Peripheral Bones Research Articles

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999

This study evaluated the clinical characteristics of childhood and adolescent tuberculosis (TB) at the end of the twentieth century in a referral children's hospital in northern Taiwan. The hospital charts were reviewed retrospectively of children/adolescents aged less than 18 y who were seen in a children's hospital in northern Taiwan between 1994 and 1999 and diagnosed with TB. A total of 62 individuals was diagnosed during this period. The patients' demographic data, presenting symptoms, clinical features, bacteriological results, drug susceptibility and tuberculin skin-test results were analysed. Most diagnosed cases lay in one of two main age ranges, younger than 5 y and adolescents. The presenting symptoms of study subjects were typically non-specific. Bone involvement occurred for 21 patients (33.9%) and was the most common extrapulmonary manifestation. Mycobacterium tuberculosis was isolated from 47 patients (75.8%). Five isolates were resistant to pyrazinamide, three to streptomycin and one to isoniazid, but no multidrug resistant isolates of TB were detected from culture-proven cases. Seventeen of 47 (36.2%) culture-proven patients revealed negative acid-fast staining initially but, subsequently, M. tuberculosis was isolated from various clinical specimens using a standard method at a later date. The tuberculin skin test was positive for 24 of 32 patients (75%) who received such an examination. Extrathoracic TB was more common in children below 5 y of age than their adolescent counterparts, and chiefly involved the peripheral long bones. The potential drug resistance of M. tuberculosis in childhood and adolescent TB did not appear to have been a major problem in northern Taiwan before the year 2000.

Demonstration of intravital microfissures in undecalcified plastic-embedded temporal bones with the prestaining technique.

Microfissures in the human otic capsule have been observed since the start of the century, but it was Otto Mayer, in 1930, who first realized that some of them were of intravital origin and not just processing artifacts. Since then, a small number of publications, based on decalcified temporal bones, have mostly confirmed his findings. With the introduction by Frost in the late 1950s of the undecalcified bone technique and the bulk staining technique for peripheral bones, a method was developed and refined for identifying even very small intravital microfissures (microdamage). Bulk staining of undecalcified otic capsules has not yet been used to verify the findings from the previous decalcified specimens. The present report presents our experience with the pertinent techniques, and suggests modifications and shortcuts pertinent to temporal bone research. Both large and tiny microfissures of intravital genesis are demonstrable within bulk-stained undecalcified human otic capsules. The importance of microfissures in the petrous bone in the causation of otosclerosis and perilymphatic leakage has long been discussed, and the present techniques may advance our understanding of these pathological conditions

Xenopus ADAM 13 is a metalloprotease required for cranial neural crest-cell migration

Background: Cranial neural-crest (CNC) cells originate from the lateral edge of the anterior neuroepithelium and migrate to form parts of the peripheral nervous system, muscles, cartilage, and bones of the face. Neural crest-cell migration involves the loss of adhesion from the surrounding neuroepithelium and a corresponding increase in cell adhesion to the extracellular matrix (ECM) present in migratory pathways. While proteolytic activity is likely to contribute to the regulation of neural crest-cell adhesion and migration, the role of a neural crest-specific protease in these processes has yet to be demonstrated. We previously showed that CNC cells express ADAM 13, a cell surface metalloprotease/disintegrin. Proteins of this family are known to act in cell-cell adhesion and as sheddases. ADAMs have also been proposed to degrade the ECM, but this has not yet been shown in a physiological context.Results: Using a tissue transplantation technique, we show that Xenopus CNC cells overexpressing wild-type ADAM 13 migrate along the same hyoid, branchial, and mandibular pathways used by normal CNC cells. In contrast, CNC cell grafts that express protease-defective ADAM 13 fail to migrate along the hyoid and branchial pathways. In addition, ectopic expression of wild-type ADAM 13 results in a gain-of-function phenotype in embryos, namely the abnormal positioning of trunk neural-crest cells. We further show that explanted embryonic tissues expressing wild-type, but not protease-defective, ADAM 13 display decreased cell-matrix adhesion. Purified ADAM 13 can cleave fibronectin, and tissue culture cells that express wild-type, but not protease-defective, ADAM 13 can remodel a fibronectin substrate.Conclusions: Our findings support the hypothesis that the protease activity of ADAM 13 plays a critical role in neural crest-cell migration along defined pathways. We propose that the ADAM 13-dependent modification of ECM and/or other guidance molecules is a key step in the directed migration of the CNC.

