Cystic Radiolucencies Research Articles

8-year survivorship of a 4th Generation Fixed Bearing Total Ankle Replacements

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Infinity (Wright Medical Group) Total Ankle Replacement (TAR) has been implanted in patients since 2014 and is now the most common primary ankle used in the National Joint Registry of England and Wales. We report a prospective series of 106 Infinity TARs, with 8-year survivorship data from two, non-designer centres in the UK. The primary aims were to assess survivorship and complications of the Infinity TAR. The secondary aims were to assess patient reported and radiological outcomes. Methods: Prospectively collected data between March 2014 to December 2016 was assessed from two specialist centres in the United Kingdom. All operations were performed, or supervised, by one of 5 surgeons with a minimum experience of 10 TAR per year. Inclusion criteria were any patient with end-stage tibiotalar arthritis, considered by the operating surgeon to be suitable for primary TAR. Revision TAR, or conversion from arthrodesis, were not included in this study. Implant survivorship, complications, patient reported outcome scores (PROMS) and radiological data were collected for each patient. PROMS data comprised the Manchester Oxford Foot Questionnaire (MOX-FQ) and the EuroQol-5 Dimension (EQ5D-5L) score. Pre-operatively, weight bearing radiographs were assessed for the degree of sagittal and coronal deformity. Post-operatively, weight bearing radiographs at 6 weeks were assessed for the degree of deformity correction. Cystic radiolucencies on the most recent follow up radiograph was assessed by using an established scoring system. Results: 102 patients, comprising 106 TARs, were included. Mean age at implantation was 68 years (range 42 to 89 years). Mean follow up time was 98 months (range 83 to 113 months). 12 patients received further surgeries: 8 revision TARs, 3 debridement and grafting of talar cysts, and 1 capsular release. The reasons for revision surgery were unexplained pain (5 patients), proven deep infection (1 patient), tibial subsidence (1 patient) and instability (1 patient). Mean time to revision surgery was 43 months (range 15 to 82 months). Current survivorship of the cohort is 91%. Cystic radiolucencies were present in 35% of patients but the majority were small and asymptomatic. MOXFQ and EQ5D-5L PROMS showed significant and sustained post-operative improvements (p < 0.01). Conclusion: This series of 106 modern fixed bearing TAR shows an 8-year survivorship of 91%. 3 cases of talar cysts were grafted. The most common reason for revision surgery was unexplained pain and the deep infection rate was 1%. The fixed bearing Infinity TAR appears to be a safe, effective intervention in the treatment of end stage ankle osteoarthritis and gives significant improvement in disease specific and general health status outcomes.

Single-Center, Early Experience with the First 3D-Printed Surface, Fixed Bearing, Total Ankle Arthroplasty: A Minimum of 2-Year Follow-Up

Introduction/Purpose: As the fourth generation of total ankle arthroplasty (TAA) implants evolve, treatment solutions for end- stage ankle arthritis continue to improve. Technological advancements in CT guided planning and 3-D printing offers surgeons the ability to perform TAA with patient specific instrumentation and implants. 3-D printed components are designed to act as scaffold in hopes to facilitate early in-growth, to increase implant stability, to support long-term survivorship, and ultimately to improve the quality of life our patients. We present our early experience at a single academic center with a minimum of 2-year follow up data on the first 3-D printed, fixed bearing, TAA in the United States. We hypothesize that 3-D printed technology will demonstrate improved long-term survival and increased bony in-growth on the implant-bone interface. Methods: A retrospective review was performed on patients who underwent TAA with a minimum of 2-year clinical and radiographic data in which this 3-D printed TAA was utilized at our single academic center. Patient demographic, radiographic, and functional outcome scores were collected preoperatively, at 6 months, 1 year, and 2 years. The severity of ankle arthritis and associated deformities in patients were stratified using the COFAS classification. The primary outcomes of this study were implant survivorship, comparative analysis of preoperative and postoperative Patient Reported Outcomes Measurement Information System (PROMIS) physical function scores, VAS pain scores, radiographic development of linear radiolucency >2 mm, cystic radiolucency > 5mm, subsidence, and adverse events within 2 years of surgery. Results: Thirty patients were included with a median follow-up of 26 months (range, 24-36 months). Implant survival rate was 90%. One patient was revised to a stemmed TAA secondary to tibial subsidence. One patient required a TTC fusion secondary to Charcot collapse. One patient was revised to a staged ankle fusion secondary to periprosthetic joint infection. Two patients (6.7%) experienced linear radiolucency >2mm with tibial subsidence in which one patient required a revision TAA (mentioned above) and another who was asymptomatic. No significant cystic radiolucency >5 mm were identified. Five patients required re-operation from complications unrelated to the implant. VAS scores decreased significantly from 6 (IQR, 4-8) to 1 (IQR, 2-4) (P <.001; r=0.55). PROMIS Physical scores increased significantly from 43.6 (IQR, 33-47.7) to 50.8 (44.8-57.7)(P <.001; r=0.60). Conclusion: The utilization of this new 3-D printed, fixed bearing TAA demonstrated a ninety percent overall implant survival rate in our small cohort of patients. Further data will be required to determine the long term efficacy of this new 3-D printed implant on patient outcomes. Our early experience and complications presented in our study demonstrate that this 3-D printed TAA implant is safe and effective in the treatment of end-stage ankle arthritis.

