John D. Camp

Osteitis Deformans: Paget's Disease of the Bone

Osteitis deformans was described by Sir James Paget (1) in 1876 and now bears his name. Very little has been added to his explicit observations on the advanced clinical form of the disease. Biochemical, pathologic, and roentgenologic investigations have made it possible, however, to segregate osteitis deformans in its preclinical stage from a large group of forms of benign osteitis. At the Mayo Clinic prior to January 1938, a diagnosis of osteitis deformans was made in 367 cases. The analysis of the findings in that group will be given in this paper. It is not a new observation that osteitis deformans manifests itself roentgenologically in various forms. In this study, however, we shall attempt to correlate the clinical manifestations of the disease with the roentgenologic evidence in a series of 200 cases. The criteria for the roentgenographic classification will be discussed later. Historical Review Both Wrany, in 1867, and Wilks (2), in 1869, as quoted by Paget, deserve credit for recognizing the clini...

Symmetrical calcification of the cerebral basal ganglia; its roentgenologic significance in the diagnosis of parathyroid insufficiency.

In 1939 Eaton, Love and I (1) reported I six cases in which symmetric calcification of the cerebral basal ganglia was observed roentgenographically. In two of these cases there was definite clinical evidence of spontaneous parathyroid insufficiency and tetany. In retrospect, our original case, which was reported (2) in 1938 would also seem to be an example of this condition, although the diagnosis was not established before death. The basic pathologic changes responsible for symmetric calcification of the cerebral basal ganglia have been noted by many writers since Bambergers (3) and Virchows (4) original observations in 1855. It was not until 1935, however, that the first report concerning the roentgenographic appearance in vivo was published. In that year Fritzsche (5) described the changes observed in roentgenograms of three siblings and Kasanin and Crank (6) presented the roentgenographic and postmortem findings in one case. None of these authors mentioned the presence of parathyroid insufficiency. ...

Contrast Myelography Past and Present

Twenty-seven years ago it was my good fortune to begin a fellowship in radiology at the Mayo Foundation under Dr. Russell D. Carman. To be the first student of this great radiologist privileged to participate in this annual tribute to my former chief is an honor that I accept with great humility and appreciation. Former lecturers have portrayed better than I can hope to do Carmans contributions to radiology. A man is great because of many things, but those of us who worked with Carman were keenly aware that he was fundamentally great because of his uncanny powers of observation which he applied assiduously to his work in an effort to know the truth and impart it to others. Morning after morning, year in and year out, he spent in the operating room and pathologic laboratory, correlating the findings of the fluoroscopic screen and the roentgenogram. He was not satisfied to be right or wrong in a diagnosis, but he must know why. Many a morning when he returned from the hospital with the films of surgical ca...

Chronic idiopathic hypertrophic osteo-arthropathy.

Chronic idiopathic hypertrophic osteoarthropathy is a condition occurring predominantly in males at the age of puberty or adolescence and characterized by the osteo-arthropathic syndrome—clubbing of the digits, enlargement of bones and joints, and thickening of the skin of the face—in the absence of any demonstrable primary disease. Its course is slowly progressive to deformity and disability, which are often of extreme degree. The nomenclature has been confounded by the dissimilarity of previous titles in the literature, such as familial acromegaloid osteosis (1, 2), idiopathic familial generalized osteophytosis (3), hypertrophic pulmonary osteo-arthropathy without primary disease (4), and acropachydermia and pachyperiostitis (5). These terms have been used because of certain characteristics of the disease, namely, its familial tendency, superficial resemblance to acromegaly, similarity to other forms of osteo-arthropathy, and the varying prominence of skin or skeletal changes. The history of chronic idi...

The Normal and Pathologic Anatomy of the Sella Turcica as Revealed at Necropsy1

THE roentgenologic interpretation and significance of changes, in and about the sella turcica are so dependent on an accurate knowledge of the normal and pathologic anatomy of this structure that this study was undertaken in an effort to demonstrate in a series of 110 cases the normal and pathologic changes found postmortem. As the roentgen image of the sella is dependent on the configuration of the sphenoid bone, dorsum sellae, and clinoid processes, observation was limited to the variations found in these structures. The sella and surrounding processes were removed in toto and the soft tissues dissected from the bone. Variations in Size The dimensions of the sella turcica in normal, specimens were measured in the antero-posterior, vertical, and transverse directions. The various averages for these dimensions are given in Figure 1, under their respective headings. The antero-posterior measurements were taken from the most dorsal point of the tuberculum sellae in the sagittal plane to the anterior edge of t...