Speed of sound measurements in mandibular and phalangeal bone during growth

The micromechanical and elastic properties of bone, its structural maturity and, indirectly, mineral density are important factors for the planning and assessment of orthodontic and/or jaw orthopaedic treatment. This clinical study was undertaken to evaluate age-related changes in the anterior mandibular body. The speed of sound (SOS) has demonstrated age dependency in various peripheral bones and has been proposed as an alternative method for investigating bone parameters without the use of radiation. The ultrasound transmission velocity was measured in 184 healthy subjects (93 females, 91 males; mean age 17.6 +/- 13.7 years). According to the statistical analysis, the data did not reveal any gender-related differences, but were significantly age-dependent. Different kinetics were established between the maturity of the phalanx and the anterior mandible. Further clinical investigations of age-dependent structural changes in bone maturation parameters may provide information that should be taken into account for early functional jaw orthopaedic treatment.

Morphogenesis of the turtle shell: the development of a novel structure in tetrapod evolution.

The turtle shell is an evolutionary novelty that is synapomorphic for chelonians. The carapace is initiated by the entrapment of the ribs by the carapacial ridge (CR), a lateral bulge of the dorsal ectoderm and dermal mesoderm. The mechanisms by which the CR is initiated, the ribs entrapped and the dorsal dermis ossified, remains unknown. Similarly, the formation of the plastron remains unexplained. Here, we present a series of anatomical investigations into plastron and carapace formation in the red-eared slider, Trachemys scripta, and the snapping turtle, Chelydra serpentina. We document the entrapment of the ribs by the CR and the formation of the plastron and carapacial bones by intramembranous ossification. We note the formation of the ossification centers around each rib, which suggest that the rib is organizing dermal ossification by secreting paracrine factors. The nuchal ossification center is complex and appears to involve multiple bone-forming regions. Individual ossification centers at the periphery of the carapace form the peripheral and pygial bones. The intramembranous ossification of the plastron proceeds from nine distinct ossification centers, and there appear to be interactions between the spicules of apposing centers as they draw near each other.

The effect of supplemental copper on osteopenia induced by ovariectomy in rats.

The effect of a copper supplement on preventing bone mass loss induced by ovariectomy in rats was investigated. Three groups of fifteen 100-day-old female Wistar rats, each with a mean initial weight of approximately 260 g per animal, were selected for a 30-day experiment. One group of 15 ovariectomized rats was fed a diet supplemented with 15 mg of copper per kilogram of feed. The other two groups: 15 ovariectomized and 15 Sham- ovariectomized rats did not receive the supplement. Morphometric (weight and length) and densitometric studies with dual-energy x-ray absorptiometry were performed on the whole femur and the fifth lumbar vertebra of each animal at the end of the 30-day period. The ovariectomized rat group fed a diet supplemented with copper did not show the bone mass loss at the axial (fifth lumbar vertebra) or peripheral (femur) level that was evidenced in the ovariectomized group. The results of the measurement of axial and peripheral bones show that a supplement of copper may have a potential therapeutic application in the treatment and prevention of involutional osteoporosis.

Effect of silicon supplement on osteopenia induced by ovariectomy in rats.

The effect of silicon (Si) supplement on preventing bone mass loss induced by ovariectomy (OVX) in rats was investigated. Three groups of 15, 100-day-old female Wistar rats each, with a mean initial weight of approximately 260 g per animal, were selected for the present study. One of the experimental group consisting of 15 OVX rats was fed a diet supplemented with 500 mg of Si per kg of feed (Si + OVX). The other two groups consisting of 15 OVX and 15 sham-OVX rats did not receive these supplements. Morphometric (weight and length) and densitometric studies with dual-energy X-ray absorptiometry were performed on the whole femur and 5th lumbar vertebra of each animal 30 days after the experiment. The Si + OVX rats did not show a loss of bone mass induced by OVX at axial level (5th lumbar vertebra) or periphery (femur). Nonetheless, a significant increase (ANOVA with Bonferroni/Dunn post hocs test) of longitudinal development of the femur (P < 0.0001) was patent. These results, obtained through the measurements of axial and peripheral bones, warrant closer scrutiny in connection with the Si inhibitory effect on bone mass loss as well as the stimulatory effect on bone formation. Both actions, namely, inhibition of resorption and stimulation of formation, infer that Si may have a potential therapeutic application in the treatment of involutive osteoporosis.