Early experience with a 3-D printed porous surface, fixed-bearing, total ankle arthroplasty: A minimum of 2-year follow-up

BackgroundThis is a pilot study reviewing patients undergoing ankle replacement with the 3-D printed INFINITY™ with ADAPTIS™ total ankle arthroplasty (TAA) system. MethodsA retrospective review was conducted of patients with a minimum two-year follow-up who underwent TAA with the INFINITY™ with ADAPTIS™ implant system. Outcome measures include implant survivorship, complications with subsequent reoperations, patient reported outcomes, and radiologic subsidence or radiolucency. ResultsThirty patients were included with median follow-up of 26 months (range, 24–36). Implant survival rate was 90% (27/30). Two patients experienced linear radiolucency > 2 mm: one required a revision TAA secondary to tibial subsidence; the other patient was asymptomatic and nonprogressive on serial radiographs. No cystic radiolucencies > 5 mm were identified. VAS, PROMIS PF, and FADI scores improved significantly. ConclusionTAA performed with the 3-D printed INFINITY™ with ADAPTIS™ implant technology led to ninety percent short term implant survivorship and improvement in patient reported outcomes with comparable results to other 4th generation arthroplasty systems as a treatment modality for end-stage ankle arthritis. Level of evidenceLevel III, Retrospective cohort study, Prognostic

Cherubism in Saudi population: a rare case report

Cherubism is a rare hereditary benign fibro-osseous disorder characterised by bilateral swelling of the mandible and/or maxilla with varying severity of involvement. It occurs because of dominant mutations in SH3BP2 gene on the chromosome 4p16.3. On radiography cherubic lesions appear as multilocular cystic radiolucencies in the jaw bones giving a soap bubble appearance. These lesions usually heal by themselves by the time the patient attains puberty. Treatment is necessary only in aggressive cases where there is severe facial deformity or vital functions are hampered. Surgical corrections are preferred when the lesion is in its dormant phase. The aim of the present case report is to illustrate a case of cherubism in a 9-year-old Saudi boy which is a very rare occurrence as only 1 case of cherubism has been reported so far in the Saudi Arabian population. KEYWORDS Cherubism; Genetic mutation; Multilocular cystic lesions; Self-regressive lesion; Calcitonin therapy.

Extended-Hours Hemodialysis without Dietary Restrictions Is Associated with Lower Risk for Developing of Dialysis-Related Amyloidosis.

