close

Вход

Забыли?

вход по аккаунту

?

Radiographic Survey of Lthe Knees.

код для вставкиСкачать
395
riceps at or separated from the superior margin of the
patella (Figure 2). These densities are not common in
the general population but are observed in approximately 4% of patients with calcium pyrophosphate deposition disease (2). In this condition, tendon calcification is not limited to the quadriceps mechanism but also
occurs elsewhere, including the rotator cuff region of the
shoulder, triceps, and achilles tendons in association
with calcification of cartilage (chondrocolcinosis), synovium, ligaments, and soft tissue. A report has appeared
that biopsy of a calcified achilles tendon in one such
patient demonstrated calcium pyrophosphate dihydrate
crystals (3).
Patellar Osteophytes. If we reserve the term
osteophyte in the current discussion to b.one formation
occurring at the articular margins of the patella, these
excrescences are seen at the posterior superior and posterior inferior margins of the patella (Figure 3). They are
distinct from anterior hyperostosis and quadriceps calcification. Osteophytes may be seen in patellofemoral
osteoarthritis and as part of the structural joint change
which is characteristic of calcium pyrophosphate deposition disease (2).
Each of these recognizable radiodensities-patellar hyperostosis, quadriceps tendon calcification, and
patellar osteophytes-is associated with different clinical manifestations and may be the radiographic clue to
an underlying disease process such as diffuse idiopathic
skeletal hyperostosis, calcium pyrophosphate deposition
disease, and osteoarthritis.
DONALD
RESNICK,M . D .
Chief. Department of Radiology
Veterans Administration Hospital
3350 La Jolla Village Drive
San Diego, California 92161
REFERENCES
I . Resnick D, Shaul SR, Robins JM: Diffuse idiopathic skeletal hyperostosis (DISH): Forestier’s disease with extraspinal manifestations. Radiology I I5:5 13-524, 1975
2. Resnick D, Niwayama G, Goergen TG, Utsinger PD, Shapiro RF, Haselwood DM. Wiesner K B Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD): pseudogout.
Radiology 122:1-15, 1977
3. Gerster JC, Baud CA, Lagier R, Boussina I, Fallet GH:
Tendon calcifications in chondrocalcinosis: a clinical, radiologic, histologic and crystallographic study. Arthritis
Rheum 20:717-722, 1977
Radiographic Survey of the Knees
Figure 3. Parellar osteophytes.
To the Editor:
The letter to the editor by Mink et al. ( I ) has
much merit in the areas that they mention: abundant
information, reducing cost, and reducing radiation.
However, for approximately 254, the standing
views of both knees are much more useful if done on a
14 X 17 cassette (standard chest size in a vertical position). This will allow the physician to determine more
adequately the amount of varus or valgus deformity,
and more bone is seen with very little additional radiation. The amount of technician time and developing
time is identical and the cost of the film is neglible for
the added information. These will allow the orthopedic
surgeons to see what type of total knees might be more
appropriate, the adequacy of bone stock, and whether
an osteotomy (though rarely indicated in rheumatoid
arthritis) may be considered.
396
Obviously additional views can be ordered if
specific complaints exist, but I certainly agree that
this is an adequate and mandatory workup in the initial
survey of all patients with a suspected diagnosis of rheumatoid arthritis and I congratulate the authors.
ED BERG, M.D.
Associate Professor of Surgery (Orthopedics)
Associate Professor of Medicine (Rheumatology)
ChieJ Section of Orthopedics
Veterans Administration Hospital
Medical College of Georgia
In three cases of classical RA treated with Dpenicillamine (600 mg for 15 days, 900 mg for 30 days),
we observed an increase in urinary excretion of zinc and
copper (Figure 1 ) and an increase in serum zinc. These
changes occurred at the same time as a fall in serum
copper (Figure 2).
We agree with Lyle (2) that cupruresis is an index
of absorption and chelating activity of D-penicillamine.
Our preliminary studies favor the hypothesis that the
favorable effect of D-penicillamine in RA is due to the
effects of the drug in zinc absorption.
PROF.U. AMBANELLI
DR. G. F. FERRACCIOLI
I Clinica Medica
Department of Rheumatology
University of Parma
Parma, Italy
REFERENCE
I . Mink JH, Gold RH, Bluestone R: Radiographic arthritis
survey. Arthritis Rheum 2 0 1564, 1977
D-Penicillamine and Zinc
To the Editor:
Based on McCall’s observations ( I ) , we raise the
possibility that D-penicillamine acts in rheumatoid arthritis (RA) by aiding the absorption of zinc.
REFERENCES
I . McCall JT, Goldstein NP, Randall RV, Gross JB: Am J
Med Sci 254:13, 1967
2. Lyle WH: Lancet 4207982, 1976
u
MgJ24 HOI
Zn
Y!
700
900
190
150
600
800
180
140
500
700
170
130
400
600
160
120
300
500
150
110
600 mg
D-Penicillamine
200
600 rng
D-Penicillamine
900 rng
D-Penicillamine
140
400
1
15
---
Zn
22
29
35
42
DAYS
Figure 1. Medium values of zinc and copper (daily urinary excretion)
aJier D-penicillamine treatment.
100
I
1
I
15
900 mg
D-Penicillamine
I
22
I
I
29
35
I
42
DAYS
Figure 2. Medium values of zinc and copper (in serum) after D-penicillaniine treatment.
Документ
Категория
Без категории
Просмотров
0
Размер файла
364 Кб
Теги
survey, radiographic, knee, lthen
1/--страниц
Пожаловаться на содержимое документа