinal tract and the liver.

[Reactivation of tuberculosis with Mycobacterium bovis infection of the oral mucosa during immunosuppression]. / Tuberkulosereaktivierung mit Mycobacterium-bovis-Infektion der Mundschleimhaut unter Immunsuppression.

HISTORY: A 70-year-old woman who had for five years been treated with tumour necrosis factor (TNF)-a-inhibitors for rheumatoid arthritis was admitted because of treatment-refractory oral ulcerations and persisting considerable soft-tissue swelling over the left maxilla. INVESTIGATIONS AND DIAGNOSIS: Multiple mucosal biopsies from the left maxillary sinus revealed necrotizing granulomatous inflammation suspicious of mycobacterial infection. This was subsequently confirmed in concurrent microbiological cultures and ultimately identified as Mycobacterium bovis. This species of the mycobacterium tuberculosis complex has in recent times rarely been seen in clinical practice in Germany. On further questioning the patient reported that she had been treated for "lung disease" as a schoolgirl. TREATMENT AND COURSE: The patient was isolated and quadruple therapy with isoniazide (INH), rifampin (RMP), ethambutol (EMB) and pyrazinamide (PZA) was initiated. Rapid improvement of her condition occurred within two weeks. When microbiological sub-typing using 16s-RNA sequencing had confirmed M. bovis, PZA was replaced by moxifloxacin. CONCLUSION: When investigating the cause of treatment-refractory infections and ulcerations, particularly among immunosuppressed patients, consideration should always be given to mycobacterial infections. Detailed and targeted history-taking is vital.

Torsion of the testicular appendix: importance of associated acute inflammation.

BACKGROUND: Torsion of the testicular appendix is the commonest cause of acute scrotum in children. The histological picture of these cases is variable and many show a heavy acute inflammatory cell infiltrate, unlike the response to pure ischaemic necrosis in other organs. The clinical implications and consequences of this associated inflammation are not clear. METHODS: A retrospective review of all cases presenting with torsion of the testicular appendix between 1987 and 2005 was carried out. In all, 79 cases were reviewed and the degree of acute inflammatory cell infiltrate and other morphological parameters were assessed and compared with the patients' clinical, operative and postoperative findings. Stains for bacteria and fungi were examined. RESULTS: A positive correlation was found between the severity of acute inflammatory cell infiltrates and the longer duration of symptoms and presence of clinical evidence of torsion of the testicular appendages. No other association was detected between the pattern or degree of acute inflammatory cell infiltrate and any other clinicopathological variable that may indicate pyogenic infection. No bacteria or fungal elements were identified. Marked lymphatic dilation may be the only histological finding to indicate the presence of early torsion in cases of scrotal pain secondary to torsion of the appendix testis. CONCLUSION: Heavy acute inflammatory cell infiltrates in the torted testicular appendix can be regarded as marker of progression of this condition. Investigation for infection is therefore not necessary in such cases.

[Ultrasonics in the differential diagnosis of space-occupying lesions of the kidney in children]. / Sonographie in der Differentialdiagnose raumfordernder Nierenerkrankungen bei Kindern.

During the last few years the coordination of ultrasound, radiology and urologic surgery led to the diagnosis and treatment of numerous diseases of the kidney. From 1976 till the beginning of 1979 we were able to diagnose 50 expanding retroperitoneal processes. These were hydronephroses, malignant tumors and enlargement of the kidney due to inflammatory affections ensuing nephrolithiasis as well as urosepsis and shock. The fact that sonography is a harmless, non invasive, simple and often repeatable examination is the most important advantage. Provided that ultrasound diagnosing is performed by an experienced person, there is a good correlation to the common x-ray methods and specially recommended for postoperative controls.

[Cardiac parameters of the newborn after tocolysis (author's transl)]. / Kardiale Parameter beim Neugeborenen nach Tokolyse.

Since 1971 premature labor has been treated with Fenoterol and Verapamil in the Department of Obstetrics and Gynecology of the University in Mannheim. In animal experiments as well as in the isolated fetal cardiac muscle elective myocardial necroses were observed following stimulation with beta-sympathomimetics. These lesions are prevented by additional application of Ca++-antagonists. Fenoterol and Verapamil are capable of passing through the placenta. To evaluate the question whether a possible cardiac lesion of the infant is caused by tocolysis, 31 newborns of mothers after tocolysis were compared to a group of 19 infants without tocolysis. At the first day of life as well as at the age of 2 and 4 weeks ECG was registered, and the serum electrolytes K+, Ca++ and Mg++ were determined. At day 1 and day 4 as well as during the 2nd and 5th week CK and CK-MB were measured, and during the 2nd week the size of heart was registered. We were unable to demonstrate pathological cardiac findings in newborns following tocolysis which were related to the preceding medication.

[Diagnostic procedure of abdominal masses in childhood (author's transl)]. / Zur Diagnostik abdominaler Tumoren im Kindesalter.

As abdominal tumor in childhood show a high rate of malignancy, a quick and exact diagnostic management is necessary. Different diagnostic procedures are described and their value in finding the diagnosis is discussed.