Dialysis-related amyloidosis (DRA) is characterized by the deposition of amyloid consisting of beta2-microglobulin in the musculoskeletal system, causing carpal tunnel syndrome, destructive spondyloarthropathy, and/or bone cysts. Increased cystic radiolucency of the bones and tendon thickening due to inflammation are common findings in DRA. We have developed a new dialysis method, extended-hours hemodialysis without dietary restrictions for the aim of improving both hypertension and malnutrition. We retrospectively evaluated the clinical effects of dialysis time on the risk for developing of DRA. The study subjects were all of the 30 patients who had received this treatment for more than 11 years. They were divided into two groups according to the weekly dialysis hours: 15 patients ≥ 16.5 hours/week (L-group) and 15 patients ≤ 15.5 hours/week (S-group). Plain x-ray imaging and ultrasonography were used to assess cystic radiolucency of the bones and thickness/diameter of the soft tissues. The proportion of the carpal bone cystic radiolucency was lower in the L-group. The severity of median nerve compression at the wrist was significantly less in the L-group (right hand: p = 0.0082, left hand: p = 0.0137). Multivariate regression analysis showed that dialysis time was a predictor of median nerve compression (β = -0.559, p = 0.005). In conclusion, extended-hours hemodialysis without dietary restrictions contributes to lower the risk for developing of DRA at the wrist. We therefore propose that extended-hours hemodialysis without dietary restrictions is a preferred method which maintains the patients' quality of life compared with the conventional hemodialysis method.

CONSERVATIVE MANAGEMENT OF A MULTICYSTIC LESION OF THE ANTERIOR MANDIBLE: HISTOLOPATHOLOGIC ASPECTS CHANGE THE DIAGNOSIS

The present study aims to report a case of a cystic lesion affecting the left paramental edentulous mandible region in a 62-year-old female patient. The patient reported a 1-year growth history, and noted pain in the area during the last few months. Clinical inspection showed a multilobulated, translucent swelling with a well-defined cystic radiolucency aspect on imaging examination. Presurgical puncture of the lesion revealed a transparent liquid content. A cystic decompression was then performed and the obtained specimen from the roof of the lesion was submitted for histopathologic examination. The results indicated that the lesion was compatible with botryoid cyst. After 5 months, an enucleation of the lesion was performed. Surprisingly a new pathologic report changed the diagnosis to multicystic ameloblastoma. We discuss the microscopic characteristics and the changes observed on the product of enucleation, as well as its clinical implications.

Contralateral Pneumothorax Mimicking Bilateral Pneumothoraces in a Patient with Autopneumonectomy

: Contralateral pneumothorax crossing the midline in a patient with autopneumonectomy can mimic bilateral pneumothoraces on chest radiography. In this study, we report a rare case of right pneumothorax mimicking bilateral pneumothoraces in a patient with left autopneumonectomy. A 37-year-old man complained of progressive chest pain and dyspnea. The initial chest radiography revealed visible visceral pleura with air in bilateral upper pleural spaces, suggesting bilateral pneumothoraces. Mediastinal structures were shifted to the left side and increased opacities with internal tubular and cystic radiolucencies were noted in the left lower lung zone. After immediate placement of a drainage tube into the right pleural space, the patient underwent chest computed tomography (CT). CT scan revealed a destroyed and totally collapsed left lung and hyper-inflated right lung with right pneumothorax crossing the midline. The contralateral pneumothorax was then gradually absorbed by keeping the chest tube in the right hemithorax. No pneumothorax recurred in 2 years of follow-up. A greater awareness of this rare condition is important in clinical practice, as catastrophic consequences can occur if a chest tube is blindly placed in the autopneumonectomy site.

Non-familial Cherubism – Report of a case

Introduction: The Cherubism is a rare disease that affects the middle and lower third of the face in individuals at the time of childhood. It is a rare hereditary benign bone disease with an autosomal dominant inheritance. The familial distribution may affect different generations and isolated non-familial cases have also been reported in literature. Lesions appear as cystic multilocular radiolucencies, histologically, resembles central giant cell granluloma and hyperparathyroidism brown tumor with numerous randomly distributed multinucleated giant cells and vascular spaces within a fibrous connective tissue stroma. Objectives: The aim of this study is to report the importance of the diagnosis of this pathology and the variety of treatments available in the literature, thus guiding to an individualized treatment. Case Report: Caucasian 8 years-old female, in good general condition, was referred to Service of Oral and Maxillofacial Surgery of Erasto Gaertner Hospital (EGH), Curitiba – PR, Brazil, complaining of bilateral swelling of the maxilla and mandible since 4 years-old. Apparently, the girl is the first one who developed the genetic pathology in at least 4 generation of her family. After biopsy, cherubism diagnosis was confirmed and the treatment of choice was periodic monitoring. Discussion: Cherubism studies with long-term follow-up with clinical and radiographic documentation indicate that the spontaneous resolution of bone lesions is rare. Treatment of cherubism is controversial and various modalities have been reported as the use of calcitonin, osseous plasty surgery, curettage, orthognathic surgery, liposuction and palliative treatments.