Significance of intracranial calcification in the roentgenologic diagnosis of intracranial neoplasms.

In these days of specialized procedures which may facilitate a precise localization of mass lesions of the brain, one must not overlook the fact that ordinary roentgenography of the skull, when used intelligently and as the patients symptoms may indicate, will reveal with considerable accuracy the site and frequently the type of an intracranial lesion. Calcification within a lesion is the most significant roentgenologic sign of intracranial disease. Not only does the position of the calcium shadows localize the lesion, but not infrequently the arrangement of the calcium deposits will enable a prediction of the probable histologic character of the mass. Since non-neoplastic as well as neoplastic lesions may exhibit roentgenographic evidence of calcification, and inasmuch as the roentgenographic characteristics of such calcification are now well established, the experienced radiologist on his preliminary examination frequently can identify non-neoplastic lesions that may be producing symptoms which imitate...

The Osseous Changes in Hyperparathyroidism Associated with Parathyroid Tumor: A Roentgenologic Study

ERDHEIM first pointed out the significance of the parathyroid glands in relation to metabolism of calcium in the skeletal system. His observations of more or less marked increase in the parenchyma of the parathyroid glands in osteomalacia have since been confirmed by many observers, although his interpretation of this change as a form of compensatory hypertrophy has led to much discussion. Verbitz, Langhans, and Kocher, in 1907, all reported association with a parathyroid tumor of multiple brown tumors of bone. Strada, in 1909, observed a woman, aged 54 years, with osteomalacia who had hyperplasia of the parathyroid glands. In three cases of senile osteomalacia, however, Strada observed that the parathyroid glands were normal. Bauer, in 1911, and Todyo, in 1912, found hyperplasia of the parathyroid glands in cases of osteomalacia and osteoporosis. Molineus, in 1913, found hyperplasia of the parathyroid glands accompanying three cases of osteomalacia with multiple brown tumors of the bone, multiple fractur...

Pseudofractures in Diseases Affecting the Skeletal System1

PSEUDOFRACTURES may be described as transverse zones of rarefaction varying in width from less than a millimeter to more than a centimeter, affecting various portions of the skeletal system and usually symmetrically distributed. They are mistaken frequently for true fractures and, since they are generally an indication of certain weaknesses or dysfunction of the skeletal system, it is important that their true character be identified. Several authors have concluded that certain of these lesions constitute a new disease entity, while others have reported them under a great variety of names, such as pseudofractures (36), spontaneous fractures (61), Loosers zones (23), Umbauzonen (48), Umbaufrakturen (63), multiple spontaneous idiopathic symmetrical fractures (56), osteoporosis melolytica (47), march fractures (19), and insufficiency fractures (33). Because of the obvious confusion regarding the significance of the condition and the relationship of the different forms which it assumes, this study was undert...

Roentgenologic observations concerning erosion of the sella turcica.

Many observations have been made in the past which indicate that the normal sella turcica varies widely in size and shape (1–3). So great is this variation that recognition of disease based on alterations of size alone is frequently difficult and even misleading. Rasmussen (4) has shown, also, that there is no constant relation between the size of the sella and the size of the pituitary gland. This further decreases the va lue of measurements of the sella alone as an index of pituitary disease. My own experience, over a period of many years, indicates that in the past the average roentgenologist has paid too much attent ion to variat ions in the dimensions of the sella turcica and has underestimated the significance of certain basic changes in structure which will indicate the presence of disease long before measurements alone have any value. These basic changes—erosion, decalcification and destruction of bone—are intimately related to one another. They may express themselves in focal or generalized chang...

Developmental Thinness of the Parietal Bones1

A variation in the appearance of the parietal bones encountered during the examination of roentgenograms of the head is a condition which is probably best described as “developmental thinness of the parietal bones.” By this is meant the presence of an area near the superior margin of both, or less commonly one, of the parietal bones which appears to interrupt the normal smooth convexity of the parietal eminence and form a shallow depression involving about a fourth of the area of the parietal bone. It is manifested by a partial or complete absence of the diploe of the calvarium at the site and by a corresponding thinness of the skull in the involved portion. Less often the defect may assume the configuration of a parietal groove or sulcus. Known to anatomists and pathologists, it has escaped the attention of roentgenologists, as judged from the scant mention it has received in roentgenologic literature. In our experience the condition is fairly common and it is of interest because it may be confused with ...