History Of Hemophilia Research Articles

The History of Hemophilia in Iran.

The History of Hemophilia in Iran.

Intraduodenal hematoma presenting with small bowel obstruction, pancreatitis, and subsequent obstructive jaundice in a hemophiliac patient

Introduction: Intraduodenal hematoma (IDH) is a rare cause of small bowel obstruction. IDH usually results from blunt trauma to the abdomen. case report : We report a case of a 24-year-old male with a history of hemophilia A who presented with intraduodenal hematoma presenting with small bowel obstruction, pancreatitis, and subsequent obstructive jaundice. conclusion: spontaneous intraduodenal hematomas are rare clinical entity warrants high index of suspicion in patients with underlying risk factors such as hemophiliac patients.

Radial artery pseudoaneurysm: A rare complication after arthroscopic treatment of a volar wrist ganglion in a hemophilia patient

Vascular complications of wrist arthroscopy are rare. We report the case of a 42-year-old male patient with a history of hemophilia who had a ganglion located where the radial pulse is taken that had been causing him pain for five months. After infusion of Exacyl (antifibrinolytic agent), the ganglion was drained arthroscopically. Fifteen days later, the patient presented with a pseudoaneurysm of the radial artery requiring urgent reoperation.

Judith Graham Pool and the discovery of cryoprecipitate

The history of concentrated factor VIII (FVIII) beginsin the early 1940s, when Edwin J. Cohn [1] pioneeredfractionation of plasma with various proportions ofethanol. His ‘fraction I’ contained fibrinogen and alsoFVIII (but methods of assay had not yet been devel-oped) and von Willebrand factor (which had not yetbeen defined). The utility of fraction I in haemophiliawas demonstrated early [2] and modest amounts wereused in developed countries throughout the 1950s and1960s, but its sterile production required a large labo-ratory. A commercial version became available in theUnited States as a concentrate of fibrinogen, rich inFVIII; in one measurement [3], the ratio of FVIII tototal protein was sevenfold that of native plasma. In1965, it cost about 17.5 cents (U.S. $ 0.175) per FVIIIunit [4]. Meanwhile, community blood banks wereseparating and freezing plasma from whole blood forlocal use. Blood banks in the United States generallyset the price of plasma low, as a by-product of wholeblood collection, so it was widely used. The hemostat-ic efficacy of whole plasma was sub-optimal becauseonly a limited volume could be infused at one time.In the early 1960s, Cutter Laboratories in Berkeley,California, and its scientists were trying to make animproved concentrate of FVIII, with help from north-ern California ‘clotters’, including Paul M. Aggeler ofthe University of California at San Francisco andJudith Graham Pool of Stanford University. I had thefelicity of being a haematology Fellow in Dr. Aggeler’slaboratory from 1962 to 1965, which were headyyears in the history of haemophilia treatment.The first FVIII concentrate I ever saw, in 1963, wasan experimental, lyophilized product from Cutter Lab-oratories. We were planning to extract all remaining,very rotten teeth from a malnourished man withsevere haemophilia A, to prepare him for dentures.We dreaded the event: a similar patient, who had thesame operation a year earlier, was hospitalized for2 weeks, needing several bags of plasma per day plusoccasional red blood cell transfusions. With the pre-cious new concentrate, however, our patient’s hemo-stasis during dental extractions was perfectly normal.Cutter could not produce much of this marvellousmaterial because the yield of concentrated FVIII fromplasma was low. Enter Dr. Judith Graham Pool.She had earned her Ph.D. in physiology from theUniversity of Chicago in 1946 and had joined the fac-ulty of Stanford University in 1953, investigatingcoagulation with particular attention to FVIII. WithJean Robinson, she had developed the ‘two-stage’assay for FVIII in 1959. In the early 1960s she usedthat method to assay FVIII in plasma fractions pre-pared by Cutter’s Drs. Albert Pappenhagen andEdward Hershgold. Their starting material was pooledplasma, frozen in large containers, which they thawedcautiously. They knew that the potency of FVIII inplasma dwindled at room temperature, so they werecareful not to thaw the plasma completely. But Dr.Pool found very little FVIII in their thawed superna-tant. She then tested the small amount of unthawed,fibrous-looking paste at the bottom of the containers,and, in 1964, found the FVIII [5].The genius of Dr. Pool was her leap from that labo-ratory observation to the practical idea of using thelast-to-thaw property of FVIII to separate ‘cryoprecipi-tate’ from whole plasma in an ordinary blood bank,re-freezing the small volume in its own sterile plasticbag and storing bags in a freezer so that eventuallyseveral could be given to a patient at one time [4].Meanwhile, the thawed plasma could be used forextraction of other plasma proteins. The method wasso simple, and cost so little for the additional materi-als, that it was rapidly copied by blood banks aroundthe world. Cryoprecipitate became widely availablenot only for patients with haemophilia A or vonWillebrand disease but also for patients deficient infibrinogen or factor XIII. It was a great, miraculousgift to the world. Many tens of thousands of patientshave benefitted.Meanwhile, more highly concentrated commercial,lyophilized FVIII preparations were developed, usingvarious technologies (often including cryoprecipita-tion). The first was licensed in the USA at the end ofthe 1960s and then cost ten cents (U.S.$0.10) perFVIII unit in Los Angeles. We quickly adopted its useand, by 1970, started to introduce our haemophiliapatients to self-infusion at home. Our local bloodbank had switched from the use of glass bottles forblood collection to plastic bags only in the late 1960s,delaying the development of cryoprecipitate. Further-more, instead of charging only the incremental costsof the additional processing required to extract