First Case of Salivary Mucocele Originating from the Minor Salivary Gland of the Soft Palate in a Dog

We found a case of salivary mucocele that originated in the minor salivary gland (palatine gland) of the soft palate in a dog. At first admission, the soft palate swelled remarkably. Computed tomography (CT) revealed cystic radiolucency inside a large quantity of liquid in the soft palate, and most of the airway was occupied. Marsupialization was performed, but since a recurrence was observed one month later, the salivary mucocele was removed. There has been no report of salivary mucocele arising from the minor salivary gland of the soft palate in dogs. To our knowledge, this case is the first. Complete removal, including minor salivary glands surrounding the lesion, is necessary for treatment of salivary mucocele in dogs.

A Case of Mucoepidermoid Carcinoma Associated with Maxillary Cyst

We report a case of a mucoepidermoid carcinoma associated with a maxillary cyst. The patient was an 18-year-old man presenting with the chief complaint of left buccal swelling. The left maxillary third molar was semi-impacted in the direction of the crown on the buccal side. Orthopantomography revealed a cystic radiolucency extending over a wide area, ranging from the left maxilla to the maxillary sinus and nasal cavity. Computed tomography revealed a multilocular lesion surrounded by a thin shell of bone. Biopsy findings revealed a cystic lesion, but the cause could not be identified preoperatively. The cystic lesion was resected under general anesthesia. The lesion was multilocular and surrounded by a bone shell, and had expanded into the maxillary sinus. At the same time, indurated soft tissue adhering strongly to the palatine bone on the inferior palatine side of the lesion was resected. Histopathological examination showed a cystic lesion and mucoepidermoid carcinoma. An additional resection was planned and the maxilla partially resected. Mucoepidermoid carcinomas usually occur in the parotid and minor salivary glands, but in rare cases appear in the center of a jaw bone, almost always in the mandible. In the present case, the carcinoma was associated with a cystic lesion believed to have developed from maxillary bone and involved an impacted tooth adjacent to the tumor. This suggested a central mucoepidermoid carcinoma in the maxillary cyst. Postoperatively, the missing teeth have been replaced with a denture and the course has been good, with no recurrences or metastases identified.

Postoperative Maxillary Cyst: A Case Report

Postoperative maxillary cyst is a quite rare delayed complication of surgical intervention associated with maxillary sinuses. It occurs many years after surgery. This paper describes a 54-year-old woman presenting with swelling of left cheek for seven-years duration. The orthopantomograph revealed a unilocular cystic radiolucency with well-defined margins in left maxillary sinus. In the computerized tomography, the cyst had a sclerotic wall with bony condensations. Aspiration cytology revealed many neutrophil leukocytes. Cyst was drained and enucleated. Histopathologically, it had a fibrous wall with inflammation and focal reactive bone formation and lined by a respiratory-type epithelium. In the clinical history, it is learned that she had a maxillary sinus surgery 8 years ago and the diagnosis was made considering the clinical and histopathological findings.