Mechanical analysis of bone and its microarchitecture based on in vivo voxel images

Prevention of osteoporotic fractures requires accurate methods to detect the increase in bone fragility at an early disease stage as well as effective therapies to reduce the risk of bone fractures. Presently the prediction of the patient-specific bone fracture risk is primarily based on bone density, since this is the only parameter which can routinely be measured in vivo. However, these predictions might not always be precise because the fracture risk is also determined by the bone microarchitecture and the bone's loading conditions. The aim of this paper is to introduce and evaluate new methods which could contribute to a better quantification of bone fracture risk. Recently, a new approach, combining computational engineering methods (finite element (FE) method) and 3D high-resolution imaging techniques, has been introduced which can account not only for bone density but also for microarchitecture and loading conditions. High-resolution imaging techniques allow acquisition of 3D images of the bone microarchitecture, whereas FE methods applied to these images allow very precise calculation of the mechanical properties of bone. However, such a detailed FE analysis was not feasible for bone in vivo mainly because the resolution was not sufficient to measure the bone microarchitecture. It is shown here, from preliminary results, that the FE approach based on high-resolution images from a new CT scanner now allows prediction of the mechanical behavior of peripheral bones in vivo. It is expected that, eventually, the FE approach will lead to a better patient-specific fracture risk prediction than earlier methods based on bone density alone. Hence, with this new approach, it might be possible to detect the increase in bone fragility at an early stage of osteoporosis and it might also be possible to evaluate treatments more accurately.

Hip fracture patients without vertebral fracture have a preferential osteopenia in the proximal femur

In 84 recent hip fracture patients, lateral spinal radiographs were examined for the presence of vertebral fracture. Sixty-three patients (75%) had the complication of vertebral fracture and 21 patients did not. Furthermore, we classified those hip fracture patients according to the presence or absence of vertebral fracture and investigated the characteristics on the extent of osteopenia in axial and peripheral bones. The bone mineral density (BMD) of the lumbar spine, proximal femur, and distal radius were lower in the hip fracture patients with vertebral fracture (HX with VX) than in the hip fracture patients without vertebral fracture (HX without VX), indicating that hip fracture patients can be further divided into subgroups. In making a comparison with age-matched controls, we found that the BMD of all examined sites in the HX with VX were significantly low. Yet, it was only in the BMD of the proximal femur that we could find a significant difference between the HX without VX and age-matched controls. We concluded that hip fracture patients without vertebral fracture have a preferential deficit bone density in the proximal femur and a similar density in the lumbar spine and distal radius when compared with normal women of their age.

SAPHO Presenting with a Lesion in the Symphysis Pubis

SAPHO is an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis. It is used to define characteristic bone or joint lesions associated with either pustulosis palmoplantaris or acne. The bone lesions are characterized by sclerosis and hyperostosis, and there may be an associated synovitis. These bone lesions occur most frequently in the anterior thoracic wall, but may be found elsewhere. The lesions tend to have a benign course, and usually are treated with nonsteroidal anti-inflammatory drugs (NSAIDs). The etiology of the SAPHO syndrome is unknown at present. We report the following case because the patient presented with involvernent of the pubis, with a symptomatic osteitis pubis. The presence of palmoplantar pustulosis allowed proper identification of the disease.Characteristic sclerotic bone lesions, found usually in the anterior thoracic wall and associated with palmoplantar pustulosis, were initially de-scribed in Japan in 1967 (1); several similar descriptions followed (2-6). Similar skeletal lesions have also been found associated with other dermatology disorders, mainly acne conglobata (7-13). These bony lesions may occur in various sites in the axial skeleton and occasionally in peripheral bones, where they may be associated with an inflammatory synovitis. In 1987, the acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) was coined to refer to this cluster of cutaneous and osteoarticular manifestations (14).Although involvement of the symphysis pubis has occasionally been mentioned in patients with SAPHO (14, 15), the features of the disease in this particular joint have not been described. In this report, we describe the case of a woman with palmoplantar pustulosis who was seen for pubic pain and sclerotic bone lesions akin to those of SAPHO.