Interprosthetic humeral fracture revision using a tibial allograft total elbow prosthetic composite in a patient with hemophilia A : a case report

IntroductionInterprosthetic fractures of the humerus are rare. Revisions of total elbow arthroplasty components in these cases are difficult. We report the first case of a patient with hemophilia who underwent a revision with a tibial allograft prosthetic composite without the need for hardware augmentation.Case presentationA 43-year-old Caucasian man with a history of hemophilia and transfusion-related human immunodeficiency virus and hepatitis B and C presented with an interprosthetic fracture of his humerus after months of pain between his total elbow and total shoulder arthroplasties. Because of the poor remaining bone stock available in his distal humerus, a revision using a barrel-staved tibial allograft prosthetic composite was performed. Our patients’ factor VIII level was optimized before the operation and he suffered no major long-term complications at 28 months. His only complication was an incomplete radial nerve palsy that ultimately recovered and left him with some numbness on the dorsum of his hand.ConclusionCareful use of an allograft prosthetic composite is a very reasonable option when a patient experiences an interprosthetic fracture. We have successfully performed revision total elbow arthroplasty for a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation, which resulted in his return to full activities of daily living, minimal pain and full incorporation of the allograft to host bone.

Splenic rupture and intracranial haemorrhage in a haemophilic neonate: Case report and literature review

Splenic rupture and intracranial haemorrhage are life-threatening conditions infrequently encountered in neonates without history of birth trauma. External manifestations of birth trauma; namely, capput succadeneum and cephalhematoma, when present raise suspicions for more serious intracranial or visceral damage. Rupture of normal spleen without an obvious source of trauma in haemophilic neonate is a rare event. The concurrence of both conditions and the unusual presentation make this case a rare one that is seldom encountered in the literature. Additionally, when splenic rupture occurs, the consensus is to employ all non-operative techniques aimed at salvaging the spleen, thus avoiding the immune-compromised state associated with splenectomy. However, in this case, we present a 3-day-old male with family history of haemophilia A, who was diagnosed with splenic rupture and bilateral subdural haematomas and underwent splenectomy, albeit with post-operative complications, in light of haemodynamic instability and high ongoing transfusion requirements.

The history of hemophilia

The history of hemophilia

Experience with a single dose of recombinant activated factor VII for the management of mild-to-moderate bleeds in haemophilia

Experience with a single dose of recombinant activated factor VII for the management of mild-to-moderate bleeds in haemophilia

Primary Esophageal B-Cell Lymphoma

A 43-year-old man with a history of hemophilia and hepatitis C presented to an outside hospital with hematemesis and concomitant 6-g/dL drop in hemoglobin. He had a history of solid/liquid dysphagia and odynophagia during the last 6 months. Initial esophagogastroduodenoscopy (EGD) showed large blood clots in the proximal esophagus that obstructed the view. A computed tomography scan of the chest showed a heterogeneous density soft tissue mass within the lumen or arising from the wall of the esophagus, likely a clot distending.

Diary Observational Study in Hemophilia (DOSE): Evaluation of Enrolled Population and Overall Diary Data Capture in Congenital Hemophilia Patients with Alloantibody Inhibitors.