慢性血液透析患者における肩関節超音波検査の検討― 透析アミロイドーシス診断の指標としてのshoulder-capsular distance (SCD)―

Dialysis-related amyloidosis (DRA) is a serious complication in patients receiving long-term hemodialysis. Intrigued by the fact that the shoulder joint is primarily favored by DRA, we measured the shoulder-capsular distance (SCD) by ultrasonography to investigate the relationship between SCD and the duration of hemodialysis, patient age and biochemistry findings. The SCD of patients receiving hemodialysis was significantly increased, and there was a positive correlation between SCD and the duration of hemodialysis. The SCD tended to show a significant increase in patients receiving long-term hemodialysis over 10 years. Although the SCD was not significantly correlated with serum levels of beta 2-microglobulin and C-PTH, there was a significant positive correlation between the SCD and the serum levels of AI. In patients receiving long-term hemodialysis for 10 years or more, the SCD was increased significantly in the groups patients with the complications of carpal tunnel syndrome (CTS), cystic radiolucencies (CRL) or destructive spondyl arthropathy (DSA) compared with the value in complication-free patients. The results of this study suggest that the majority of patients with SCD > 8mm had the complication of DRA. Since ultrasonography is a non-invasive, east-to-perform procedure, ultrasonographic measurement of the SCD seems to be useful in the diagnosis of DRA.

Intraosseous Embolotherapy of Central Arteriovenous Malformations in the Jaw: Long-Term Experience With 8 Cases

To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw. Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraosseous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression. Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications. Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.

Rotational Acetabular Osteotomy for Advanced Osteoarthritis Secondary to Dysplasia of the Hip

Satisfactory intermediate and long-term results of rotational acetabular osteotomy for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study was to examine the results of rotational acetabular osteotomy in patients with advanced osteoarthritis secondary to developmental dysplasia of the hip. We performed a retrospective review of the results of rotational acetabular osteotomy in forty-three patients (forty-three hips). All of the patients had radiographic evidence of advanced-stage osteoarthritis, defined as narrowing of the joint space with cystic radiolucencies and small osteophytes according to the staging system of the Japanese Orthopaedic Association. Forty-one patients were female, and two were male. The mean age was 43.8 years at the time of surgery, and the mean duration of follow-up was 8.5 years. Clinical follow-up was performed with use of the system of Merle d'Aubigné and Postel. The center-edge angle, acetabular roof angle, head lateralization index, and minimum width of the joint space were measured on radiographs made preoperatively, postoperatively, and at the time of final follow-up. Postoperative joint congruency was classified into four grades. The mean preoperative Merle d'Aubigné clinical score was 13.3 points, which improved to a mean of 15.4 points at the time of the latest follow-up (p < 0.0001). The mean center-edge angle improved from 0.7 degrees preoperatively to 29 degrees at three months postoperatively (p < 0.0001), the mean acetabular roof angle improved from 30 degrees to 11 degrees (p < 0.0001), the mean head lateralization index improved from 0.69 to 0.65 (p < 0.01), and the mean minimum width of the joint space improved from 2.2 to 2.5 mm (p < 0.0003). Ten hips had radiographic evidence of progression of osteoarthritis. Kaplan-Meier survivorship analysis, with radiographic signs of progression of osteoarthritis as the end point, predicted a ten-year survival rate of 72.2%. Rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip in properly selected patients can improve clinical scores and is associated with a lack of radiographic signs of progression of osteoarthritis in most patients.

ROTATIONAL ACETABULAR OSTEOTOMY FOR ADVANCED OSTEOARTHRITIS SECONDARY TO DYSPLASIA OF THE HIP

Background: Satisfactory intermediate and long-term results of rotational acetabular osteotomy for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study was to examine the results of rotational acetabular osteotomy in patients with advanced osteoarthritis secondary to developmental dysplasia of the hip. Methods: We performed a retrospective review of the results of rotational acetabular osteotomy in forty-three patients (forty-three hips). All of the patients had radiographic evidence of advanced-stage osteoarthritis, defined as narrowing of the joint space with cystic radiolucencies and small osteophytes according to the staging system of the Japanese Orthopaedic Association. Forty-one patients were female, and two were male. The mean age was 43.8 years at the time of surgery, and the mean duration of follow-up was 8.5 years. Clinical follow-up was performed with use of the system of Merle d'Aubigné and Postel. The center-edge angle, acetabular roof angle, head lateralization index, and minimum width of the joint space were measured on radiographs made preoperatively, postoperatively, and at the time of final follow-up. Postoperative joint congruency was classified into four grades. Results: The mean preoperative Merle d'Aubigné clinical score was 13.3 points, which improved to a mean of 15.4 points at the time of the latest follow-up (p < 0.0001). The mean center-edge angle improved from 0.7° preoperatively to 29° at three months postoperatively (p < 0.0001), the mean acetabular roof angle improved from 30° to 11° (p < 0.0001), the mean head lateralization index improved from 0.69 to 0.65 (p < 0.01), and the mean minimum width of the joint space improved from 2.2 to 2.5 mm (p < 0.0003). Ten hips had radiographic evidence of progression of osteoarthritis. Kaplan-Meier survivorship analysis, with radiographic signs of progression of osteoarthritis as the end point, predicted a ten-year survival rate of 72.2%. Conclusions: Rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip in properly selected patients can improve clinical scores and is associated with a lack of radiographic signs of progression of osteoarthritis in most patients. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Rotational Acetabular Osteotomy for Advanced Osteoarthritis Secondary to Dysplasia of the Hip