In vivo quantitative ultrasound imaging of peripheral bones with a new device

In vivo quantitative ultrasound imaging of peripheral bones with a new device

Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients.

Kidney transplant recipients have multiple factors leading to osteoporosis. The purpose of this study was to determine the fracture rate after kidney transplantation and the significance of osteodensitometry with dual energy x-ray absorptiometry (DXA) in identifying the risk patients. Bone mineral density (BMD) was measured with DXA in 100 graft recipients (mean interval 63 +/- 53 months after transplantation) and correlated with the incidence of fractures. Fracture rate of peripheral bones increased from 0.009 before transplantation and 0.012 on hemodialysis to 0.032 fractures per patient and year after transplantation. Seventeen fractures of peripheral bones occurred in 11% of the patients within a mean of 103 +/- 59 months after transplantation. Three additional patients had fractures of the lumbar spine. Patients with fractures were characterized by low or low-normal BMD (0.93 +/- 0.23 versus 1.04 +/- 0.17 g/cm2 at lumbar spine), a frequent history of parathyroidectomy (21% versus 6%), and a longer transplant interval (103 +/- 59 versus 57 +/- 49 months). Fractures occurred in patients with low and normal BMD. DXA at the femoral neck proved to be of no value to define patients at risk of fractures. DXA at the lumbar spine also proved to be of limited value for this question. Therefore, alternatively, more sensitive methods of BMD and of bone architecture measurements are necessary for identifying the kidney transplant recipients at risk of fracture.

The determination of ultrasound velocity in the os calcis, thumb and patella during childhood

Maximising the accumulation of bone tissue during growth and puberty is one of the most important aims in the prevention of osteoporosis. For prevention studies in children it is necessary to develop methods for skeletal status without radiation. Ultrasonic velocity (speed of sound = SOS) has been proposed as an alternative method. Using a new ultrasonic system (Osteoson K4, Minhorst, Germany), we investigated the reproducibility and age-dependency of SOS in several peripheral bones in 218 children and young adults. Intra-observer (day to day) reproducibility: calcaneus CV = 0.64%, patella CV = 1.18% and thumb CV = 0.43% (n = 25). Inter-observer reproducibility: calcaneus CV = 1.1%, patella CV = 2.48% and thumb CV = 0.62% (n = 16). SOS in thumb and patella increased with age and peaked at 20-25 years. SOS in the calcaneus showed no increase after puberty. Studies in bones from pigs show no dependency of SOS from the thickness of analysed cortical or trabecular bone slices. We conclude that the reproducibility of SOS measurements especially in the thumb is comparable with those of radiation methods. The SOS data in growing, healthy children and the independency from bone dimensions provides more evidence that SOS describes the elastic qualities of the bones.

Bone mass and ageing

Bone can be divided into two kinds of tissue, cortical and trabecular bone. The skeleton comprises approximately 80% cortical bone, mainly in peripheral bones, and 20% trabecular bone, mainly in the axial skeleton. Bone density increases with skeletal growth to a peak in late adolescence or early adulthood. Bone loss subsequently occurs with ageing in both sexes, and in females accelerated loss occurs at the menopause. The risk of osteoporotic fracture in later life is the result of peak bone mass achieved at skeletal maturity and subsequent age-related and postmenopausal bone loss. Peak bone mass is largely genetically determined but is also influenced by environmental factors such as dietary calcium and physical activity. Bone loss with ageing occurs at different rates and different times in different skeletal sites. Femoral neck bone loss probably occurs in a linear fashion throughout life from early adulthood but may be accelerated at the menopause. Spinal bone loss may commence before the menopause but is rapidly increased in the immediate postmenopausal years. Bone strength is directly related to bone density, but the loading force is also relevant to risk of fracture.

Psoriatic arthritis and synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome.