Abstract 3484Poster Board III-421 IntroductionTreatment of bleeding episodes in patients with congenital hemophilia (CH) can be complicated by the development of alloantibodies (inhibitors). This results in “difficult to control” bleeding episodes, which could lead to significant joint disease and decreased quality of life (QoL). As the site of treatment has moved from the hemophilia treatment center (HTC) and hospital to the home setting, the correlation between prescribed care and the way patients and their families manage their disease at home and the effects on daily life deserves attention. This analysis reports the overall results of the recently completed DOSE study. MethodsPatients with congenital hemophilia with inhibitors (CHwI) with 4+ bleeding episodes in the prior 3 months who were prescribed rFVIIa (NovoSeven, Bagsvaerd, Denmark) as their first line or recommended therapy for bleeding episodes including breakthrough bleeds on prophylaxis were eligible for the study. The patients or their caregivers captured all bleed treatments, daily activities, QoL [EQ-5D, health and pain visual analog scales (VAS)], family anxiety/stress, and activity changes over a period of at least 90 days or until they captured 4 bleeds. Patients or caregivers recorded data in primary paper diaries with optional internet-based data entry. Participating sites completed registration forms with demographics, hemophilia history, and descriptions of currently prescribed care. ResultsThere were 51 patients enrolled in this study from 18 participating sites. Mean age was 22.6 years (median 16.1), with 27.5% less than age 11, 19.6% ages 11-18, and 39.2% over age 18. The majority were white (70.6%). Mean (SD) weight was 72.4 (43.8) kg (median 61.0 kg). Nearly half (49%) had a central venous access device. The patients were diagnosed with hemophilia A (84.3%) or hemophilia B (15.7%) with inhibitors, with current severity of illnesses described as severe (76.5%) or moderate/severe (19.6%) in most patients. Mean (SD) age at diagnosis was 0.5 (0.7) years (range 0-4 years). Mean (SD) age at first bleed was 0.6 (0.9) years (range 0-6 years). Most subjects had a history of joint bleeds, with muscle, mucosal, and head bleeds also reported. Mean (SD) number of bleeds in the past year was 17.6 (15.4) with mean number of severe bleeds reported as 5.9 (9.2). There were 45.1% reported to have ever had immune tolerance. First line therapy for joint bleeds was rFVIIa in 94.1% with a mean (median) initial dose of 152.2 mcg/kg (120.0), with 33% prescribed 250-270 mcg/kg. Initial dosing for muscle and other bleeds was similar. From the enrolled population, at least 38 patients have completed paper or electronic diaries of 22-180 days duration (median 96 days). There were over 3705 total diary days captured, including 174 bleeding events and 421 bleed treatment days. On average, bleed days accounted for 7.6% of diary days (range 0-68.6%). Of the 174 bleeds, 100 were joint bleeds including 37 target joint bleeds, 19 were muscle bleeds, 4 were mouth/gum bleeds, 2 were in the brain, 1 was in the nose and 1 was in/on the skin, 31 were other. There were instances of two types of bleeds reported during the same episode. Bleed duration was reported as 2.6 (3.0) days (range 1-26). ConclusionsDOSE represents the first large-scale diary study in the small population of patients with congenital hemophilia with high responding inhibitors. In this preliminary analysis of the data, there are several unexpected and previously unpublished results: 1) there is a surprisingly large number of patients with central venous access particularly when considering the mean age of the group, 2) less than half of the patients have undergone immune tolerance despite the fact that the participating centers are all established Hemophilia Treatment Centers, 3) a significant proportion of patients use doses of 250-270 mcg/kg. We expect further detailed analysis to provide valuable data and insight from which hypotheses can be generated for future studies of this rare patient population. Disclosures:Young:Novo Nordisk Inc.: Consultancy, Speakers Bureau. Off Label Use: This abstract describes dosing of rFVIIa that is higher than that in the package insert. Shapiro:Novo Nordisk Inc.: Consultancy, Speakers Bureau. Valentino:Novo Nordisk Inc.: Consultancy, Research Funding. Kessler:Novo Nordisk Inc.: Consultancy. Cooper:Novo Nordisk Inc.: Employment.

