Alvin H. Felman

Madelung's Deformity: Observations in 17 Patients

IN 1878, MADELUNG (8) described a painful abnormality of the wrist and forearm which characteristically began in adolescence. The radiographic alterations of the radius and ulna were described later. The most complete review of the subject is that of Anton et al. (1), who collected and summarized the literature through 1938. Considering this clinical and radiographic abnormality a deformity rather than a syndrome, these workers distinguished it from Madelungs disease, which is characterized by diffuse symmetrical lipomatosis of the upper part of the back, shoulders, and neck. They also suggested that the deformity of the wrist and forearm be considered a dyschondroplasia of the distal radial epiphysis. While this may be a logical name for the entity, it has not found wide usage, Madelungs deformity remaining the preferred term. In 1929, Leri and Weill (7) reported a case of dwarfism and radiographic alterations of the forearm and wrist similar to Madelungs deformity, although no reference was made to M...

The Radiographic Detection of Glass in Soft Tissue

The Physical basis of radiology rests on the unequal absorption of x rays as they pass through objects of different densities and effective atomic numbers. It is not generally appreciated that all types of commercial glass possess physical characteristics that are different from those of human tissues. The higher density and effective atomic number of glass compared to those of surrounding soft tissue cause it to be visible on the appropriately exposed radiograph. A review of the American radiologic literature uncovered only one reference concerning the radiopacity of glass, and that was written in 1932 (6). In 1958 two articles appeared, one in The Archives of Industrial Health (9) and the other in The British Journal of Surgery (4), reporting the radiopacity of glass and its detection in soft tissues. The German literature contains a report published in 1964 which concluded that all ordinary glass, when embedded in the tissues of the hand, could be detected radiographically (3). Information gained from ...

Ultrasonography in primary hepatic tumors in early childhood

Ultrasonography was useful in preoperative investigation of primary hepatic tumors in nine children, aged 4 weeks to 4 years. In all patients, the hepatic origin and the solid or mixed echogenic nature of the tumor was determined. In two children (one with hemangioendothelioma, one with cystic mesenchymoma) the ultrasonographic findings were even more specific when correlated with angiography and/or histology. Ultrasonography in children with hepatomegaly should be performed as a screening procedure before angiography, to determine if enlargement of the liver is of tumorous origin. For follow-up, ultrasonography should be preferred over radionuclide imaging because it does not require the use of ionizing energy.

Staphylococcal osteomyelitis, sepsis, and pulmonary disease. Observations of 10 patients with combined osseous and pulmonary infections

The clinical and roentgenographic findings in 10 patients with combined staphylococcal infection fo the bones, joints, and lungs are reviewed. Chest roentgenograms early in the course of the illness suggested septic embolic disease, but in most cases the associated osseous infections were overlooked. Primary therapy, directed toward the sepsis and pulmonary complications, was often unsuccessful until the associated osteomyelitis was recognized and treated. The radiologist and clinician should recognize the roentgen pattern of septic pulmonary emboli and be alert to the possibility of associated skeletal infection. Surgical drainage is often necessary.

Renal ultrasound in the neonatal period

Ultrasound was used for imaging the kidneys in 55 neonates. The normal kidney in a neonate is characterized by prominent medulla and fetal lobulation, the main renal vessels are frequently demonstrated. Of 29 infants with normal kidneys by ultrasound, 4 had renal disease (3 acute tubular necrosis, one partial renal artery thrombosis) and one had a pelvic kidney. In 24 infants congenital abnormalities or acquired renal disease was diagnosed. Multicystic dysplastic kidney and hydronephrosis were the most frequently observed abnormalities. Polycystic kidneys at the early stage (both adult type and infantile) appeared as enlarged hyperechoic kidneys. In 2 neonates the kidneys were normal but they had adrenal mass lesions.

Supralevator imperforate anus with unusual associated anomalies: Colonic ureteral ectopy, intraluminal calcified meconium

This case illustrates a complex of congenital ano-rectal and renal abnormalities not previously reported. Colonic urcteral ectopy, an extremely rare occurance, was also found in this patient and an explanation of the probable embryogenesis is proposed. The roentgen pattern of intraluminal calcified meconium is also illustrated.

Multiple Epiphyseal Dysplasia Three Cases with Unusual Vertebral Abnormalities

THE AUTHOR recently had the opportunity to study two siblings as well as the photographs of roentgenograms of the father who died in 1965.3 The three patients are dwar fed and have diffuse epiphyseal abnormalities and severe vertebral deformities. A review of the reported cases of generalized epiphyseal dysplasias failed to disclose any similar examples. The progressive verte bral changes which began in childhood and eventually produced severe deformity in the adult are of particular interest. Complete destruction of the capital femoral epiphyses and virtual disappearance of the femoral necks are also unique to these cases. Moderat e dwarfing has resulted from the combined vertebral and epiphyseal deformities. A dominant hereditary transmission is appar ently operative. Presentation of the clinical and x–ray findin gs of these cases and a discu ssion of the vertebral abnormalities associated with the pre sently classified groups of generalized epiphyseal dysplasias form the basis of this report. Descripti...

Spondylometaphyseal Dysplasia: A Variant Form

Spondylometaphyseal dysplasia (SMD), a heterogeneous group of chondro-osseous dysplasias with combined vertebral and metaphyseal abnormalities, is being recognized and reported more frequently. The cumulative experience with these patients suggests that the Kozlowski type of SMD is a distinct form, and transmitted as an autosomal dominant. Many other forms of SMD exist which, as yet, cannot be completely classified. A father and daughter who demonstrate a variant form of SMD, both with absence of the odontoid processes, are described and their place in the spectrum of this group of diseases is discussed.

Congenital eventration of the diaphragm: Diagnosis by ultrasound

Ultrasound was utilized in 3 infants to diagnose preoperatively eventration of the diaphragm. In all children the organ simulating a chest mass was the liver.

Tillaux fractures of the tibia in (adolescents)

The juvenile “Tillaux” fracture occurs in a specific age group and may be misinterpreted as a simple sprain if proper examination is not performed. Anatomic reduction is necessary to prevent long term damage to the ankle joint. Computed tomography is of help in the evaluation of adequacy of reduction.