Satisfactory intermediate and long-term results of rotational acetabular osteotomy for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study was to examine the results of rotational acetabular osteotomy in patients with advanced osteoarthritis secondary to developmental dysplasia of the hip. We performed a retrospective review of the results of rotational acetabular osteotomy in forty-three patients (forty-three hips). All of the patients had radiographic evidence of advanced-stage osteoarthritis, defined as narrowing of the joint space with cystic radiolucencies and small osteophytes according to the staging system of the Japanese Orthopaedic Association. Forty-one patients were female, and two were male. The mean age was 43.8 years at the time of surgery, and the mean duration of follow-up was 8.5 years. Clinical follow-up was performed with use of the system of Merle d'Aubigné and Postel. The center-edge angle, acetabular roof angle, head lateralization index, and minimum width of the joint space were measured on radiographs made preoperatively, postoperatively, and at the time of final follow-up. Postoperative joint congruency was classified into four grades. The mean preoperative Merle d'Aubigné clinical score was 13.3 points, which improved to a mean of 15.4 points at the time of the latest follow-up (p < 0.0001). The mean center-edge angle improved from 0.7 degrees preoperatively to 29 degrees at three months postoperatively (p < 0.0001), the mean acetabular roof angle improved from 30 degrees to 11 degrees (p < 0.0001), the mean head lateralization index improved from 0.69 to 0.65 (p < 0.01), and the mean minimum width of the joint space improved from 2.2 to 2.5 mm (p < 0.0003). Ten hips had radiographic evidence of progression of osteoarthritis. Kaplan-Meier survivorship analysis, with radiographic signs of progression of osteoarthritis as the end point, predicted a ten-year survival rate of 72.2%. Rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip in properly selected patients can improve clinical scores and is associated with a lack of radiographic signs of progression of osteoarthritis in most patients. Therapeutic Level IV.

Postoperative Maxillary Cyst

The postoperative maxillary cyst develops as a delayed complication many years after radical operation on the maxillary sinus to relieve chronic sinusitis. Trapping of the mucosa of the maxillary sinus in the wound and closure of the nasoantral window made beneath the inferior turbinate before filling of the postoperative bony cavity by regenerated granulation tissue are believed to be most responsible for the development of this cyst. Although reports of the cyst are extremely rare in the English literature, it has constituted more than 20% of jaw cysts in Japan. However, the incidence has decreased to 16% to 17% because of the decrease in chronic maxillary sinusitis and the surgical intervention for treatment of the disease. The cyst occurs more often in men than in women, developing in the fourth and fifth decades 10 to 30 years after radical sinus surgery. The most common symptoms are swelling and pain in the cheek and the mucogingival fold. Radiographically, the cysts appear as unilocular or multilocular, well-defined, cystic radiolucencies in the region of the maxillary sinus. CT is quite useful in clarifying the number, size, location, and shape of the cysts, as well as bony perforation and involvement of tooth apices. A Caldwell-Luc type of operation is usually performed for the treatment of these cysts. A small cyst can be treated by enucleation and primary closure or enucleation and open packing. Marsupialization is also used for large cysts with extensive bony perforation. In most cases, the cysts have a relatively thin cyst wall and contain brown, mucinous fluid. The prognosis is good, but recurrence is encountered in a limited number of cases. Histologically, the lining is mainly ciliated columnar epithelium, but transition to columnar, cuboidal, and squamous epithelia is often observed, even in a single cyst.