Spinal epidural hematoma in hemophilic children: controversies in management

Spinal epidural hematoma (SEH) is an uncommon complication in hemophilic children. It can produce rapidly progressive neurological deficits. We aim to discuss the different management options for these patients. A 13-year-old boy with a history of hemophilia A was admitted with acute onset of localized spine pain and weakness. No trauma was reported on review of the history. Recombinant factor VIII aggressive replacement therapy was started. Spinal magnetic resonance imaging revealed an extradural mass lesion extending from D5 to D6 level. Emergency hemilaminectomies of D5 and D6 and evacuation of the clot were done. The patient made excellent recovery following surgery. Early diagnosis and immediate aggressive replacement therapy are mandatory in the management of SEH. Prompt surgical decompression to avoid any permanent neurological deficit is a safe and effective treatment option for an SEH in selected hemophilic children.

Gallbladder Tuberculosis Mimics Cholecystitis

Purpose: A 37-year-old impoverished African-American male with a history of hemophilia A presented with complaints of two months of right upper quadrant abdominal pain, nausea, night sweats, and low grade fevers. Abdominal exam revealed a tender right upper quadrant. Labs were unremarkable. A right upper quadrant ultrasound revealed a thickened gallbladder wall and gallstones consistent with cholecystitis, which led to a cholecystectomy. There was no evidence for peritoneal tuberculosis intraoperatively. However, the pathology report of the gallbladder revealed caseating granulomas containing acid fast bacilli (AFB) consistent with a diagnosis of tuberculosis. The patient's PPD, HIV test, chest X-ray and sputum AFB were all negative. Post-operatively the patient showed an improvement in symptoms and was discharged two days later and referred for tuberculosis treatment. Tuberculosis (TB) has changed its face recently due to increasing numbers of HIV infections, poverty, and migration. Very few cases of gallbladder tuberculosis (GT) have been reported. A correct preoperative diagnosis of GT is rare, and it can mimic other gallbladder diseases. GT often occurs in women over 30 years of age and can present with cystic duct obstruction and gallstones. The route of infection may be peritoneal, hematogenous or lymphatic. GT may present with symptoms such as abdominal pain, weight loss, fever, nausea, vomiting or a palpable abdominal mass. Anemia, elevated ESR, and positive tuberculin tests are usually found during laboratory examination. In most reported cases the chest X-rays were normal. The abdominal ultrasound and computed tomography scan findings may also show a gallbladder mass, dilated gallbladder, thickened gallbladder wall, ascites, biloma or abdominal lymphadenopathy. However, these finding are not specific for GT. The correct diagnosis of gallbladder tuberculosis is usually made after a cholecystectomy. However, with a high index of suspicion, aspiration cytology of tuberculomas or percutaneous drainage of bile with culture could confirm the diagnosis of GT in some patients without surgery. This case demonstrates the need to consider GT in patients with known TB or high risk patients with symptoms consistent with gallbladder disease.Figure: Gallbladder Tuberculosis described above.

Index of Suspicion in the Nursery

One day after a “routine” circumcision, an otherwise healthy 3-day-old term neonate presents with swelling, ecchymosis, and oozing from the circumcision site. There are no petechiae or other bruises. Pregnancy and delivery had been uncomplicated. His vital signs and growth parameters are normal. Results of his neurologic examination are normal, and he has no skeletal abnormalities or dysmorphic features. He is the third of three male children born to a nonconsanguineous couple. The two older brothers had normal perinatal courses, including uncomplicated circumcisions. There is no family history of hemophilia. Laboratory work reveals a platelet count of 9.0×103/mcL (9.0×109/L), white blood cell count of 15.0×103/mcL (15.0×109/L), hemoglobin of 17.6 g/dL (176 g/L), and hematocrit of 45.8% (0.458). Review of the blood smear shows no platelet clumps. Ultrasonography of the head shows no intraventricular hemorrhage. The mother has no history of immune thrombocytopenia (ITP), and her platelet count is normal. A platelet transfusion is ordered. One hour after the transfusion, a platelet count is 18.0×103/mcL (18.0×109/L). Four hours later, the platelet count is 10.0×103/mcL (10.0×109/L). Further evaluation of the parents yields the diagnosis. The differential diagnosis of severe neonatal thrombocytopenia can be categorized broadly into disorders of increased platelet consumption or decreased production (Table⇓). Included in these categories are congenital viral infection, sepsis, perinatal asphyxia, placental insufficiency, maternal ITP, and neonatal alloimmune thrombocytopenia (NAIT). In addition, a variety …