Psoriatic arthritis is an inflammatory arthropathy associated with psoriasis, and its clinical presentation varies from case to case. Distal interphalangeal involvement is characteristic but not seen in all patients. Enthesopathy, including that of the spine, is common and contributes to the classification of psoriatic arthritis as a seronegative spondyloarthropathy. The etiopathogenesis of psoriatic arthritis is not well understood, and evolution as measured by follow-up is variable. Treatment includes nonsteroidal anti-inflammatory drugs and some of the drugs used in the treatment of rheumatoid arthritis. Sulfasalazine and, in the more severe cases, cyclosporine, are being studied for efficacy and tolerance. Some cases of psoriatic arthritis are associated with an inflammatory bone disease, frequently seen on the anterior chest wall, which is part of the newly described SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. SAPHO syndrome is characterized by this bone involvement, which can affect the spine and peripheral bones. Various skin conditions are associated with this syndrome, but they do not necessarily occur in all cases. Chronic recurrent multifocal osteomyelitis, which is seen mostly in children, may be a presentation of SAPHO syndrome. Associations with sacroiliitis, bowel disease, and psoriasis link SAPHO syndrome with the spondyloarthropathies.

Bone density measurements

Early diagnosis of osteoporosis is difficult. Bone density measurements, however, are helpful in screening patients at risk. Technology now provides means of measuring densities of both peripheral and central bones. The most practical method is dual X-ray densitometry, which is of good sensitivity and accuracy. Single photon absorptiometry on peripheral bones can be used to screen populations at risk. Computed tomography is also useful but the radiation dose is relatively high. In dual X-ray densitometry, calibration methods and comparisons with reference values are fairly reliable. The best sites for measurements are the lumbar spine and proximal femur, in which osteoporotic fractures are common. In general, however, one measurement is not enough. Biological variation is great. Repeated measurements will allow estimation of the rate of bone loss. Precise location of a previous site is sometimes difficult on reexamination and extraskeletal calcifications can be sources of error. Bone densitometry in connection with the prevention and treatment of osteoporosis is fairly easily performed with a single patient. Knowledge about the correlation between bone density and fracture risk is not yet adequate. The results of measurement of bone mineral density relate only to mineral content, not bone quality, i.e., differential diagnosis of osteoporosis and osteomalacia is not possible.

Bone scan and red blood cell scan in a patient with epidermal naevus syndrome

A bone scan and red blood cell scan in the rare epidermal naevus syndrome, associated with multiple haemangiomas of the bone and hypophosphataemic osteomalacia in a 20-year-old man are reported. The typical pattern of osteomalacia on the bone scan was associated with lesions of increased bone metabolism in the peripheral bones. The haemangiomas did not pool labelled red blood cells. Thus, the bone scan seems to be suitable for diagnosing the complete extent of haemangiomas in bone, but they could not be specifically proven by red blood cell pooling.

Isolated digital metastasis in bronchogenic carcinoma

Malignant metastasis to the bones of the hand is rare. Metastases may be isolated and presentation deceptive. Routine bone scan involves only the axial skeleton and therefore does not rule out metastasis elsewhere. A specific request must be made to scan peripheral bones if this is the area of interest. We present a case which illustrates these points and emphasizes the role of palliative surgery where other measures have failed.

A CASE OF METASTATIC ESOPHAGEAL CARCINOMA TO THE DISTAL PHALANX OF THE LITTLE FINGER

It is well known that bone metastases frequently occur in the vertebra, pelvis, tubular bone and rib, but those to the peripheral bones of the hand and foot are extremely rare. The patient, a 62-year-old man, suffered from a painful tumor in the left little finger about five months after esophagectomy for carcinoma of the middle intra-thoracic esophagus. X-ray examination showed an osteolytic findings in the distal phalanx of the left little finger, without other apparent bone metastases. Amputation of this finger was performed for a purpose of reduction in pain. The pathlogical examination revealed metastasis to the finger from the esophageal carcinoma (squamous cell carcinoma). He died 45 days after the amputation of general cancerous cachexia. Generally the prognoses of peripheral bone metastases are poor, due to the advanced stage of the primary regions of cancer. The common treatments available are irradiation and chemotherapy, but amputation of the affected part of the bone may be helpful for relief of pain, such as this reported case.

Urinary excretion of adrenaline and noradrenaline in lumberjacks with vibration syndrome.

vibration syndrome includes vibration induced white finger and disturbances of the peripheral nerves, muscles, bones, and joints. The pathophysiology of the disturbance of the peripheral circulation is not completely understood, however. It has been hypothesised that workers with vibration syndrome have overactivity of the sympathoadrenal system and that this may play a part in the aetiology45; there have, however, been few studies to verify this hypothesis. purpose of the present study was to determine whether activity of the sympathoadrenal system is increased in lumberjacks with vibration syndrome, using urinary excretion of adrenaline and noradrenaline as an index.67