A clinical study of dialysis-related osteoarthropathy in long-term hemodialysis patients

Amyloid osteoarthropathy has been seen frequently in long-term hemodialysis (HD) patients, in which the bone X-ray examination reveals characteristic cystic radiolucency (CRL) of the carpal bone, shoulder joint, hip joint and knee joint, and destructive spondylarthropathy (DSA) of cervical vertebrae. To clarify the clinico-pathological significance of CRL and DSA in HD-related amyloidosis, we investigated the grade and frequency of CRL or DSA and these relationship with age, HD duration, primary diseases, osteoarticular symptoms and blood analysis in 817 HD patients (492 male and 325 female, age: 52.6 + 15.5 years, dialysis duration: 6.8 + 5.4 years). The number of cases with osteoarticular symptoms increased with the prolongation of HD duration. CRL and DSA were observed even in patients without osteoarticular symptoms: 26.7% for carpal bone, 26.2% for shoulder joint, 17.3% for hip joint and 22.2% for DSA. The grade and frequency of CRL and DSA also increased in accordance with age and HD duration. In patients with CRL of the carpal bone, shoulder CRL was noticed in 39.7%, hip CRL in 25.8%, and DSA in 14.3% of cases, respectively, and these frequencies increased with the prolongation of HD duration. In the carpal CRL negative group, shoulder CRL was noticed in 14.6%, hip CRL in 7.5%, and DSA in 6.0%, respectively. Although there was no relationship between CRL or DSA and serum beta 2-MG level in any of the cases, the serum beta 2-MG level was lower in patients with HD showing shoulder CRL (+2) and DSA (+) for more than 16 years. No significant relationship was noticed between CRL or DSA and serum C-PTH and aluminum level. These results suggested that aging was related to CRL or DSA formation in dialysis-related amyloidosis. The findings also suggested that systemic bone X-ray examination should be considered in patients with carpal bone CRL, high-age patients and long-term HD patients even without osteoarticular symptoms.

Diagnostic aspects of beta 2-microglobulin amyloidosis.

Osteoarticular symptoms and signs, such as carpal tunnel syndrome, periarthritis humeroscapularis, synovial and joint inflammation, lead to the clinical diagnosis of beta 2-microglobulin (beta 2-M) amyloidosis. Radiologically, destructive arthropathy, spondylarthropathy and periarticular cystic bone radiolucencies can be demonstrated by plain X-ray and conventional and computed tomography. Magnetic resonance is used to visualize amyloid masses in special locations such as the cervical spine. Joint ultrasonography demonstrating thickening of synoviae and tendons has become a useful non-invasive diagnostic tool, although it is not specific for beta 2-M amyloidosis, and results depend on observer experience. Efforts to develop more specific methods for demonstration of amyloid deposits have led to two scintigraphic techniques based on the injection of radiolabelled proteins which are incorporated into the amyloid tissue. One method uses serum amyloid P component, a non-specific constituent of all types of amyloid. An alternative imaging technique based on radiolabelled beta 2-M as the specific precursor molecule of beta 2-M amyloidosis appears to be a more sensitive diagnostic method. Both tracer techniques have been used so far only in small single-centre clinical studies, and a more widespread application will require the introduction of recombinant material as the protein source for labelling. The 'gold standard' for the definitive diagnosis of beta 2-M amyloidosis, and also for reference in the evaluation of new diagnostic techniques, remains the histomorphological demonstration of beta 2-M amyloid by Congo red staining, green birefringence under polarized light, positive immunostaining with anti-beta 2-M antibodies, and electronoptic visualization of amyloid fibrils in tissue obtained invasively by biopsy, surgery or autopsy.

Cystic radio-lucency of carpal bones in haemodialysis patients An early indicator of the onset of carpal tunnel syndrome

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radiolucency of carpal bones in 35% of the hands. Radiographs were classified into three groups: Group A—cyst growing, Group B—cyst not growing, and Group C—cyst absent. The prevalence of carpal tunnel syndrome was 100% ( 27 27 ) in Group A, 5.6% ( 1 18 ) in Group B, and 6.5% ( 6 93 ) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.