An Interesting Cecal Mass in a Patient with AIDS

FigurePurpose: Disseminated histoplasmosis is a common opportunistic infection in AIDS patients who are severely immunocompromised. Gastrointestinal histoplasmosis (GIH) generally occurs in association with disseminated histoplasmosis or rarely as localized lesions. GIH is defined by radiological or endoscopic findings in conjunction with positive gastrointestinal tissue cultures or histopathologic observation of broad budding yeasts of H. capsulatum in tissue specimens. GIH typically occurs with median CD4 counts of 35 and patients naïve to anti-retroviral therapy. Common clinical features include fever, abdominal pain and diarrhea. Colon is the most frequently affected site (67%) followed by the cecum (17%). Endoscopic findings of GIH are usually multiple ulcers or pseudopolyps; however it can rarely present as a mass or constricting lesion suspicious for malignancy. We describe a case of a 45-year-old white male with history of hemophilia A and AIDS. Patient was admitted to us with a three week history of sharp right lower quadrant abdominal pain and weight loss. Patient had no history of opportunistic infection and was naïve to anti-retroviral therapy. On physical examination, the right lower quadrant was tender to palpation with voluntary guarding. Laboratory examination revealed a CD4 count of 17/μL. A computed tomography (CT) scan of his abdomen showed a non-obstructing cecal mass with an ‘apple-core’ appearance highly suspicious for malignancy (marked by white arrow in Fig. 1). Subsequent colonoscopy showed multiple small ulcers in the cecum, ascending colon and the transverse colon with a three centimeter mass in the cecum (Fig. 2). Histopathology of the ulcers and the mass showed numerous intracellular budding yeasts consistent with H. capsulatum. Patient was started on itraconazole and reported resolution of abdominal pain during an outpatient follow-up after a three week period.[figure1][figure2]Figure

Haematuria in patients with haemophilia and its influence on renal function and proteinuria

To investigate renal function in a group of patients with a history of haemophilia and haematuria. We reviewed 32 medical records of the patients with haemophilia and gross haematuria identified through a computerized haemophilia registry, from January 1993 to December 2004. In all patients but three (two refused to participate and one died) clinical and laboratory tests were performed by the nephrologist. One patient had chronic renal failure because of diabetic nephropathy. In two patients reduced renal function was detected by creatinine clearance measurements, and one of them had Duchenne muscular dystrophy. In four patients minimal proteinuria was diagnosed by the biuret method. Mild reduction in renal function of unknown cause was found in only one of the 29 patients tested.

Disability in Indian patients with haemophilia

Chronic shortage of clotting factor concentrates, exorbitant treatment costs and the poor economic status of patients makes disability an inevitable consequence of haemophilia in India. The prevalence and risk factors for disability were studied in 148 patients with severe haemophilia A registered at five haemophilia clinics in the country. Disability was measured using a scoring method that used a compilation of functional ability, mobility and range-of-motion scores for each patient. Patients ranged in age from 5 to 55 years. Only nine of 148 patients were free of disability. The proportion of disability free patients in the 5-12, 13-24 and 25+ age groups were 14.3%, 4.4% and 0% respectively. The risk factors significantly associated with disability were patients age, socio-economic status, number of persons in the family, family history of haemophilia, frequency of physiotherapy exercises, home use of coagulation factor concentrate and type of blood product(s) used, that is clotting factor concentrate or cryoprecipitate. The study highlights the need to provide coagulation factor concentrates in sufficient amounts to prevent disability, the beneficial role of physiotherapy exercises and the advantage of older patients as peer educators for younger patients. The most important utility of the data is to demonstrate the widespread prevalence of disability amongst patients, its social costs in terms of incomplete education and unemployment, which justifies the need to include haemophilia as one of the conditions under the Disability Act of India.

Remarkable Variation in the Informativeness of RFLP Markers Linked to Hemophilia B Locus in Indian Population Groups: Implication in the Strategy for Carrier Detection

Hemophilia B, an X-linked recessive bleeding disorder, is caused by heterogeneous mutations in the factor IX (F9) gene. Hence, carriers of the disease are usually detected by F9 gene linked RFLP analysis. We aimed to test a set of RFLP markers (DdeI, XmnI, MnlI, TaqI & HhaI), used worldwide for carrier detection, to estimate its heterozygosity in different population groups of India, and identify additional single nucleotide polymorphisms (SNPs) if necessary. A total of 8 population groups encompassing different regions of India, consisting of 107 unrelated normal females without any history of hemophilia B in the family and 13 unrelated obligate carriers were recruited in the study. Regions of F9 gene were amplified by PCR from genomic DNA of the donors followed by restriction enzyme digestion and/or sequencing as appropriate. Combined informativeness for the markers varied between 52–86% among normal females belonging to different geographical locations of India. Haplotype analysis revealed that the most prevalent haplotype lacked the restriction sites for all five RFLP markers. Screening regions of F9 gene that harbor 10 SNPs reported in dbSNP yielded only two SNPs, which increased the overall informativeness in each population group and heterozygosity in the obligate carriers for the disease from 38% to 69%. Our data show that heterozygosity of commonly used RFLP markers is remarkably variable across different regions of India. Thus prudent selection of the markers based on specific population groups including usage of additional markers is recommended for efficient carrier detection.

Interferon-α-Associated Acquired Factor VIII Inhibitor.

Introduction: Development of an acquired inhibitor to factor VIII (acquired hemophilia) is a rare autoimmune phenomenon that has been associated with a variety of medical conditions such as autoimmune diseases, malignancies, drugs like penicillin and postpartum state. It often presents with acute, life-threatening hemorrhage. Interferon alpha (IFN) is an immune system modulator that is widely used for the treatment of hepatitis C and various malignancies. It is known to stimulate or exacerbate autoimmune diseases and has been described in four separate reports to be associated with the development of inhibitors to factor VIII. All but one of these four cases represented patients with underlying malignancy or congenital hemophilia A.Case Report: Our patient is a 55-year old non-hemophiliac with no prior diagnosis of cancer who developed new-onset bruising while on IFN therapy for hepatitis C. This was not evaluated or treated further at that time. Six months after completing IFN therapy, he presented to the emergency room with respiratory distress. On examination, he was found to have a large supraglottic hematoma and underwent an urgent tracheostomy for impending respiratory failure. This was followed by severe postoperative bleeding which the otolaryngologists were unable to control surgically. Laboratory testing showed a prolonged activated prothrombin time and infusion of fresh frozen plasma failed to achieve hemostasis. A hematology consultation was obtained and the patient was treated with activated recombinant factor VII (rVIIa) which resulted in prompt cessation of bleeding. Existence of factor VIII inhibitor was confirmed by abnormal mixing studies (no correction), low factor VIII activity (2.1%) and high inhibitor titer (42 Bethesda Units/ml [BU]). Following hospital discharge, inhibitor titers slowly declined to less than 1 BU after immunosuppressive therapy with steroids, alkylating agents and rituximab given sequentially over a period of nine months. The factor VIII activity has also increased to 15%. The patient has since had occasional mild to moderate soft tissue bleeding which responded well to rVIIa.Conclusion: One previous report has described a patient without a history of hemophilia or cancer who developed factor VIII inhibitor while being treated with pegylated IFN for hepatitis C. Our patient represents only the second such report and adds to the slowly growing body of literature pointing to this association. Although this data is anecdotal, we believe that the potential for such inhibitors to produce serious and even life threatening hemorrhage warrants awareness of and attention to this possibility by clinicians treating patients with IFN. Simple clinical vigilance along these lines may help identify and address this condition in a timely fashion before it has a chance to produce catastrophic bleeding.

Continuous infusion of factor VIIIc during heart surgery in a patient with haemophilia A

Continuous infusion of factor VIIIc during heart surgery in a patient with haemophilia A

Hemophilic Pseudotumor: Radiologic-Pathologic Correlation

HomeRadioGraphicsVol. 23, No. 4 PreviousNext AFIP ARCHIVESHemophilic Pseudotumor: Radiologic-Pathologic CorrelationJames M. Stafford, Tina T. James, Anton M. Allen, Lisa R. DixonJames M. Stafford, Tina T. James, Anton M. Allen, Lisa R. DixonAuthor Affiliations1From the Departments of Radiology (T.T.J., J.M.S., A.M.A.) and Pathology (L.R.D.), University of Tennessee Medical Center, Knoxville, 1924 Alcoa Hwy, Knoxville, TN 37920. Received October 16, 2002; revision requested November 25 and received January 10, 2003; accepted January 13. Address correspondence to J.M.S. (e-mail: [email protected]).James M. StaffordTina T. JamesAnton M. AllenLisa R. DixonPublished Online:Jul 1 2003https://doi.org/10.1148/rg.234025154MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References 1 Starker L.. Knochenusur durch ein hamophiles, subperiostales Hamatom. Mitt Med Chir 1918–1919; 31:381. 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